Abstract Number: 48

Granular parakeratosis induced by benzalkonium chloride exposure from bath oils and laundry rinse aids

A.J. Robinson, R.S. Foster, A. Halbert, D. Orchard

Meeting: 2016 Dermcoll

Session Information

Date: -

Session Title: Paediatric Symposium

Session Time: -

Benzalkonium chloride (BAK) is a quaternary ammonium cationic detergent, used as a skin disinfectant and also a sanitising agent in a number of household and industrial cleaners. Multiple studies have reported the potential for BAK to act as a major skin irritant. We present a case ser- ies of six children who presented with granular paraker- atosis, all with a history of BAK exposure. Four of these patients were exposed via their clothing, following the addition of either DettolTM or CanestenTM rinse solution as a post-wash rinse cycle to the household washing machine. Two of the patients had BAK exposure through bath oil (Oilatum PlusTM bath oil and QV Flare UpTM oil). Each patient presented with a brightly erythematous ten- der eruption with associated superficial desquamation, pri- marily distributed around the neck and flexural areas, especially the axillae and groin. This eruption progressed from the flexures with an annular morphology, and during resolution the skin became dry, brown and scaly. Clinically and histologically this was in keeping with granular parak- eratosis, with histology typically showing parakeratosis with retention of keratohyaline granules and a superficial predominately lymphocytic infiltrate. Following cessation of BAK exposure and supportive care with emollients, each patient’s eruption resolved over the following 3–4 weeks. Whilst topical steroids were helpful for alleviating pruritus in these patients, they did not seem to expedite resolution. We discuss the case series of these patients, along with a review of the literature regarding BAK as a causative agent in irritant contact dermatitis.