Baby-wipe dermatitis: preservative-induced hand eczema in parents and persons using moist towelettes.

BACKGROUND: Hand eczema can have complex causative or aggravating influences, and the pattern, history, and patch test data are helpful in identifying sources and antigen substitution. OBJECTIVE: We studied our patients with hand eczema associated with exposure to baby wipes for pattern and sensitivities. METHODS: Patient records over a 10-year period containing key words were reviewed for relevance of exposure, patch test data, and outcome. RESULTS: A total of 6 women and 3 men with hand eczema were found to be allergic to (preservatives found in) different brands of moist towelettes used in diaper hygiene. Many were allergic to fragrance materials as well. The eruptions were mostly worse on the thumb and 2 adjacent fingers, with which the item was held. Five of the 9 were parents of infants, although no infant had a problem. Only 1 patient suspected the source. All improved with avoidance, although most had multiple other contact allergies, including corticosteroids. CONCLUSIONS: Hand eczema in a grip-like pattern is good reason to inquire about baby wipes as a possible source, as most patients do not recognize that source even after undergoing patch tests.

Treatment of toxicodendron dermatitis (poison ivy and poison oak).

Toxicodendron dermatitis results from a reaction to an oil soluble oleoresin that is present in many parts of the poison ivy and poison oak plants. Prophylactic measures include avoidance, protective clothing, barrier creams and hyposensitization. Treatments include washing the area immediately with a solvent suitable for lipids and the use of anti-inflammatory agents, especially corticosteroids.

Fingertip dermatitis in a retail florist.

Prevalence of plant contact dermatitis in retail florists varies with exposure, and the number of reports of contact allergy to cut tulips is rather small. Alpha-methylene-gamma-butyrolactone is better known as the cause of both Alstroemeria dermatitis in retail florists and tulip finger in wholesale floral workers who handle the bulbs. Our patient presented with prominent erythema, scaling, and peeling of the skin of the thumb, index, and middle fingers of his right hand. Results of a patch test to alpha-methylene-gamma-butyrolactone were strongly positive, and the patient determined that the exposure had occurred when he stripped leaves from the tulip stems to arrange cut flowers. Other natural sources of the antigen include Alstroemeria; Bomarea; Dioscorea hispida; Erythronium; Gagea; Fritillaria; and at least one species of onion, Allium triquetrum.

Protein-contact eczematous reaction to cornstarch in clothing.

Protein contact dermatitis is an eczematous reaction to antigens often associated with immediate hypersensitivity. A patient with a history of atopic eczema and multiple immediate sensitivities was seen for a persistent dermatitis of the face, hands, and clothing areas of the trunk and arms. Investigation showed a positive prick test to cornstarch, and avoidance of glove powder and starch in her clothing cleared what had been a recalcitrant problem.

Occupational protein contact dermatitis to cornstarch in a paper adhesive.

BACKGROUND: Protein contact dermatitis is better known in food-service and health-care workers than in industrial workers. Cornstarch has seldom been a problem, although it can cause contact urticaria to glove powder. OBJECTIVE: To present the case of a paper-bag maker who developed severe occupational (protein) contact dermatitis within two-three hours after returning to work. She lacked any evidence of urticaria and demonstrated largely negative patch-test results. METHODS: Following a history of occupational exposure to a cornstarch-based adhesive, the patient was patch-tested to materials with which she had worked, which she contacted, and with which she had attempted treatment. Following patch testing, she was prick-tested to cornstarch, the principal ingredient in the adhesive. RESULTS: Patch testing was negative except for a very mild reaction to the adhesive. Prick testing to cornstarch was more severe than the histamine control. The test site became eczematous and remained so for more than ten weeks. Avoidance of cornstarch and the adhesive was followed by clearing. CONCLUSION: Workup for prominent occupational contact dermatitis without urticaria may sometimes require testing for type 1 allergy.

Contact sensitization to cyanoacrylate adhesive as a cause of severe onychodystrophy.

BACKGROUND: The technology used for artificial nails, the chemistry of cyanoacrylates and the reported reactions to these products are briefly reviewed. MATERIALS AND METHODS: We studied three patients with prominent fingernail dystrophy, nail bed hyperkeratosis, fingertip eczema, and onycholysis, two of whom also had eczematous lesions at distant sites, ostensibly from hand transfer. Patch testing was performed with a standard screening tray, dried cyanoacrylate adhesives, and, in one case, with fingernail clippings. RESULTS: All three patients were prominently patch-test positive to the polymerized 2-ethylcyanoacrylate, used as an adhesive on artificial (plastic) fingernails. One patient was also mildly formaldehyde sensitive, one was mildly reactive to two acrylate allergens, and one was extremely allergic to toluenesulfonamide formaldehyde resin. One patient had a positive patch test to her fingernail clippings 2 months after use of the adhesive was discontinued and an attempt was made to remove it. CONCLUSIONS: Reactions to cyanoacrylate adhesives used for artificial nails can cause both nail dystrophy and fingertip eczema, and may produce eczema elsewhere, probably from hand transfer. Persistence is likely due to retained polymer, which slowly degrades in the presence of water probably releasing antigens. Patch testing with the dried adhesive on an adhesive plaster seems to be reliable.