Allergic contact dermatitis in a child caused by isothiazolinones in a “noise putty”

Abstract

K E Y W O R D S : allergic contact dermatitis, case report, children, fingertip dermatitis, methylchloroisothiazolinone, methylisothiazolinone, noise putty, slime Methylisothiazolinone (MI) and methylchloroisothiazolinone (MCI) are the main allergens of the last decade in adults, and cases are being increasingly reported in children. We present a case of fingertip dermatitis in a young boy caused by exposure to a "noise putty" related to contact allergy to MCI/MI. CASE REPORTA 7-year-old boy was referred because of a 1-year history of recalcitrant chronic hand dermatitis. He had a history of asthma and familial atopy, but not of atopic dermatitis. Clinical examination showed FIGURE 1 (A), Fingertip dermatitis with erythematous and fissured lesions. (B), Positive reactions to methylchloroisothiazolinone (MCI) (++), methylisothiazolinone (MI) (++), "noise putty" (red circle) (++), and fragrance mix I (+) DUCHARME ET AL. 393eczema involving all fingertips ( Figure 1A). This was not influenced by school or sport activities. He had been treated with topical steroids, achieving partial improvement but with many relapses. Patch testing was performed by the use of IQ Ultimate chambers (Chemotechnique Diagnostics, Vellinge, Sweden) fixed on the upper back with an occlusion time of 48 hours with Urgoderm (URGO, Chenove, France). The patient was tested with the European baseline series adapted for children 1 and with his hygiene and cosmetic products, topical drugs applied, school materials, and various toys. Readings were performed on day (D) 2 and D3. Patch test results were strong positive on D2 (+ +) and D3 (++) for MI 2000 ppm aq., MCI/MI 200:100 ppm aq., and1 of the patient's toys: a manufactured "noise putty" ( Figure 1B). We also observed a weak positive reaction to fragrance mix I 8% pet. The "noise putty" was deemed to be of probable clinical relevance. Indeed, the patient's father noticed that the fingertip dermatitis worsened after the boy handled it. We instructed the parents and the boy to stop using this paste, and to avoid MCI and MI as preservatives. At a 1-year follow-up, resolution of symptoms with no relapse was documented. DISCUSSIONBoth preservatives, MCI and MI, are well-known causes of allergic contact dermatitis resulting from the use of cosmetics, detergents, and industrial products. In small children, the main sources are nappies and wet wipes. 2,3 "Noise putty" is a manufactured playdough that has become very popular among children, and that makes amusing noises.The "noise putty" in the present case had been bought at a fairground, with the information on the packaging stating "produced in China", but containing no ingredients list. Therefore, we contacted one of the biggest French importers of "noise putty" to inquire about the usual composition; it gave us a non-exhaustive list, despite our repeated requests: "polyvinyl alcohol, glycerine, borax, ethyl paraben, deionized water and various dyes". The regional Poison Control Centre confirmed that isothiazolinones are used in dyes contained in man...

“Slime”: A trending cause of isothiazolinone contact allergy in children

“…Patch testing was performed in six cases. 8,10,11,14 Similarly to our patients, five children showed positive reactions to MCI/MI and MI, and one showed a positive reaction to paraben mix. The source of isothiazolinones was the glue or liquid detergent used for the preparation of slime.…”

“…Slime dermatitis has been reported in only 12 children previously (Supporting Information Table S1). [7][8][9][10][11][12][13][14] Of these, 10 were female, as were all of our patients. Patch testing was performed in six cases.…”

Contact Allergy in Children

“…Preservatives in play gels (Fig. 3), nowadays called "slimes," have been described as causes of acute eczema on the hands [1]; parabens have been reported in the past and together with isothiazolinones also as more recent culprits [120,121], as is the case with playdough that makes amusing noises and has become very popular among children [122].…”

Hidden risks in toys: A systematic review of pediatric toy contact dermatitis

“…With the help of poison control, it was discovered that the noise putty contained MCI/MI. 24 Lastly, a 10-year-old girl was found to have irritant contact dermatitis of the hands after opening a "sqwish ball" with scissors. In this case it was unclear whether the eruption was secondary to contact with diisononyl phthalate, one of the ingredients of the sqwish ball core material, or as a result of the efforts to scrub the sticky material from her hands.…”