Atypical and severe airborne isothiazolinone contact dermatitis mimicking Kaposi–Juliusberg syndrome

Abstract

A 14-year-old boy with a history of mild atopic dermatitis (AD) was referred with an acute and extensive facial eruption.Physical examination showed erythematous and vesicular lesions, some of which were clearly umbilicated and agglomerated (Fig. 1a), located on the face, neck, and distal forearms, including very oedematous eyelids. Cervical lymphadenomegaly was observed, but no mucosal involvement, respiratory symptoms or fever were present. Superinfection of his AD with herpes simplex virus (HSV) was suspected, and intravenous aciclovir 30 mg/kg daily was immediately initiated.However, no clinical improvement occurred after 48 h (Fig. 1b), and HSV polymerase chain reaction and Tzanck cytodiagnosis gave negative results. Moreover, the patient reported that the ceiling above his bunk bed had been freshly painted when the eruption occurred. SuspectingConflicts of interest: The authors declare no conflict of interest related to this topic. No funding supported this work.airborne contact dermatitis, we introduced topical steroids once daily, and this resulted in complete remission within a week.Patch testing was performed with IQ Ultra Chambers ™ (Chemotechnique Daignostics, Vellinge, Sweden) with the European baseline series and octylisothiazolinone (OIT) 0.01% pet. and benzisothiazolinone (BIT) 0.05% pet. Readings on day (D) 2 and D3 (according to ESCD recommendations) showed 2+ reactions to methylisothiazolinone (MI) 0.2% aq. and to methylchloroisothiazolinone (MCI)/MI 0.02% aq. on D2 and D3; both MI and MCI/MI were contained in the ceiling paint. This case was reported to the regional poison centre. DiscussionMI and MCI are inexpensive and efficient biocides. Since 2010, various reports of contact dermatitis have been related (1) to these widely used preservatives, mainly with MI and MCI/MI in rinse-off and leave-on cosmetic products, although the MCI/MI mixture is no longer authorized for use in the latter. The isothiazolinones, including BIT and OIT, are also used as industrial biocides in glues, household products, inks, etc. (2). In water-based paints, isothiazolinones are mainly present as BIT and MI rather than as MCI/MI, and airborne and systemic contact dermatitis, possibly with mucosal involvement, have

Experimental determination of indoor air concentration of 5-chloro-2-methylisothiazol-3(2H)-one/ 2-methylisothiazol-3(2H)-one (CMIT/MIT) emitted by the use of humidifier disinfectant

“…In Europe, contact dermal exposure to CMIT/MIT has been of significant concern [27,28]. In addition to dermal exposure via direct contact, cases of concern with respect to airborne products (e.g., paint) have been reported with some patients exhibiting asthmatic symptoms [27,29]. Limited inhalation toxicity studies using rats have shown lung redness and inflammation at high doses [30,31].…”

Contact Allergy: A Review of Current Problems from a Clinical Perspective

“…Undisclosed presence was noted in adhesive labels, leading to ACD of the exposed fingers [ 96 ], partially airborne ACD after using ironing water preserved with MI in 4 British patients [ 97 ], soothing and cooling gel pads applied to the lower lids during application of lash extensions [ 98 ], airborne ACD accompanied by a dry cough in a construction worker [ 99 ], (partly airborne) ACD due to a stainless steel cleaning spray [ 100 ], foot dermatitis due to a shoe glue preserved with MI [ 101 ], occupational ACD in two gynaecologists due to MI in ultrasound gel [ 102 ], chronic dermatitis of the trunk and proximal extremities in a 7-year-old girl due to liquid laundry detergent [ 103 ], although it has been claimed, based on a small study, that MI cannot be detected in the laundered fabric [ 104 ]. Newly painted rooms, with airborne exposure to MI for several weeks, is a well-known cause of elicitation of ACD by MI [ 85 , 105 , 106 , 107 ], partly leading to very severe and atypical clinical presentations [ 108 ]. The need of a complete declaration of MI (and all isothiazolinones) has been illustrated by the case of a 9-year-old boy with widespread airborne ACD where a (online accessible) product data sheet informed about the presence of MI, MCI, and BIT and thus the cause was found [ 109 ].…”

Isothiazolinone derivatives and allergic contact dermatitis: a review and update

“…Besides MI, also BIT is often present in water-based paints. 25,51,54 Isothiazolinone derivatives: a review Several atypical clinical manifestations elicited by isothiazolinones have been described: systemic ACD from BIT after inhalation via airborne exposure 46,55 ; nummular eczema in a housepainter 56 ; lupus erythematosus-like eruptions 57 ; 'lymphomatoid' dermatitis 44,57,58 ; Kaposi-Juliusberg syndrome-like rash in a boy 37 and following exposure to paints 59 ; lichenoid eruptions; also a flare-up of a long-standing oral lichen planus, after the erroneous use of a dishwashing liquid for a dental prosthesis 60 ; and scalp lesions mimicking folliculitis decalvans due to a MI-containing hair gel. 61 A combination of urticarial and eczematous skin eruptions has been frequently observed, although Type I hypersensitivity, confirmed by positive prick tests, has never been reported.…”

“…Several atypical clinical manifestations elicited by isothiazolinones have been described: systemic ACD from BIT after inhalation via airborne exposure; nummular eczema in a housepainter; lupus erythematosus‐like eruptions; ‘lymphomatoid’ dermatitis; Kaposi–Juliusberg syndrome‐like rash in a boy and following exposure to paints; lichenoid eruptions; also a flare‐up of a long‐standing oral lichen planus, after the erroneous use of a dishwashing liquid for a dental prosthesis; and scalp lesions mimicking folliculitis decalvans due to a MI‐containing hair gel …”