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Infant rash may be due to baby wipes

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Baby wipes have an almost universal presence in the nursery; however, a new study has found that they can cause a rash, known as contact dermatitis. The study was published online on January 13 in the journal Pediatrics by researchers at the University of Connecticut School of Medicine in Farmington, Connecticut.

The study authors note that methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) is a combination preservative, which is used in personal care and household products. Studies have found that the combination of the two substances is a common cause of allergic contact dermatitis. Because of this problem, in recent years, MI alone, without MCI, has been increasingly used in consumer products; the move was an attempt to minimize allergic reactions.

The investigators note that wet wipes (baby wipes) have been extensively tested and are traditionally believed to be harmless. They explain that MI in baby wipes has not been previously reported to cause allergic contact dermatitis in US children. In addition, only one case of allergic contact dermatitis in a child in Belgium has been reported. The study authors reported six cases of children with chronic, perianal/buttock (the area surrounding the anus and buttocks), and facial eczematous dermatitis; the rash did not improve following administration of multiple topical and oral antibiotics as well as corticosteroids. All the children tested positive to MCI/MI on patch testing and none wore diapers. All the children were subjected to baby wipes containing MI (without MCI). After discontinuation of the baby wipes, rapid and complete resolution of the allergic contact dermatitis occurred.

The study authors note that their study is the first report of pediatric allergic contact dermatitis from MI in wet wipes in the United States; furthermore, it is the largest case series to date. They explain that allergic contact dermatitis from MI in baby wipes is frequently misdiagnosed as eczema, impetigo, or psoriasis. They note that baby wipes are increasingly marketed in personal care products for all ages; thus, and MI exposure and sensitization will likely increase. They recommend that dermatitis of the perianal, buttock, facial, and hand areas with a history of baby wipe use should raise suspicion of allergic contact dermatitis from MI. A definite diagnosis can be made with patch testing. They note that prompt resolution of the rash should occur after discontinuing use of the baby wipes. They caution that all isothiozolinones should be avoided in personal care and household products for these individuals.

Take home message:
Rashes are common in young children who wear diapers. If your child has a persistent rash that does not respond well to treatment and you use baby wipes containing MI (check the label), consider discontinuing them. If the rash promptly resolves, an MI allergy is likely to be the culprit. Plain soap and water can serve as a substitute for baby wipes.