Allergic contact dermatitis in young children may be an under-recognized cause of perineal dermatitis. The diapered infant skin is uniquely susceptible to allergic contact dermatitis because of more permeable neonatal skin, a moist environment, frequent contact with irritants and resultant skin barrier breakdown, and exposure to topical products such as diaper wipes, diaper preparations, and disposable diapers. To our knowledge, potential allergens in these products have not been thoroughly catalogued or studied.
Objective
We explore and review potential allergenic ingredients in diaper wipes, topical diaper preparations, and disposable diapers.
Method
We analyzed 63 diaper wipes, 41 topical diaper preparations, and the 3 top selling diaper brands available from two of the largest retailers in the United States. Each potential allergen is discussed, and epidemiologic studies of rates of sensitization to potential allergens in children are also reported.
Conclusions
Botanical extracts, including members of the Compositae family, were the most commonly represented potential allergen in both diaper wipes and topical preparations. Other potential allergens identified with high frequency include α-tocopherol, fragrances, propylene glycol, parabens, iodopropynyl butylcarbamate, and lanolin. Frequent culprits such as formaldehyde releasers and methylchloroisothiazolinone/methylisothiazolinone were not prevalent in our analyzed products.
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References
1.
WestonWL, WestonJA, KinoshitaJ, et al.Prevalence of positive epicutaneous tests among infants, children, and adolescents. Pediatrics, 1986; 78(6): 1070–1074.
2.
MortzCG, AndersenKE. Allergic contact dermatitis in children and adolescents. Contact Dermatitis, 1999; 41(3): 121–130.
3.
JacobSE, BrodB, CrawfordGH. Clinically relevant patch test reactions in children — United States based study. Pediatr Dermatol, 2008; 25(5): 520–527.
4.
ZugKA, McGinley-SmithD, WarshawEM, et al.Contact allergy in children referred for patch testing: North American Contact Dermatitis Group data, 2001–2004. Arch Dermatol, 2008; 144(10): 1329–1336.
5.
ZugKA, PhamAK, BelsitoDV, et al.Patch testing in children from 2005 to 2012: results from the North American contact dermatitis group. Dermatitis, 2014; 25(6): 345–355.
6.
KlunkC, DominguesE, WissK. An update on diaper dermatitis. Clin Dermatol, 2014; 32(4): 477–487.
7.
PhilippR, HughesA, GoldingJ. Getting to the bottom of nappy rash. ALSPAC Survey Team. Avon Longitudinal Study of Pregnancy and Childhood. Br J Gen Pract, 1997; 47(421): 493–497.
8.
OnkenAT, BaumstarkJ, BelloniB, et al.Atypical diaper dermatitis: contact allergy to mercapto compounds. Pediatr Dermatol, 2011; 28(6): 739–741.
RoulS, DucombsG, Leaute-LabrezeC, et al.“Lucky Luke” contact dermatitis due to rubber components of diapers. Contact Dermatitis, 1998; 38(6): 363–364.
11.
BelhadjaliH, Giordano-LabadieF, RanceF, et al.“Lucky Luke” contact dermatitis from diapers: a new allergen?. Contact Dermatitis, 2001; 44(4): 248.
12.
ChangMW, NakraniR. Six children with allergic contact dermatitis to methylisothiazolinone in wet wipes (baby wipes). Pediatrics, 2014; 133(2): e434–e438.
13.
AdmaniS, MatizC, JacobSE. Methylisothiazolinone: a case of perianal dermatitis caused by wet wipes and review of an emerging pediatric allergen. Pediatr Dermatol, 2014; 31(3): 350–352.
14.
Belloni FortinaA, CooperSM, SpiewakR, et al.Patch test results in children and adolescents across Europe Analysis of the ESSCA Networka 2002–2010. Pediatr Allergy Immunol, 2015; 26: 446–455.
15.
OdioM, ThamanL. Diapering, diaper technology, and diaper area skin health. Pediatr Dermatol, 2014; 31(suppl 1): 9–14.
16.
JacobSE, HerroEM, GuideS, et al.Allergic contact dermatitis to Pampers Drymax. Pediatr Dermatol, 2012; 29(5): 672–674.
17.
GuinJD, KincannonJ, ChurchFL. Baby-wipe dermatitis: preservative-induced hand eczema in parents and persons using moist towelettes. Am J Contact Dermat, 2001; 12(4): 189–192.
HorowitzP, McLeodRP, EichenfieldLF, et al.Skin-cleansing and care principles for special pediatric populations. Semin Cutan Med Surg, 2013; 32(2Suppl 2): S30–S32.
20.
AdamR. Skin Care of the Diaper Area. Pediatr Dermatol, 2008; 25(4): 427–433.
21.
PanahiY, SharifMR, SharifA, et al.A randomized comparative trial on the therapeutic efficacy of topical aloe vera and Calendula officinalis on diaper dermatitis in children. ScientificWorldJournal, 2012; 2012: 810234.
22.
FerreiraM, TeixeiraM, SilvaE, et al.Allergic contact dermatitis to Aloe vera. Contact Dermatitis, 2007; 57(4): 278–279.
23.
ReiderN, IssaA, HawranekT, et al. Absence of contact sensitization to Aloe vera (L.) Burm. f. Contact Dermatitis, 2005; 53(6): 332–334.
de GrootAC. Propolis: a review of properties, applications, chemical composition, contact allergy, and other adverse effects. Dermatitis, 2013; 24(6): 263–282.
26.
RajparaS, WilkinsonMS, KingCM, et al.The importance of propolis in patch testing—a multicentre survey. Contact Dermatitis, 2009; 61(5): 287–290.
27.
GualaA, OberleD, RamosM. Efficacy and safety of two baby creams in children with diaper dermatitis: results of a postmarketing surveillance study. J Altern Complement Med, 2007; 13(1): 16–18.
28.
PaulsenE, ChistensenLP, AndersenKE. Cosmetics and herbal remedies with Compositae plant extracts—are they tolerated by Compositae-allergic patients?. Contact Dermatitis, 2008; 58(1): 15–23.
29.
ReiderN, KomerickiP, HausenBM, et al.The seamy side of natural medicines: contact sensitization to arnica (Arnica montana L.) and marigold (Calendula officinalis L.). Contact Dermatitis, 2001; 45(5): 269–272.
30.
CalapaiG, MiroddiM, MinciulloPL, et al.Contact dermatitis as an adverse reaction to some topically used European herbal medicinal products-part 1: Achillea millefolium-Curcuma longa. Contact Dermatitis, 2014; 71: 1–12.
31.
SchemanA, SchemanN, RakowskiEM. European Directive fragrances in natural products. Dermatitis, 2014; 25(2): 51–55.
32.
Belloni FortinaA, RomanoI, PesericoA. Contact sensitization to Compositae mix in children. J Am Acad Dermatol, 2005; 53(5): 877–880.
SugiuraM, HayakawaR, KatoY, et al.Results of patch testing with lavender oil in Japan. Contact Dermatitis, 2000; 43(3): 157–160.
39.
KwiecińskiJ, EickS, WójcikK. Effects of tea tree (Melaleuca alternifolia) oil on Staphylococcus aureus in biofilms and stationary growth phase. Int J Antimicrob Agents, 2009; 33(4): 343–347.
40.
HartfordO, ZugKA. Tea tree oil. Cutis, 2005; 76(3): 178–180.
41.
RutherfordT, NixonR, TamM, et al.Allergy to tea tree oil: retrospective review of 41 cases with positive patch tests over 4.5 years. Australas J Dermatol, 2007; 48(2): 83–87.
42.
FisherAA. Perfume dermatitis in children sensitized to balsam of Peru in topical agents. Cutis, 1990; 45(1): 21–23.
WarshawEM, BelsitoDV, TaylorJS, et al.North American Contact Dermatitis Group patch test results: 2009 to 2010. Dermatitis, 2013; 24(2): 50–59.
50.
WarshawEM, Boralessa RatnayakeD, MaibachHI, et al.Positive patch-test reactions to iodopropynyl butylcarbamate: retrospective analysis of North American contact dermatitis group data, from 1998 to 2008. Dermatitis, 2010; 21(6): 303–310.
51.
FieldsKS, NelsonT, PowellD. Contact dermatitis caused by baby wipes. J Am Acad Dermatol, 2006; 54(suppl 5): S230–S232.
52.
NatkunarajahJ, OsborneV, HoldenC. Allergic contact dermatitis to iodopropynyl butylcarbamate found in a cosmetic cleansing wipe. Contact Dermatitis, 2008; 58(5): 316–317.
53.
SchnuchA, MildauG, KratzEM, et al.Risk of sensitization to preservatives estimated on the basis of patch test data and exposure, according to a sample of 3541 leave-on products. Contact Dermatitis, 2011; 65(3): 167–174.
54.
WarshawEM, MaibachHI, TaylorJS, et al.North American contact dermatitis group patch test results: 2011–2012. Dermatitis, 2015; 26(1): 49–59.
55.
NardelliA, MorrenMA, GoossensA. Contact allergy to fragrances and parabens in an atopic baby. Contact Dermatitis, 2009; 60(2): 107–109.
56.
SassevilleD, AlfalahM, LacroixJP. “Parabenoia” Debunked, or “Who’s Afraid of Parabens?” Dermatitis, 2015; 26(6): 254–259.
SassevilleD, StanciuM. Allergic contact dermatitis from ethylhexylglycerin in sunscreens. Dermatitis, 2014; 25(1): 42–43.
59.
Stausbøl-GrønB, AndersenKE. Allergic contact dermatitis to ethylhexylglycerin in a cream. Contact Dermatitis, 2007; 57(3): 193–194.
60.
TostiA, VoudourisS, PazzagliaM. Contact sensitization to 5-chloro-2-methyl-4-isothiazolin-3-one and 2-methyl-4-isothiazolin-3-one in children. Contact Dermatitis, 2003; 49(4): 215–216.
61.
KazandjievaJ, GergovskaM, DarlenskiR. Contact dermatitis in a child from methlychloroisothiazolinone and methylisothiazolinone in moist wipes. Pediatr Dermatol, 2014; 31(2): 225–227.
62.
BoyapatiA, TamM, TateB, et al.Allergic contact dermatitis to methylisothiazolinone: exposure from baby wipes causing hand dermatitis. Australas J Dermatol, 2013; 54(4): 264–267.
63.
PatelAN, WoottonCI, EnglishJS. Methylisothiazolinone allergy in the paediatric population: the epidemic begins?. Br J Dermatol, 2014; 170(5): 1200–1201.
64.
ShaughnessyCN, MalajianD, BelsitoDV. Cutaneous delayed-type hypersensitivity in patients with atopic dermatitis: reactivity to topical preservatives. J Am Acad Dermatol, 2014; 70(1): 102–107.
65.
WarshawEM, BottoNC, MaibachHI, et al.Positive patch-test reactions to propylene glycol: a retrospective cross-sectional analysis from the North American Contact Dermatitis Group, 1996 to 2006. Dermatitis, 2009; 20(1): 14–20.
66.
TocciEM, RobinsonA, BelazarianL, et al.Excipients in oral antihistamines can perpetuate allergic contact dermatitis. Pediatr Dermatol, 2015; 32(6): e242–e244.
HaldM, MennéT, JohansenJD, et al.Allergic contact dermatitis caused by sorbitan sesquioleate imitating severe glove dermatitis in a patient with filaggrin mutation. Contact Dermatitis, 2013; 69(5): 313–315.
69.
AsarchA, ScheinmanPL. Sorbitan sesquioleate, a common emulsifier in topical corticosteroids, is an important contact allergen. Dermatitis, 2008; 19(6): 323–327.
70.
TostiA, GuerraL, MorelliR. Prevalence and sources of sensitization to emulsifiers: a clinical study. Contact Dermatitis, 1990; 23(2): 68–72.
71.
ColoeJ, ZirwasMJ. Allergens in corticosteroid vehicles. Dermatitis, 2008; 19(1): 38–42.
72.
SmithVM, ClarkSM, WilkinsonM. Allergic contact dermatitis in children: trends in allergens, 10 years on. A retrospective study of 500 children tested between 2005 and 2014 in one UK centre. Contact Dermatitis, 2016; 74(1): 37–43.
73.
MatizC, JacobSE. The lanolin paradox revisited. J Am Acad Dermatol, 2011; 64(1): 197.
74.
GijbelsD, TimmermansA, SerranoP, et al.Allergic contact dermatitis caused by alkyl glucosides. Contact Dermatitis, 2014; 70(3): 175–182.
FotiC, BonamonteD, MascoloG, et al.The role of 3-dimethylaminopropylamine and amidoamine in contact allergy to cocamidopropylbetaine. Contact Dermatitis, 2003; 48(4): 194–198.
77.
SchnuchA, LessmannH, GeierJ, et al.Is cocamidopropyl betaine a contact allergen? Analysis of network data and short review of the literature. Contact Dermatitis, 2011; 64(4): 203–211.
78.
GirouxL, PrattMD. Contact dermatitis to incontinency pads in a (meth)acrylate allergic patient. Am J Contact Dermat, 2002; 13(3): 143–145.
RystedtI. Factors influencing the occurrence of hand eczema in adults with a history of atopic dermatitis in childhood. Contact Dermatitis, 1985; 12(4): 185–191.
85.
HeineG, SchnuchA, UterW, et al.Type-IV sensitization profile of individuals with atopic eczema: results from the Information Network of Departments of Dermatology (IVDK) and the German Contact Dermatitis Research Group (DKG). Allergy, 2006; 61(5): 611–616.
86.
ThyssenJP, JohansenJD, LinnebergA, et al.The association between contact sensitization and atopic disease by linkage of a clinical database and a nationwide patient registry. Allergy, 2012; 67(9): 1157–1164.
87.
SimonsenAB, DeleuranM, JohansenJD, et al.Contact allergy and allergic contact dermatitis in children—a review of current data. Contact Dermatitis, 2011; 65(5): 254–265.
