Tolerance to Different Toilet Paper Preparations: Toxicological and Allergological Aspects

Abstract

Background and Design: A controlled open trial was performed in 40 individuals suffering from chronic perianal eczema. Various toilet paper preparations representing the conventional type made of pure cellulose, the recycled and the moist type were investigated using the patch test as were allergens possibly related to toilet paper. In addition, a chronic use test and a repeated rubbing test were performed with a conventional and a recycled toilet paper preparation. Results: A total of 20 patients could be evaluated in full. A variety of reactions were seen in the patch test, most of which were of the allergic type. Allergens included many different chemical entities, e.g. preservatives used in moist toilet paper such as Kathon CG and Euxyl K 400. In a volunteer allergic to Euxyl K 400, allergy to the moist toilet paper regularly used by him was established. After discontinuation of its application, perianal dermatitis disappeared. In the repeated rubbing test at the forearm, 10 volunteers showed a reaction with the recycled paper preparation while no such reaction was seen upon the application of the conventional type of toilet paper. The validity of these findings was corroborated by corresponding results in the use test. Conclusion: There is clearly a potential for allergic reactions to components of moist toilet paper and reactions to recycled toilet paper presumably irritant by nature. These irritant reactions are probably caused by the rough texture of current paper types and do not reflect the presence of potentially toxic ingredients such as metal salts.

Perianal Contact Eczema – an Unusual Presentation of Dermatitis Artefacta

“…Some potential allergens from toilet paper preparations are preservatives, as Kathon™ CG (Rohm and Haas, Philadelphia, PA, USA) and Euxyl™ K 400 (Schülke & Mayr, Hamburg, Germany). There have also been reported irritant reactions to recycled toilet paper, presumably irritant in nature [Blecher and Korting, 1995]. We believe that in our patient the induction of the perianal eczema probably took place at the beginning of perianal complaints.…”

“…Perianal eczema is generally considered to be caused by contact dermatitis, either of the allergic or non-allergic type [Blecher and Korting, 1995]. It usually occurs in children under 8 years of age [Bafounta et al, 1998] and is mainly related to local irritants [Frosch, 1995].…”

Ätiologische Faktoren der perianalen Dermatitis: Prospektive Studie mit 126 Patienten

“…These substances are used by up to 57% of patients with anogenital complaints [8]: some major culprits include popular hemorrhoid remedies that contain potent sensitizers (local anesthetics, Myroxylon pereirae, bufexamac), dyes and perfumes used in scented toilet paper, feminine hygiene sprays and other "deodorants" for the area around the anus or genitals, medicated talcum powders, and medicated skin cleansers and soaps, especially perfumed soaps [5][6][7][8]11]. However, the leading symptom "anal itch" is not specific and can even be triggered by over-the-counter medications (suppositories, creams, ointments) intended to treat anal problems.…”

Methyldibromoglutaronitrile: An Increasingly Important Allergen in the UK

“…Moistened toilet tissue as a source of sensitisation to MDBGN has been highlighted in several studies originating from the Netherlands [1,21,36,37]. The first reported case of MDBGN being the causative allergen in moistened toilet tissue was by De Groot and Weijland [36] in 1991.…”