The Children and Suncreen Study

Archives of Dermatology

Childhood sun exposure is thought to be a key risk factor for future skin cancer development. Often used as a stand-alone primary prevention method, sunscreen is the most common form of sun protection used by children. Because there is a linear relationship between the thickness of sunscreen application and the sun protection factor (SPF), sunscreens may have an effectively lower SPF if applied in inadequate amounts. In this crossover study of children's use of 3 sunscreen dispenser types, Diaz et al demonstrate that children applied significantly more sunscreen when using a pump and a squeeze bottle compared with a roll-on. All sunscreens were applied at substantially less than the recommended thickness.

Wet Wipes Linked to contact dermatitis in children

Skin & Allergy News

 

MILWAUKEE – Despite extensive testing, seemingly innocuous wet wipes have been linked to allergic contact dermatitis in children.

The first reported case occurred in a healthy 8-year-old girl who presented with chronic, recalcitrant erythematous, eczematous patches and plaques with crusting and fissuring around the mouth and perianal area. She had been using wipes containing methylisothiazolinone (MI), without methylchloroisothiazolinone (MCI).

Within 22 months, an additional five children had been diagnosed with allergic contact dermatitis to MI in wet wipes, Dr. Mary Wu Chang and Ms. Radhika Nakrani reported at the annual meeting of the Society for Pediatric Dermatology.

All cases were confirmed on patch testing, and all patients had rapid, complete resolution within about 2 days after discontinuing use of the wipes. Ms. Nakrani also interviewed the parents to determine the type of wipes used, identified as Cottonelle and Huggies brands (both manufactured by Kimberly-Clark). The preservative MI was identified in these brands.

 

"This is going to explode," Dr. Chang, a pediatric dermatologist at the University of Connecticut, West Hartford, said in an interview. "There’s more marketing [of wipes] now for non–diaper wearing children, and older people use wipes out of convenience."

 

The case series was described as the first report of pediatric allergic contact dermatitis to MI in wet wipes in the United States.

Although the MCI/MI patch test (T.R.U.E. Test) detected contact allergy to MI in the six children, identifying MI contact sensitization may require specialized MI patch tests with higher concentrations of MI or the use of small squares of the wipes themselves, Dr. Chang observed. Patch testing containing 100 ppm of MCI/MI mixture consists of only 25 ppm of MI and may be inadequate to detect MI alone, missing 33%-60% of cases.

 

Acute contact dermatitis was suspected in the index case, when the 8-year-old girl presented to pediatric dermatology after suffering for 11 months. She was initially misdiagnosed with impetiginized eczema and had received numerous oral and topical corticosteroids and antibiotics, said Dr. Chang. Questioning revealed that the patient used wet wipes for toileting and facial cleansing, and the rash resolved after the wipes were discontinued. MI sensitivity was confirmed on patch testing. Ms. Nakrani also interviewed the parents to determine the type of wipes used, and the preservative MI was identified in these brands.

 

"Remember to ask about wet wipe use, even in individuals who do not wear diapers and even if the rash in on the face," Dr. Chang said.

 

In the five other cases, allergic reactions to MI in the wet wipes were misdiagnosed as impetigo, psoriasis, diaper dermatitis, or atopic dermatitis, and unsuccessfully treated with a multitude of medications including steroids, antifungals, and topical tacrolimus (Protopic). The children, aged 3-8 years, had experienced symptoms for 1-12 months, according to the authors, who earned top honors for their poster presentation at the meeting.

The index patient also suffered from chronic retroauricular dermatitis, which resolved after discontinuing a shampoo containing MI.

MI was named the 2013 contact allergen of the year by the American Contact Dermatitis Society. In another recent study, Australian researchers reported 23 reactions to MI from a variety of personal care products, including 7 cases of hand dermatitis in parents of young children that was caused by an allergic reaction to MI in baby wipes (Australas. J. Dermatol. 2013 May 29 [doi: 0.1111/ajd.12062]).

 

The preservative MI was previously used only in a 3:1 MCI/MI combination (Kathon CG) that is widely known to cause allergic contact dermatitis. In an attempt to minimize such reactions, MI has been used alone, explained Ms. Nakrani, a medical student at the University of Connecticut.

However, its permitted concentration has increased by more than 25 times – from 3.7 ppm to 100 ppm – because it was thought to be a weaker sensitizer than MCI, she said.

"Once we found out the culprit was MI in the wet wipes and instructed parents to read labels and avoid MI, parents became more vigilant about the other products they were using like shampoos and soaps, and it really turned things right around once they stopped using these products," Ms. Nakrani said. "One mom, very grateful that the rashes finally cleared, said her child was going to school and everyone thought it was contagious."

The investigators have not contacted Kimberly-Clark regarding their findings. Bob Brand, director of external communications for Kimberly-Clark, would not specifically say whether they had received complaints of allergic contact dermatitis to MI in their wet wipes, but said all of their products undergo a thorough safety review prior to commercialization.

 

"While we understand there might be concern regarding a potential reaction to one of our products, consumers can use our wipes with confidence and know that the concentration levels of MI in our products are considered safe and well within the recommended levels as established by scientific and regulatory bodies such as the Cosmetic Ingredient Review Expert Panel in the U.S.A. and the European Commission Scientific Committee on Consumer Safety," he told Skin & Allergy News.

 

The formulation of the wipes appears to vary by product. Ms. Dianna Kenneally, principal scientist, baby care scientific communication, for Procter & Gamble, said in a separate interview that Proctor & Gamble baby wipe brands do not contain MI.

 

 

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Communications About Family Members' Risk of Melanoma

Archives Of Dermatology

As many as 5% to 12% of patients with melanoma have a family history of the disease, and patients with a positive family history of melanoma should be observed closely because of their elevated risk. When the initial diagnosis of melanoma is made, dermatologists play a crucial role in communicating risk assessment to their patients and recommending that family members be screened.

Feet Home To More Than 100 Types of Fungus

From: Dermatology Daily

The Los Angeles Times (5/23, Netburn) reports, "At least 80 types of fungi reside on a typical person's heel, along with 60 between the toes and 40 on the toenail." In fact, "the feet are home to more than 100 types of fungus, more than any other area of the human body, according to a study published Wednesday by the journal Nature."
On it's "All Things Considered" program and on its "Shots" blog, NPR (5/22, Stein) reports that the "census of the fungi that inhabit different places on our skin" is "part of a big scientific push to better understand the microbes that live in and on our bodies. 'This is the first study of fungi, which are yeast and other molds that live on the human body,' says Julie Segre, of the National Human Genome Research Institute, who led the survey."
The NBC News (5/23, Fox) "The Body Odd" blog reports that "one family" of fungus called Malassezia "covers most of our bodies." HealthDay (5/23, Norton) reports, "The new study...took advantage of DNA-sequencing technology to analyze the fungi on 10 healthy volunteers' skin." Also covering the story are BBC News (5/23, Briggs) and Medscape (5/23, Laidman).

SELF Magazine Awards Glytone "Best Night Cream"

From: Practical Dermatology June 2013

Glytone won one of SELF Magazine's 14th annual Healthy Beauty Awards, landing the distinction of "Best Night Cream" 2013 for Glytone Anti-aging Night Cream. The publications surveyed more than 1,600 US readers on their favorite beauty products-based on products that deliver on their promise-in five different categories: Hair, Makeup, Face, Body, and Sun.

Skin Cancer Myths-And Facts

From: Skin Cancer Foundation Journal

Myth: Eighty percent of a person's lifelong sun exposure is acquired before age 18.
Fact: Actually, only about 23 percent of lifetime exposure occurs by age 18. You can-and should-protect yourself from the sun at every age.

Myth: Tanning at a salon is safer than tanning outdoors-it's a controlled does of radiation.
Fact: When compared to people who have never tanned indoors, indoor tanners have a higher risk of all skin cancers. A "controlled" dose of tanning lamp radiation provides as much as 12 times the annual ultraviolet A (UVA) dose tanners receive from sun exposure. Just one indoor tanning session increases users' chances of developing melanoma by 20 percent.

Myth: Ingredients in sunscreen can cause cancer.
Fact: Research shows that when used as directed, sunscreens are safe and effective.

Myth: The sun is the best way to obtain vitamin D.
Fact: Our bodies can produce some vitamin D following sun exposure. However, within as little as a few minutes, vitamin D manufacture reaches its maximum. Meanwhile, the sun is damaging your skin and immune system. Diet and supplements are the safest way to obtain vitamin D.

Myth: You can't sustain sun damage on a cloudy day.
Fact: Believe it or not, up to 80 percent of the sun's harmful UV rays can penetrate clouds and fog.

Myth: A "base tan" protects your skin from sunburn.
Fact: A tan is a sign of skin damage. Skin tans in response to UV damage to the skin's DNA; a tan is the skin's attempt to repair damage and prevent further injury. But imperfect repairs can eventually lead to skin cancer.

Myth: A high SPF is all that you need in a sunscreen.
Fact: A sunscreen's SPF (sun protection factor) indicates protection from UVB rays, but UVA protection is necessary, too. Apply a UVA- and UVB- screening/broad-spectrum sunscreen with an SPF of 15+ (or 30+ for extended outdoor activity).

Myth: People of color don't get skin cancer.
Fact: People of color are less likely to develop skin cancer than Caucasians, but they have a higher risk of dying from it. The dangerous and fast-spreading skin cancer acral lentiginous melanoma is more common among darker-skinned people. Whatever your skin color, protect yourself.

Myth: Windows protect us from the sun's ultraviolet rays.
Fact: While glass blocks most UVB rays, UVA radiation can get through. However, UVA-screening window film is also available.