Allergic Contact Dermatitis From Baby Wipes

A 5-year-old girl was referred for allergy patch testing due to a facial rash of 8 months’ duration. She had no history of eczema. The rash first appeared around the mouth and then extended to the cheeks. She later developed a rash on the buttocks. Her mother reported that the use of a topical corticosteroid cream had helped, but the rash had recurred.

Patch testing was performed with a limited series of skin-care product allergens, and a test reading at 72 hours indicated a strongly positive reaction to methylchloroisothiazolinone/methylisothiazolinone (MCI/MI; trade name Kathon CG). Upon questioning, the mother reported using different brands of wet wipes to clean the girl’s face after every meal; these included Cottonelle brand flushable moist wipes, which also were used in place of toilet paper and which contain MCI/MI.

The girl’s skin improved after 2 weeks of avoiding all wipes.

Baby wipes or wet wipes have been used for years to cleanse children’s genital and perianal areas during diaper changes. In recent years, the use of these moistened wipes has expanded far beyond this original purpose. Flushable moist wipes are marketed for adult use as toilet paper, while other wipes are marketed as makeup removers and facial cleansers. Baby wipes and other moist towelettes are used regularly to cleanse children’s hands and face after eating.

Because these wipes are meant to stay moist, they require the use of preservatives, which can result in allergic contact dermatitis in users. The common cosmetic preservative MCI/MI is a notable allergen, and it was the culprit in our patient. In one recent report, approximately 2.5% of patients undergoing patch testing reacted to MI, making it the fifth most commonly allergy-test–positive preservative.¹

While exposure to MCI/MI can derive from a variety of sources, moist toilet paper containing this preservative has become a well identified cause of allergic contact dermatitis.^1,2 Case reports in Europe and the United States have documented many adult cases of perianal dermatitis caused by MCI/MI in moist toilet paper.^2-5 Reports also have documented concomitant face and hand contact dermatitis from this allergen.^3-5

Our case of a child with facial dermatitis from the daily use of baby wipes in place of napkins is consistent with published findings in adults,^3-5 although this reaction has not been described often in children. Given changing skin care practices, however, pediatricians and dermatologists must be aware of this potential source of allergic contact dermatitis.

References:

1. Castanedo-Tardana MP, Zug KA. Methylisothiazolinone. Dermatitis. 2013;24(1):2-6.

2. Fields KS, Nelson T, Powell D. Contact dermatitis caused by baby wipes [letter]. J Am Acad Dermatol. 2006;54(5 suppl):S230-S232.

3. Timmermans A, De Hertog S, Gladys K, Vanacker H, Goossens A. “Dermatologically tested” baby toilet tissues: a cause of allergic contact dermatitis in adults. Contact Dermatitis. 2007;57(2):
97-99.

4. García-Gavín J, Vansina S, Kerre S, Naert A, Goossens A. Methylisothiazolinone, an emerging allergen in cosmetics? Contact Dermatitis. 2010; 63(2):96-101.

5. Gardner KH, Davis MDP, Richardson DM, Pittelkow MR. The hazards of moist toilet paper: allergy to the preservative methylchloroisothiazolinone/methylisothiazolinone. Arch Dermatol. 2010;146(8):886-89