R. Nixon, U. Flury, A. Palmer
Methylisothiazolinone (MI) is a preservative which has been used since the early 2000s, initially for occupational products, such as paints and adhesive/glues. Since 2005, it has been widely used in cosmetics and household products, especially baby wipes. It has been known to cause sensitisation in humans and guinea-pigs since the mid1980s and the first case of occupational contact dermatitis caused by MI was published in 2004. Allergic contact dermatitis to MI caused by cosmetic products was first reported in 2010. In Australia, MI was banned in leave-on cosmetics from October 2017.
We have reviewed our rates of MI allergy since the start of the epidemic in 2011. The rates of contact allergy, that is the percentage of positive patch test reactions to MI, increased from 4.1% in 2011 to a high of 20.3% in 2015. By 2017, this had decreased to 10.7%. Patients making appointments for patch testing were advised to avoid MI before attending the clinic, and many reported improvement.
shingles” eruption present for over 3 years. At the age of 73, Mr JD was diagnosed with PCR-swab proven VZV infection. Initial management was primarily symptomatic including diligent coverage/dressings to limit contact transmission. Over the next 3 years he was managed with ever enlarging dressing sizes and multiple courses of oral antibiotics for secondary infections. In 2017 he was referred to dermatology and an irritant or allergic contact dermatitis was immediately suspected. Figure 1 (left) shows the extent of involvement on initial presentation; specifics regarding tapes and dressings was clarified. BSN medical was contacted to clarify manufacturing properties.2 With potent topical corticosteroids, optimal skin cares and avoidance of the component monomers (butyl, ethyl and benzoic) and acrylic acid the patient immediately showed progress.
Conclusion: This case report highlights the importance of considering contact allergy in patients with progressive symptoms which are not improving, rather worsening, with regular nursing cares and dressings. These particular hypoallergenic tapes/adhesives, though being popular amongst patients with very sensitive skin, still contain a particular monomer (ethyl acrylate) known to be the causative allergen in about 25% of patients with an allergy to acrylate.
1. Spencer, A., Gazzani, P. and Thompson, D. (2016). Acrylate andmethacrylate contact allergy and allergic contact disease: a 13year review. Contact Dermatitis, 75(3), pp.157–164.
2. BSN Medical (Aust.) Pty. Ltd. (2017). BSN Complaint Ref. #2017FEB001, Letter to Dr MP Hishon. Marketing Manager Australia/New Zealand. Melbourne, Victoria: BSN Medical, an Essity company.