Severe contact dermatitis as a result of an antiseptic bath oil

Abstract

Siblings aged 7 and 5 years developed extensive truncal and flexural inflammation and desquamation unresponsive to standard eczema therapy. After delays in diagnosis, subsequent history revealed prior use of an antiseptic bath oil in a much stronger concentration than recommended. The case illustrates the severe irritant contact dermatitis that can arise following inadequate dilution of antiseptic bath oils, presumably as a result of skin contact with benzalkonium chloride and triclosan. Features that may direct attention to such irritant dermatitis are flexural predominance with superficial desquamation and rapid improvement after avoidance of exposure to the antiseptic solution.

Flexural allergic contact dermatitis to benzalkonium chloride in antiseptic bath oil

“…The potential for a bath emollient to be ‘trapped’ in the skin flexures, anogenital area and inner thighs may have contributed to the distribution of the rash in our patients (note the classical sparing of the vault of the axillae). Such a distribution equates with that already described in cases of irritancy to Oilatum ® Plus 5–8 . This problem could be exacerbated if the bath product was not mixed thoroughly or if too much was added to the bath water.…”

“…All reactions were positive (+) at day 4 with a crescendo response. There have been several recent reports of irritant contact dermatitis to Oilatum ® Plus presenting with eczema in a flexural and anogenital distribution 5–8 . In this report we describe six patients who presented with a flexural eczematous rash.…”

“…There have been several recent reports of irritant contact dermatitis to Oilatum Ò Plus presenting with eczema in a flexural and anogenital distribution. [5][6][7][8] In this report we describe six patients who presented with a flexural eczematous rash. All were shown to have an allergy to BAK as well as a history of exposure to BAK, via the bath emollient Oilatum Ò Plus.…”

“…Such a distribution equates with that already described in cases of irritancy to Oilatum Ò Plus. [5][6][7][8] This problem could be exacerbated if the bath product was not mixed thoroughly or if too much was added to the bath water.…”

Bath emollients for atopic eczema: why use them?

“…Irritation or allergic contact dermatitis has occasionally been associated with use of bath emollients containing antimicrobials 18 , 19. Emollients can make baths slippery, which may lead to accidents.…”