Refractory Rash in Children: Are Baby Wipes the Culprit?
As Quynh-Giao Nguyen, ScB, and Rajani Katta, MD, reported in their December "Photoclinic" item in Consultant for Pediatricians,1 a chemical additive in baby wipes is a common culprit in cases of allergic contact dermatitis in children. Their patient, a 5-year-old girl with a refractory facial rash of 8 months' duration, had a strongly positive patch-test reaction to methylchloroisothiazolinone/methylisothiazolinone (MCI/MI; trade name Kathon CG), the combination preservative that keeps baby wipes moist. After 2 weeks of avoiding the wipes, the girl's rash had completely resolved.
Now, a case report in Pediatrics describes 6 children with chronic, refractory perianal and/or facial eczematous dermatitis who tested positive to MCI/MI on patch testing.2 The difference in this study, published online ahead of print on January 13, is that all of the children had been applying wet wipes containing MI without MCI to the affected areas. Discontinuing the use of wipes led to rapid and complete resolution.
As authors note, wipes manufacturers recently have been increasingly using MI alone, without MCI, in an attempt to minimize such allergic reactions. But that measure may not be enough. "This is the first report of pediatric [allergic contact dermatitis] to MI in wet wipes in the United States, and the largest series to date," they write.
Because wet wipes are increasingly being marketed to all ages, the authors predict that MI exposure and sensitization are likely to increase. To avoid children's discomfort from MI dermatitis, the expense of repeated visits to health care providers, and the potential adverse effects of unnecessary and futile treatment of MI dermatitis that has been misdiagnosed as eczema, impetigo, or psoriasis, the authors offer this recommendation:
"All isothiozolinones should be avoided in personal care and household products for these patients."
—Michael Gerchufsky
References:
1. Nguyen Q-G, Katta R. Allergic contact dermatitis from baby wipes. Consultant for Pediatricians. 2013;12(12):577-578.
2. Chang MW, Nakrani R.Six children with allergic contact dermatitis to methylisothiazolinone in wet wipes (baby wipes). Pediatrics. January 13, 2014. doi:10.1542/peds.2013-1453.