Allergic contact dermatitis caused by methylisothiazolinone from different sources, including ‘mislabelled’ household wet wipes

A 39-year-old non-atopic nurse was referred to our contact allergy unit in November 2012 because of eczematous skin lesions on the arms, neck and trunk of 7-month duration. Initially, the diagnosis of pityriasis rosea of Gibert had been suspected, but a biopsy of a lesion on the trunk had shown a spongiotic dermatitis with eosinophils, compatible with eczema. Application of a cream containing hydrocortisone 17-butyrate had resulted in clearance of the lesions, which reappeared after this treatment had been stopped. Following the use of betamethasone dipropionate 0.05% and chlorhexidine 0.5% in a non-ionic ointment base, the dermatitis improved; however, 2 months later, the patient also developed palmar hand dermatitis. The history revealed that the patient had never reacted to adhesive tape, jewellery, or perfume, but that she had previously developed a severe eczematous (even bullous) reaction on the hands when handling a water-soluble paint, and that she had also suffered from dermatitis on the eyelids when her house was being painted. As a nurse in a neonatology department, the patient wore nitrile gloves and washed her hands several times a day; she also came into contact with skin cleansing products and wipes for the babies’ hygiene. She herself suspected contact with the rubber parts of the incubators to be the cause of the lesions on her arms, as the skin lesions improved when she was off work. At home, the patient came into contact with Universal Everyday® moist household tissues (Colruyt, Halle,