Genital allergic contact dermatitis in response to contact to thyme in a sanitary pad

Abstract

Nowadays many daily consumer products such as toilet paper, paper handkerchiefs, sanitary pads, and cleansing gels are treated and flavored with disinfectants and essences to increase their sterility and pleasantness. Considering the daily repeated use of such products, irritant and allergic contact dermatitis can occur, in particular if predisposing factors are present. CASE REPORTA not-atopic 42-year-old female patient came to our attention for the onset of diffuse eczematous lesions involving the genital area and spreading to the lower limbs and the upper part of the trunk. History revealed that such lesions started to appear during the last menstrual period and with the use of a specific sanitary pad (Saugella cotton touch) that she had been using for a couple of months. The sanitary pads were characterized by the presence of a microencapsulated solution of Thymus vulgaris essential oil that gradually released its ingredients following the contact with the skin. When investigated further, she reported different episodes of allergic contact dermatitis (ACD) in the past: contact dermatitis to shoes caused by rubber and p-tertbutylphenol formaldehyde resin, and occupational ACD to fragrances affecting her hands, being a perfumer. The patient denied any previous similar skin diseases in the past.After the complete resolution of the dermatitis, achieved thanks to systemic antihistamine therapy (levocetirizine 5 mg once daily) and a daily application of mometasone furoate for 10 days, we performed patch tests with the S.I.D.A.P.A. (Italian Society of Allergological, Occupational and Environmental Dermatology) baseline series (Euromedical, Calolziocorte, Italy) and with a wetted piece of the sanitary pad. Patch tests were applied on the back and left in occlusion for 2 days with Al Test (Euromedical) on Scanpor Tape (Norgesplaster, Vennesla, Norway).Readings were performed at day (D)2, D4, and D7 1 and showed positive reactions to p-tert-butylphenol formaldehyde resin, Myroxylon pereira, fragrance mix I, mercaptobenzotiazole, mercapto mix, and to the sanitary pad. Subsequently, patch tests were performed also with all the components of the sanitary pad showing a positive results to the raw and dried leaves of thyme. In addition, patch tests were performed with rosemary raw leafs, which turned out to be negative. Twenty healthy subjects were patch tested with the raw and dried leaves of thyme, with negative results. DISCUSSIONWe report the case of a 42-year-old woman who developed an ACD to a sanitary pad. These products have been described as a culprit of ACD owing to the presence of different ingredients such as colophonium, methacrylates, formaldehyde, and fragrances. 2,3 In our case, ACD was caused by thyme.Thyme (Thymus vulgaris L) is an evergreen shrub belonging to the Labiatae family, which includes many aromatic herbs such as rosemary (Rosmarinus officinalis), origanum (Origanum vulgais), peppermint (Mentha piperita), lavender (Lavandula officinalis), hyssop (Hysoppus officinalis), marjoram (Origanum majoran)...

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