Diagnosis and Treatment of Dermatitis Due to Formaldehyde Resins in Clothing

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

Disclosures

Dermatitis. 2004;15(4):169-175. 

In This Article

Results

As shown in Table 3 , we grouped the + or greater reactions and the questionable reactions together because we believe the latter to be more clinically relevant than once thought. When patients with questionable reactions complied with the avoidance guidelines for formaldehyde resins in clothing, a significant proportion improved, which emphasized the relevance of questionable reactions. Overall, 7.2% of patients had positive reactions to formaldehyde 1% aqueous. Allergic reactions to formaldehyde were found in 28 (10.1%) of the men and 33 (5.7%) of the women. Of these reactions, 79.0% were + or greater, and 21.0% were questionable.

We also screened with ethyleneurea/melamine formaldehyde resin mix 5% in petrolatum (Fixapret AC, Chemotechnique, Malmo, Sweden)). Seventeen patients had positive patch-test results, giving a total incidence of 2.0%. The incidence of a positive patch test to Fixapret AC was 1.4 % in the men and 2.3 % in the women tested. Three patients were allergic to Fixapret AC but not to formaldehyde, which again emphasizes the need to patch-test with the resins in addition to formaldehyde alone. Occupational data on several patients who tested positive to Fixapret AC are available. These patients included three male retirees, one female office worker, one female dialysis technician, and one female machinist.

Throughout this period, we also patch-tested patients for whom there was a high degree of clinical suspicion for textile dermatitis from several of the resins from the standard textile series obtained from Chemotechnique (see Table 2 ). Of our 60 tested patients, 6 (10%) had positive reactions to formaldehyde resins. Of these, 4 (66.7%) had questionably positive reactions to Fixapret CPN (Chemotechnique) yet reacted negatively to ethyleneurea/melamine formaldehyde mix. As a result of these findings, we added DMDHEU (Fixapret CPN) to our standard screening series. Of the 398 general contact dermatitis clinic patients screened to date, 2.3% have reacted to Fixapret CPN. The incidence of positive patch tests to Fixapret CPN was 2.9% in men and 1.9% in women.

In reviewing the data, we have seen a trend toward an increase in textile resin dermatitis, as shown by positive patch-test results over the last couple of years. This could be due to increased patch testing with textile resins. We observed that Fixapret CPN or Fixapret AC caused positive reactions most often, and the use of these together would detect most of our cases.

We were successful in locating several manufacturers that claim to use low-formaldehyde-releasing resins or no such resins in the finishing of their textiles, adhering to the stricter Japanese standard. These companies are listed in Table 4 , which also includes Japanese manufacturers and several American companies that market in Japan, all of whose products may be safe for patients with formaldehyde sensitivity.

A textile finish handout was created for use in educating patients with sensitivity to formaldehyde textile resins at the University Hospital Dermatitis Clinic ( Table 5 ). The handout was distributed to eight patients who tested positive to formaldehyde textile resins. Verbal feedback was received from three patients at a follow-up visit, and two patients sent written feedback. Two obstacles to compliance were identified as (1) frustration with labeling and (2) difficulty in avoiding formaldehyde resins in "dress" clothes. Two factors observed to be helpful were (1) having a list of suggested stores from which to purchase new clothes and (2) being able to telephone the clinic nurse with questions. Many questions revealed concerns over contact with fabrics in the home environment, including "craft fabrics" and those used in sheets, upholstered furniture, needlework floss, and knitting yarn. We have seen textile-allergic patients react to upholstered furniture and to fabrics used for crafts, and our handout was modified to include these materials. Also, questions regarding contact with starched or dry-cleaned clothes and about touching clothes while doing the family wash were common. Several patients were curious as to whether washing clothes many times would eventually eliminate formaldehyde and formaldehyde resins from the clothing. We have modified our handout to indicate that washing a new garment may reduce the levels of free formaldehyde but is not sufficient to prevent elicitation of a textile resin reaction in a previously sensitized patient. In addition, we have stated that starching, dry cleaning, and contact with family laundry should be safe. We deleted the statement that 100% cotton fabric that wrinkled easily was acceptable because many patients misconstrued this to mean that all 100% cotton fabrics were acceptable (see Table 5 ).

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