Diagnosis and Treatment of Dermatitis Due to Formaldehyde Resins in Clothing

Ryan M. Carlson; Mary C. Smith; Susan T. Nedorost

Dermatitis. 2004;15(4):169-175.

Methodology

Patch tests were performed on 852 patients in the University Hospitals of Cleveland Environmental and Occupational Dermatitis Clinic from August 1999 to April 2004. We tabulated patch-test reactions to formaldehyde and to several of the formaldehyde textile resins supplied by Chemotechnique Diagnostics. Antigens placed in Finn Chambers (Epitest Ltd Oy, Tuusula, Finland) on Scanpor tape (Norgesplaster A/S, Vennesla, Norway) were removed at 48 hours, and readings were taken on day 3 or 4 and on day 7 (for the first 250 patients, only a day 7 reading was done owing to logistic constraints). We contacted numerous textile manufacturers in an attempt to find those that use low-formaldehyde-releasing resins or no such resins in the finishing of their products, and we obtained a list of garment manufacturers that comply with the stricter Japanese standards for formaldehyde release from textile finishes. We included only those that agreed to be included in the study. Subsequently, we distributed our revised patient education materials to patients who were allergic to formaldehyde resins, and we have received preliminary feedback.

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Cite this: Diagnosis and Treatment of Dermatitis Due to Formaldehyde Resins in Clothing - Medscape - Dec 01, 2004.

Common Formaldehyde Resins
Resin Type	Relative Formaldehyde Release*
Urea formaldehyde/DMU	High
Melamine formaldehyde	High
DMDHEU (Fixapret CPN)	Low
DMDHEU blended or reacted with glycols (modified) (Fixapret ECO)	Very low
Dimethoxymethyl dihydroxyethylene urea (methylated DMDHEU)	Very low
Dimethyl dihydroxyethylene urea (Fixapret NF)	None

Adapted from Hatch KL, Maibach HI;^[5] Fowler JF et al.^[6]
DMDHEU = dimethylol dihydroxyethyleneurea; DMU = dimethylol urea.
*High signifies a formaldehyde release of > 1,000 ppm; low, a release of < 100 ppm; and very low, a release of < 30 ppm.^[5]

Adapted from Fowler JF et al;^[6] Scheman JA et al;^[9] Metzler-Brenckle L, Rietschel RL.^[10]
*Finishes were supplied by Chemotechnique Diagnostics, Malmö, Sweden.

Dimethylol dihydroxyethyleneurea 4.5% aqueous (Fixapret CPN)
Dimethyl dihydroxyethyleneurea 4.5% aqueous (Fixapret NF)
Dimethylol dihydroxyethyleneurea, modified 5% aqueous (Fixapret ECO)
Ethyleneurea/melamine formaldehyde 5% mix in petrolatum (Fixapret AC)
Urea formaldehyde10% in petrolatum
Melamine formaldehyde 7% in petrolatum

Table 3. Patch-Test Results from August 1999 to April 2004
Allergen Tested	Total No. of Patients Tested		No. of Patients Testing Positive
Allergen Tested	Women	Men	Women (%)	Men (%)	Total (%)
Formaldehyde 1% aqueous	574	278	33 (5.7)	28 (10.1)	61 (7.2)
Ethyleneurea/melamine formaldehyde 5% pet (Fixapret AC)	574	278	13 (2.3)	4 (1.4)	17 (2)
DMDHEU 4.5% aqueous (Fixapret CPN)	260	138	5 (1.9)	4 (2.9)	9 (2.3)

DMDHEU = dimethylol dihydroxyethyleneurea; pet = petrolatum.

Adapted from Fowler JF et al;^[6] Scheman JA et al;^[9] Metzler-Brenckle L, Rietschel RL.^[10]
*Finishes were supplied by Chemotechnique Diagnostics, Malmö, Sweden.

Dimethylol dihydroxyethyleneurea 4.5% aqueous (Fixapret CPN)
Dimethyl dihydroxyethyleneurea 4.5% aqueous (Fixapret NF)
Dimethylol dihydroxyethyleneurea, modified 5% aqueous (Fixapret ECO)
Ethyleneurea/melamine formaldehyde 5% mix in petrolatum (Fixapret AC)
Urea formaldehyde10% in petrolatum
Melamine formaldehyde 7% in petrolatum

Table 4. Recommended Garment Manufacturers
Companies That Market in Japan*	Companies That Claim to Adhere to Japanese Standard^†
Gap	Gap/Old Navy/Banana Republic
Talbots	Eddie Bauer
J. Crew	Liz Claiborne
Coromo, Inc.^[18]	Levi Strauss
Avantal U.S.
Vermont Country Store

*Companies that market their own clothing in Japan as listed on public reports filed by the Securities and Exchange Commission as of May 2004.
^†Information obtained by contacting each company about their use of low-formaldehyde-releasing resins or no such resins in their textile finishing; this list is not necessarily comprehensive, and only companies that responded are included.

Table 5. Educational Handout for Patients with Textile Finish/Formaldehyde Resin Allergic Contact Dermatitis
University Hospitals
Health System
University Hospitals of Cleveland
For Textile Finish/Formaldehyde Resin Allergic Dermatitis, it is recommended:
1. WEAR clothes with labels that say: - 100% silk - 100% linen (if it wrinkles easily) - 100% polyester - 100% acrylic - 100% nylon - spandex - flannel (if soft) - denim (jeans) - wool (may cause irritation)
2. DO NOT WEAR clothes with labels that say: - Permanent press - Wrinkle resistant - Color-fast - Stain-resistant - "Blends" (including rayon, polyester-cotton) - corduroy or shrink-proof wool
3. It may be helpful to remember this: -Soft, easily wrinkled fabrics = SAFE -Heavy, stiff fabrics = UNSAFE
4. Things that cause rubbing, pressure or sweating could cause your condition to flare. So, loose fitting clothes are helpful and you may be able to tolerate more kinds of fabrics in cooler temperatures than you can in higher temperatures (in the summer).
5. Start by READING THE LABELS IN YOUR CLOSET. Put to one side all the clothes that are safe to wear. See 1 above. Wear only these clothes for one month.
6. If you need to buy new clothes, remember that clothing made in Japan may be the safest choice for imported textiles. Japan enforces the strictest standards for formaldehyde release from the textile finishes. Also, the companies that market in or out of Japan meet acceptable standards and are generally safe.
7. Clothing made by GAP, OLD NAVY, BANANA REPUBLIC, LIZ CLAIBORNE, EDDIE BAUER, CUDDL DUDS, and LEVI STRAUSSS is recommended. Also, products from VERMONT COUNTRY STORE and AVANTAL U.S. claim to use very low amounts of formaldehyde resins in finishing their textiles (amounts below the U.S. industry standard.
8. Do note that washing clothing will not significantly reduce the levels of formaldehyde resins in your clothing necessary for an allergic reaction. Use of dry cleaning fluids and spray starch are okay. Washing your family's clothes is okay if you do not develop fingertip dermatitis.
9. If exposure to formaldehyde resins in your clothes cannot be avoided, then you may consider wearing undergarments to protect your skin. Silk is an acceptable choice for an undergarment.
10. If you have been told that you are also allergic to formaldehyde preservatives, you also need to check your personal care products such as cosmetic creams, medication, nail products and shampoo. The Contact Allergen Replacement Database (CARD) printout provided by your doctor can be your shopping list for products that do not contain the allergens.
11. You may also come in contact with fabrics containing formaldehyde in other than clothes, such as bed sheets, upholstered furniture and craft fabrics. Use of knitting yarns and needlework floss is acceptable.
12. Keep in mind that you MUST AVOID FORMALDEHYDE RESINS AT ALL TIMES. Even exposure once a month would be enough to cause a rash to continue. "Dress clothes" only worn on weekends is enough to maintain your dermatitis.
13. Also, realize that since you have had an allergic reaction, now even low levels of formaldehyde may be enough to cause flares. Try to add only one new product per week. If you have a flare after a new product, STOP FOR 3 WEEKS until clear.
14. Remember this is a difficult process. Be patient and call with questions.

Table 5. Educational Handout for Patients with Textile Finish/Formaldehyde Resin Allergic Contact Dermatitis
University Hospitals
Health System
University Hospitals of Cleveland
For Textile Finish/Formaldehyde Resin Allergic Dermatitis, it is recommended:
1. WEAR clothes with labels that say: - 100% silk - 100% linen (if it wrinkles easily) - 100% polyester - 100% acrylic - 100% nylon - spandex - flannel (if soft) - denim (jeans) - wool (may cause irritation)
2. DO NOT WEAR clothes with labels that say: - Permanent press - Wrinkle resistant - Color-fast - Stain-resistant - "Blends" (including rayon, polyester-cotton) - corduroy or shrink-proof wool
3. It may be helpful to remember this: -Soft, easily wrinkled fabrics = SAFE -Heavy, stiff fabrics = UNSAFE
4. Things that cause rubbing, pressure or sweating could cause your condition to flare. So, loose fitting clothes are helpful and you may be able to tolerate more kinds of fabrics in cooler temperatures than you can in higher temperatures (in the summer).
5. Start by READING THE LABELS IN YOUR CLOSET. Put to one side all the clothes that are safe to wear. See 1 above. Wear only these clothes for one month.
6. If you need to buy new clothes, remember that clothing made in Japan may be the safest choice for imported textiles. Japan enforces the strictest standards for formaldehyde release from the textile finishes. Also, the companies that market in or out of Japan meet acceptable standards and are generally safe.
7. Clothing made by GAP, OLD NAVY, BANANA REPUBLIC, LIZ CLAIBORNE, EDDIE BAUER, CUDDL DUDS, and LEVI STRAUSSS is recommended. Also, products from VERMONT COUNTRY STORE and AVANTAL U.S. claim to use very low amounts of formaldehyde resins in finishing their textiles (amounts below the U.S. industry standard.
8. Do note that washing clothing will not significantly reduce the levels of formaldehyde resins in your clothing necessary for an allergic reaction. Use of dry cleaning fluids and spray starch are okay. Washing your family's clothes is okay if you do not develop fingertip dermatitis.
9. If exposure to formaldehyde resins in your clothes cannot be avoided, then you may consider wearing undergarments to protect your skin. Silk is an acceptable choice for an undergarment.
10. If you have been told that you are also allergic to formaldehyde preservatives, you also need to check your personal care products such as cosmetic creams, medication, nail products and shampoo. The Contact Allergen Replacement Database (CARD) printout provided by your doctor can be your shopping list for products that do not contain the allergens.
11. You may also come in contact with fabrics containing formaldehyde in other than clothes, such as bed sheets, upholstered furniture and craft fabrics. Use of knitting yarns and needlework floss is acceptable.
12. Keep in mind that you MUST AVOID FORMALDEHYDE RESINS AT ALL TIMES. Even exposure once a month would be enough to cause a rash to continue. "Dress clothes" only worn on weekends is enough to maintain your dermatitis.
13. Also, realize that since you have had an allergic reaction, now even low levels of formaldehyde may be enough to cause flares. Try to add only one new product per week. If you have a flare after a new product, STOP FOR 3 WEEKS until clear.
14. Remember this is a difficult process. Be patient and call with questions.

Table 4. Recommended Garment Manufacturers
Companies That Market in Japan*	Companies That Claim to Adhere to Japanese Standard^†
Gap	Gap/Old Navy/Banana Republic
Talbots	Eddie Bauer
J. Crew	Liz Claiborne
Coromo, Inc.^[18]	Levi Strauss
Avantal U.S.
Vermont Country Store

Table 4. Recommended Garment Manufacturers
Companies That Market in Japan*	Companies That Claim to Adhere to Japanese Standard^†
Gap	Gap/Old Navy/Banana Republic
Talbots	Eddie Bauer
J. Crew	Liz Claiborne
Coromo, Inc.^[18]	Levi Strauss
Avantal U.S.
Vermont Country Store

Table 5. Educational Handout for Patients with Textile Finish/Formaldehyde Resin Allergic Contact Dermatitis
University Hospitals
Health System
University Hospitals of Cleveland
For Textile Finish/Formaldehyde Resin Allergic Dermatitis, it is recommended:
1. WEAR clothes with labels that say: - 100% silk - 100% linen (if it wrinkles easily) - 100% polyester - 100% acrylic - 100% nylon - spandex - flannel (if soft) - denim (jeans) - wool (may cause irritation)
2. DO NOT WEAR clothes with labels that say: - Permanent press - Wrinkle resistant - Color-fast - Stain-resistant - "Blends" (including rayon, polyester-cotton) - corduroy or shrink-proof wool
3. It may be helpful to remember this: -Soft, easily wrinkled fabrics = SAFE -Heavy, stiff fabrics = UNSAFE
4. Things that cause rubbing, pressure or sweating could cause your condition to flare. So, loose fitting clothes are helpful and you may be able to tolerate more kinds of fabrics in cooler temperatures than you can in higher temperatures (in the summer).
5. Start by READING THE LABELS IN YOUR CLOSET. Put to one side all the clothes that are safe to wear. See 1 above. Wear only these clothes for one month.
6. If you need to buy new clothes, remember that clothing made in Japan may be the safest choice for imported textiles. Japan enforces the strictest standards for formaldehyde release from the textile finishes. Also, the companies that market in or out of Japan meet acceptable standards and are generally safe.
7. Clothing made by GAP, OLD NAVY, BANANA REPUBLIC, LIZ CLAIBORNE, EDDIE BAUER, CUDDL DUDS, and LEVI STRAUSSS is recommended. Also, products from VERMONT COUNTRY STORE and AVANTAL U.S. claim to use very low amounts of formaldehyde resins in finishing their textiles (amounts below the U.S. industry standard.
8. Do note that washing clothing will not significantly reduce the levels of formaldehyde resins in your clothing necessary for an allergic reaction. Use of dry cleaning fluids and spray starch are okay. Washing your family's clothes is okay if you do not develop fingertip dermatitis.
9. If exposure to formaldehyde resins in your clothes cannot be avoided, then you may consider wearing undergarments to protect your skin. Silk is an acceptable choice for an undergarment.
10. If you have been told that you are also allergic to formaldehyde preservatives, you also need to check your personal care products such as cosmetic creams, medication, nail products and shampoo. The Contact Allergen Replacement Database (CARD) printout provided by your doctor can be your shopping list for products that do not contain the allergens.
11. You may also come in contact with fabrics containing formaldehyde in other than clothes, such as bed sheets, upholstered furniture and craft fabrics. Use of knitting yarns and needlework floss is acceptable.
12. Keep in mind that you MUST AVOID FORMALDEHYDE RESINS AT ALL TIMES. Even exposure once a month would be enough to cause a rash to continue. "Dress clothes" only worn on weekends is enough to maintain your dermatitis.
13. Also, realize that since you have had an allergic reaction, now even low levels of formaldehyde may be enough to cause flares. Try to add only one new product per week. If you have a flare after a new product, STOP FOR 3 WEEKS until clear.
14. Remember this is a difficult process. Be patient and call with questions.