Case and Resarch Letter
Contact Dermatitis Due to Methylchloroisothiazolinone/Methylisothiazolinone (Kathon CG) as a Contaminant in the Manufacturing Process of a Cream
Eccema de contacto por metilcloroisotiazolinona/metilisotiazolinona (Kathon CG) como contaminante del proceso de fabricación de una crema
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Cervigón-González, L. Conde-Salazar, L.M. TorresIglesias, Á. Palomo-Arellano" "autores" => array:4 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "Cervigón-González" "email" => array:1 [ 0 => "icervigon@sescam.jccm.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "Conde-Salazar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "L.M." "apellidos" => "TorresIglesias" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Á." "apellidos" => "Palomo-Arellano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Dermatología, Hospital General Nuestra Señora del Prado, Talavera de la Reina, Toledo, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Dermatología Laboral, Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Eccema de contacto por metilcloroisotiazolinona/metilisotiazolinona (Kathon CG) como contaminante del proceso de fabricación de una crema" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1313 "Ancho" => 1585 "Tamanyo" => 179485 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Positive patch test to nickel sulfate, Kathon CG, and the product itself at 96<span class="elsevierStyleHsp" style=""></span>h.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">To the Editor:</span></p><p id="par0005" class="elsevierStylePara elsevierViewall">Kathon CG (Cosmetic Grade) is a mixture of methylisothiazolinone (1.125%), methylchloroisothiazolinone (0.375%), magnesium nitrate and magnesium chloride (23%), and water (75%).<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> Isothiazolinones are heterocyclic compounds used as biocides because of their antimicrobial properties against gram-positive and gram-negative bacteria, fungi, and algae.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Kathon CG is used in a wide range of cosmetics and hygiene and personal care products in maximum permissible concentrations of 7.5<span class="elsevierStyleHsp" style=""></span>ppm (stay-on products) and 15<span class="elsevierStyleHsp" style=""></span>ppm (rinse-off products).<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4</span></a> It is also used in industry, where the concentrations can be higher.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Kathlon CG was included as an allergen in the standard series in the 1980s at a concentration of 100<span class="elsevierStyleHsp" style=""></span>ppm and is still one of the most common allergens in both the workplace and the home.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4–8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We report the case of a 30-year-old woman with a personal and family history of atopic dermatitis and respiratory allergy who presented with acute eczema on both hands after contact with a neutral massage cream (+BO pro, Telic, S.A.) that she used in her work as a physiotherapist. The cream contains water, liquid paraffin, petrolatum, stearic acid, cetyl alcohol, ceteth-25, PEG-8 stearate, benzyl alcohol, ceteareth-12, fragrance, methylparaben, propylparaben, triethanolamine, and diazolidinyl urea.</p><p id="par0025" class="elsevierStylePara elsevierViewall">With a presumptive diagnosis of allergic contact dermatitis, we performed patch tests with a Spanish Group for Research Into Contact Dermatitis and Skin Allergies (GEIDAC) standard series, a Martí Tor cosmetics series and the product itself. Readings at 48<span class="elsevierStyleHsp" style=""></span>h, 96<span class="elsevierStyleHsp" style=""></span>h, and 7 days revealed sensitization to nickel sulfate (++) with past relevance, Kathon CG (+++) with unknown relevance, and the product itself (+++) with present relevance (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">We contacted the manufacturer, who confirmed that Kathon CG is not present in the finished product, nor is it used in the manufacture of the starting materials of which the cream is composed. We requested the components separately, which showed negative results in the patch tests at 48<span class="elsevierStyleHsp" style=""></span>h, 96<span class="elsevierStyleHsp" style=""></span>h, and 7 days.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The patient was asked whether the cream could have been mixed or contaminated with another substance or manipulated by another worker. She assured us that she herself had unsealed the container and applied the product with washed hands and that the eczema had appeared a few hours later.</p><p id="par0040" class="elsevierStylePara elsevierViewall">To rule out the possibility that the product had been adulterated and was an irritant, controls were carried out on 10 volunteers, with negative results at 96<span class="elsevierStyleHsp" style=""></span>h in all cases.</p><p id="par0045" class="elsevierStylePara elsevierViewall">On suspicion that the product could contain methylchloroisothiazolinone/methylisothiazolinone, we contacted the manufacturer, who investigated other possible sources of contact and thus discovered the curious way in which small amounts of this biocide had contaminated the product.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The mixer, the metering pump, and the pipes of the packaging machine are cleaned and disinfected after each production run with hydrogen peroxide and rinsed with deionized water. As moisture may remain in the less accessible points of the system (bends and filters), Kathon CG is added to the rinse water to ensure a completely sterile process.</p><p id="par0055" class="elsevierStylePara elsevierViewall">As a result of this finding, the company marketing the cream compensated the patient and changed the procedure for cleaning the machinery, replacing the Kathon CG in the rinse water with other biocides (methylparaben, propylparaben, and diazolidinyl urea).</p><p id="par0060" class="elsevierStylePara elsevierViewall">We believe that the very small amount of methylchloroisothiazolinone/methylisothiazolinone that may be contained in the finished product is due to contamination. The rinse water which is used to clean the packaging machine contains Kathon CG and may briefly come into contact with the cream, especially in the first few bottles of the production run. Although it would have been advisable to determine the presence of Kathon CG in the content of the bottle used by the patient, it was not possible to do so because of the technical difficulty involved.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The patient's atopic predisposition and her work, in which she uses the cream daily, probably accentuated the problem and caused the severe acute dermatitis.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Cervigón-González I, et al. Eccema de contacto por metilcloroisotiazolinona/metilisotiazolinona (Kathon CG<span class="elsevierStyleSup">®</span>) como contaminante del proceso de fabricación de una crema. Actas Dermosifiliogr. 2013;104:81-2.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1313 "Ancho" => 1585 "Tamanyo" => 179485 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Positive patch test to nickel sulfate, Kathon CG, and the product itself at 96<span class="elsevierStyleHsp" style=""></span>h.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Kathon CG® (combinación de clormetilisotiazolinona y metilisotiazolinona) continúa siendo un frecuente alérgeno responsable de eccema de contacto" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.M. 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Gonzalea Lastra" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "1989" "volumen" => "80" "paginaInicial" => "551" "paginaFinal" => "553" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "revisión de 22 casos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Guimaraens" 1 => "A. Hasson" 2 => "L. Conde-Salazar" 3 => "C.G. Sensibilización al Kathon" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "1989" "volumen" => "80" "paginaInicial" => "735" "paginaFinal" => "738" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Revisión 1990-1997" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "en Servicio de Dermatología Laboral" "etal" => false "autores" => array:5 [ 0 => "L. Conde Salazar" 1 => "M. Flis" 2 => "M.A. González" 3 => "D. Guimaraens" 4 => "C.G. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 19 | 12 | 31 |
| 2024 Octubre | 108 | 47 | 155 |
| 2024 Septiembre | 104 | 46 | 150 |
| 2024 Agosto | 157 | 74 | 231 |
| 2024 Julio | 134 | 48 | 182 |
| 2024 Junio | 106 | 56 | 162 |
| 2024 Mayo | 94 | 45 | 139 |
| 2024 Abril | 101 | 36 | 137 |
| 2024 Marzo | 102 | 31 | 133 |
| 2024 Febrero | 72 | 32 | 104 |
| 2024 Enero | 77 | 42 | 119 |
| 2023 Diciembre | 71 | 28 | 99 |
| 2023 Noviembre | 76 | 37 | 113 |
| 2023 Octubre | 48 | 21 | 69 |
| 2023 Septiembre | 71 | 34 | 105 |
| 2023 Agosto | 51 | 28 | 79 |
| 2023 Julio | 69 | 48 | 117 |
| 2023 Junio | 121 | 27 | 148 |
| 2023 Mayo | 219 | 35 | 254 |
| 2023 Abril | 193 | 40 | 233 |
| 2023 Marzo | 115 | 29 | 144 |
| 2023 Febrero | 73 | 28 | 101 |
| 2023 Enero | 48 | 50 | 98 |
| 2022 Diciembre | 67 | 47 | 114 |
| 2022 Noviembre | 65 | 41 | 106 |
| 2022 Octubre | 38 | 42 | 80 |
| 2022 Septiembre | 45 | 44 | 89 |
| 2022 Agosto | 46 | 41 | 87 |
| 2022 Julio | 36 | 43 | 79 |
| 2022 Junio | 34 | 21 | 55 |
| 2022 Mayo | 129 | 47 | 176 |
| 2022 Abril | 111 | 48 | 159 |
| 2022 Marzo | 105 | 61 | 166 |
| 2022 Febrero | 114 | 26 | 140 |
| 2022 Enero | 145 | 64 | 209 |
| 2021 Diciembre | 86 | 51 | 137 |
| 2021 Noviembre | 93 | 53 | 146 |
| 2021 Octubre | 116 | 60 | 176 |
| 2021 Septiembre | 91 | 53 | 144 |
| 2021 Agosto | 77 | 49 | 126 |
| 2021 Julio | 54 | 45 | 99 |
| 2021 Junio | 53 | 48 | 101 |
| 2021 Mayo | 73 | 64 | 137 |
| 2021 Abril | 125 | 109 | 234 |
| 2021 Marzo | 89 | 49 | 138 |
| 2021 Febrero | 80 | 45 | 125 |
| 2021 Enero | 52 | 29 | 81 |
| 2020 Diciembre | 67 | 31 | 98 |
| 2020 Noviembre | 50 | 42 | 92 |
| 2020 Octubre | 48 | 26 | 74 |
| 2020 Septiembre | 76 | 26 | 102 |
| 2020 Agosto | 84 | 32 | 116 |
| 2020 Julio | 65 | 29 | 94 |
| 2020 Junio | 60 | 41 | 101 |
| 2020 Mayo | 66 | 32 | 98 |
| 2020 Abril | 41 | 40 | 81 |
| 2020 Marzo | 47 | 43 | 90 |
| 2020 Febrero | 2 | 6 | 8 |
| 2020 Enero | 4 | 11 | 15 |
| 2019 Diciembre | 8 | 11 | 19 |
| 2019 Noviembre | 4 | 6 | 10 |
| 2019 Octubre | 0 | 15 | 15 |
| 2019 Septiembre | 4 | 15 | 19 |
| 2019 Agosto | 4 | 11 | 15 |
| 2019 Julio | 8 | 15 | 23 |
| 2019 Junio | 4 | 27 | 31 |
| 2019 Mayo | 6 | 63 | 69 |
| 2019 Abril | 2 | 59 | 61 |
| 2019 Marzo | 0 | 21 | 21 |
| 2019 Febrero | 6 | 12 | 18 |
| 2019 Enero | 0 | 5 | 5 |
| 2018 Diciembre | 3 | 9 | 12 |
| 2018 Noviembre | 3 | 3 | 6 |
| 2018 Octubre | 24 | 1 | 25 |
| 2018 Septiembre | 11 | 0 | 11 |
| 2018 Junio | 0 | 4 | 4 |
| 2018 Mayo | 0 | 12 | 12 |
| 2018 Abril | 0 | 6 | 6 |
| 2018 Marzo | 3 | 0 | 3 |
| 2018 Febrero | 71 | 6 | 77 |
| 2018 Enero | 86 | 6 | 92 |
| 2017 Diciembre | 75 | 10 | 85 |
| 2017 Noviembre | 96 | 11 | 107 |
| 2017 Octubre | 63 | 8 | 71 |
| 2017 Septiembre | 74 | 19 | 93 |
| 2017 Agosto | 69 | 10 | 79 |
| 2017 Julio | 78 | 23 | 101 |
| 2017 Junio | 91 | 15 | 106 |
| 2017 Mayo | 74 | 10 | 84 |
| 2017 Abril | 84 | 20 | 104 |
| 2017 Marzo | 69 | 21 | 90 |
| 2017 Febrero | 63 | 11 | 74 |
| 2017 Enero | 51 | 14 | 65 |
| 2016 Diciembre | 91 | 7 | 98 |
| 2016 Noviembre | 128 | 11 | 139 |
| 2016 Octubre | 126 | 11 | 137 |
| 2016 Septiembre | 191 | 20 | 211 |
| 2016 Agosto | 146 | 15 | 161 |
| 2016 Julio | 84 | 14 | 98 |
| 2016 Junio | 12 | 16 | 28 |
| 2016 Mayo | 11 | 15 | 26 |
| 2016 Abril | 16 | 13 | 29 |
| 2016 Marzo | 8 | 1 | 9 |
| 2016 Febrero | 9 | 13 | 22 |
| 2016 Enero | 11 | 1 | 12 |
| 2015 Diciembre | 21 | 8 | 29 |
| 2015 Noviembre | 13 | 1 | 14 |
| 2015 Octubre | 17 | 14 | 31 |
| 2015 Septiembre | 9 | 1 | 10 |
| 2015 Agosto | 14 | 2 | 16 |
| 2015 Julio | 156 | 20 | 176 |
| 2015 Junio | 114 | 11 | 125 |
| 2015 Mayo | 302 | 17 | 319 |
| 2015 Abril | 131 | 19 | 150 |
| 2015 Marzo | 123 | 12 | 135 |
| 2015 Febrero | 127 | 13 | 140 |
| 2015 Enero | 134 | 16 | 150 |
| 2014 Diciembre | 74 | 2 | 76 |
| 2014 Noviembre | 86 | 4 | 90 |
| 2014 Octubre | 87 | 3 | 90 |
| 2014 Septiembre | 55 | 8 | 63 |
| 2014 Agosto | 59 | 4 | 63 |
| 2014 Julio | 57 | 10 | 67 |
| 2014 Junio | 88 | 3 | 91 |
| 2014 Mayo | 95 | 8 | 103 |
| 2014 Abril | 71 | 1 | 72 |
| 2014 Marzo | 76 | 15 | 91 |
| 2014 Febrero | 58 | 8 | 66 |
| 2014 Enero | 58 | 8 | 66 |
| 2013 Diciembre | 48 | 17 | 65 |
| 2013 Noviembre | 33 | 13 | 46 |
| 2013 Octubre | 31 | 15 | 46 |
| 2013 Septiembre | 35 | 8 | 43 |
| 2013 Agosto | 41 | 32 | 73 |
| 2013 Julio | 17 | 35 | 52 |
| 2013 Junio | 7 | 10 | 17 |
| 2013 Mayo | 10 | 20 | 30 |
| 2013 Abril | 7 | 18 | 25 |
| 2013 Marzo | 6 | 24 | 30 |
| 2013 Febrero | 7 | 6 | 13 |
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