Tosylamide/formaldehyde resin - a consideration in the atopic toddler


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Tosylamide/formaldehyde resin - a consideration in the atopic toddler

  1. 1. Tosylamide/formaldehyde resin - a consideration in the atopic toddler Sarah Stechschulte B.A.^ & Sharon E. Jacob M.D.* ^MSIV, University of Miami *Voluntary Clinical Associate Professor, University of Miami Jacob SE, Stechschulte SA. Contact Dermatitis 2008 May;58(5):312-3. May;58(5):312
  2. 2. What is Tosylamide/formaldehyde Resin? ! A substance added to nail varnish to aid in adhesion of varnish to the nail, while improving rigidity, shine, and flow of application (1).
  3. 3. Significance of TSFR ! Youths are experimenting more with nail cosmetics at younger ages, allowing early sensitization with the chemical (2). ! Prevalence of sensitization in young children is not known
  4. 4. Case ! A 4-year old black Hispanic female presented to the Contact Dermatitis Clinic with eyelid dermatitis and worsening atopic flexural dermatitis ! Older sister found to paint child’s toddlers nails – on initial consultation eliciting environmental history
  5. 5. Obtain detailed environmental history ! Personal hygiene products: shampoo, soaps, lotions, creams, diaper balms, & diaper wipes (3). ! Medical & medicament history (3). ! Family member personal hygiene products, frequent toys/playthings, housewares, and household products (3).
  6. 6. Which children should be patch tested? ! Those with uncontrollable or worsening chronic dermatitis of greater than two months duration (3). ! Failure to improve following standard treatment protocols (3). ! Those with eyelid/hand involvement (4).
  7. 7. Which chemicals should we patch test with? ! Those with high clinical suspicion (prior exposure to allergen definitively identified) ! A customized set of allergens is made for each patient based on the child’s exposure history (3).
  8. 8. Relationship to the case ! Based on the evaluation and failure of improvement during the avoidance period, the child was patch tested with selected chemicals from Umiami Pediatric standard (3) ! A clinically relevant patch test reaction was found to tosylamide/formaldehyde resin [1+]
  9. 9. Analysis of results ! The child’s nails regularly painted by her older sister ! The child used nails to scratch her eyelids & ‘atopic’ areas ! Discontinued use of TSFR products by all members of the family resulted in considerable improvement of both the child’s eyelids and ‘atopic’ areas.
  10. 10. Discussion points ! A statistically significant association between TSFR and eyelid dermatitis has previously been recognized (5,6). ! This case reveals the importance of considering TSFR when evaluating a toddler.
  11. 11. Conclusion ! We believe that the patient’s scratching of her atopic dermatitis with TSFR varnished nails played a role in her reaction to the chemical. ! We recommend that children unable to overcome the need to scratch should not have their fingernails varnished.
  12. 12. References 1) Orton D I, Wilkinson J D. Cosmetic allergy: incidence, diagnosis, and management. Am J Clin Dermatol 2004: 5: 327–337. 2) White I R. Allergic contact dermatitis. In: Textbook of Pediatric Dermatology, 2nd edition, Harper J I, Prose N S, Oranje A P (eds): Cambridge, Blackwell Publishing Inc, 2006. 3) Jacob SE, Burk CJ, Connelly EA. Patch testing: another steroid- sparing agent to consider in children. Pediatr Dermatol 2008 Jan- Feb; 25(1):81-7. 4) Beattie P E, Green C, Lowe G, Lewis-Jones M S. Which children should we patch test? Clin Exp Dermatol 2007: 32:6–11. 5) Amin K A, Belsito D V. The aetiology of eyelid dermatitis: a 10- year retrospective analysis. Contact Dermatitis 2006: 55: 280– 285. 6) Guin J D. Eyelid dermatitis: a report of 215 patients. Contact Dermatitis 2004: 50: 87–90.