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We read with great interest the article by Gardner et al1 in the August issue of the Archives. In our opinion, the authors fail to distinguish between 2 different preservatives: the mixture in a 3:1 ratio of methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) and the nonhalogenated derivative MI alone, which is, according to the article, contained in Cottonelle moist toilet paper (Kimberly-Clark Corporation, Neenah, Wisconsin).
In Europe, MCI/MI has been widely used in cosmetics at a maximum concentration of 15 ppm.2 In both Europe and the United States, MI alone has recently been approved for use in cosmetics at up to 100 ppm, either in leave-on or rinse-off products.2 As a biocide, it is less effective than MCI/MI, and hence it requires a higher use concentration, which was believed to be safe because MI alone is a much weaker sensitizer than MCI and therefore has been considered a good alternative to the MCI/MI combination.3
We recently have observed 7 cases of allergic contact dermatitis (ACD) induced by MI, 6 of which occurred after the use of MI-containing moist toilet paper.4 As in 3 of the 4 cases reported by Gardner et al,1 Kimberly-Clark was the manufacturer of the involved product in our cases. Five of the 6 patients were patch tested with MI at 1000 ppm, which resulted in strong positive reactions in all cases. However, results of patch testing with the MCI/MI mixture at 100 ppm were negative in 2 patients, which is probably explained by a too-low MI concentration.
Occupational ACD caused by MI has been previously reported,5 - 6 thus demonstrating the potential of this substance to elicit and induce contact allergy. We estimate that the inclusion of MI as a preservative in cosmetics might not represent the solution to the problem of ACD from isothiazolinones. Moreover, considering both our European cases or the American patients described by Gardner et al,1 we may be witnessing an epidemic of ACD from this “brand new” substance. Furthermore, not only patients who are previously sensitized to the MCI/MI mixture may react to products containing MI alone but also patients who were primarily sensitized to MI may react to products containing the MCI/MI combination chemical. We strongly believe that the use of MI as a preservative in cosmetics, especially in leave-on products and wipes, might thus need to be more thoroughly regulated.
Correspondence: Dr García-Gavín, Department of Dermatology, Faculty of Medicine, San Francisco sin número, 15782, Santiago de Compostela, A Coruña, Spain (juangavin@gmail.com).
Financial Disclosure: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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