Case and Research Letters
Allergic Contact Dermatitis Due to Methyl Glucose Dioleate in a Balm Cream
Eczema alérgico de contacto por metil glucosa dioleato contenido en una crema bálsamo
T. Sanz-Sánchez
, R.M. Díaz-Díaz, C. Garrido Gutiérrez, V. Leis Dosil
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Servicio de Dermatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
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Sanz-Sánchez, R.M. Díaz-Díaz, C. Garrido Gutiérrez, V. Leis Dosil" "autores" => array:4 [ 0 => array:4 [ "nombre" => "T." "apellidos" => "Sanz-Sánchez" "email" => array:1 [ 0 => "tatiana@aedv.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R.M." "apellidos" => "Díaz-Díaz" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Garrido Gutiérrez" ] 3 => array:2 [ "nombre" => "V." "apellidos" => "Leis Dosil" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Eczema alérgico de contacto por metil glucosa dioleato contenido en una crema bálsamo" ] ] "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" => 1219 "Ancho" => 800 "Tamanyo" => 77544 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous, scaly plaques on the axillas.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Methyl glucose dioleate (MGD) is a polyethylene glycol used as an emulsifier or surfactant that is considered nonirritant and nonsensitizing on healthy skin.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 12-year-old girl referred to the dermatology clinic with very pruriginous lesions that had first appeared on the axillas and, in just a few days, spread to the arms, trunk, neck, and face. Her parents reported that 3 days previously they had applied a balm cream (Mustela) on the axillas for erythema that had appeared after application of a depilatory cream.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The physical examination revealed erythematous, scaly plaques on both axillas. They affected the skin folds and spread less intensely to the areas described above (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The lesions disappeared after 10 days with the application of topical corticosteroids.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We performed a use test with both the depilatory cream and the balm cream that the patient had used, by applying both products twice daily at the same site on the forearm. The only reaction observed was with the balm cream 3 days after application.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We performed patch tests with the standard series of the Spanish Contact Dermatitis and Skin Allergy Research Group (Grupo Español de Investigación en Dermatitis de Contacto y Alergita Cutánea [GEIDAC]), the <span class="elsevierStyleItalic">Chemotechnique</span> cosmetics series, and the balm cream as is. The only positive results were for the balm cream at 96<span class="elsevierStyleHsp" style=""></span>hours. The study was completed with the ingredients of the cream supplied by the manufacturer and revealed a positive reading only for MGD 5% in petrolatum at 48<span class="elsevierStyleHsp" style=""></span>hours (+) and 96<span class="elsevierStyleHsp" style=""></span>hours (+<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>) and the balm cream as is at 96<span class="elsevierStyleHsp" style=""></span>hours (+<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Ten control applications with MGD yielded negative results.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">MGD has a high molecular weight and is considered unable to penetrate healthy skin. It is obtained from the diester of methyl glucose and oleic acid. It is used as an emulsifier and nonionic surfactant in topical and cosmetic treatments for skin and hair care.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Safety studies show MGD to be a nonirritant, nonsensitizing product on healthy skin, although sporadic cases of allergic contact dermatitis associated with MGD have been reported (2 cases with insect repellent,<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1,2</span></a> 1 case with shampoo,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> 1 case after application of a topical antifungal,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> 2 cases with topical antibiotics in patients with leg ulcers,<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">5,6</span></a> and, more recently, a case with balm cream used during breastfeeding).<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> The widespread use of MGD in cosmetics means that these cases, while anecdotal, are sufficiently relevant to consider the substance capable of occasional sensitization.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In the case we report, allergic contact dermatitis was associated with application of a balm cream, which is generally used to prevent diaper rash and was used on the axillas of a girl who had previously reported irritation after depilation. The product was applied to skin with possible irritant contact dermatitis, which probably facilitated the appearance of the allergic contact dermatitis observed and thus enabled greater penetration of the components of the balm cream.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In summary, we report a new case of allergic contact dermatitis caused by MGD at a previously unreported site (ie, the axillas) in a girl with irritated skin.</p><p id="par0055" class="elsevierStylePara elsevierViewall">This case highlights the fact that, even though MGD is considered a safe product in healthy skin, it should not be applied when the skin is damaged. Given that very few cases have been reported, further studies are needed on skin inflammation caused by MGD at different concentrations in order to evaluate its ability to sensitize.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Lastly, it is important to perform a use test with the patient's own products in order to diagnose unusual allergens that are not included in routine test series.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Sanz-Sánchez T, Díaz-Díaz RM, Garrido Gutiérrez C, Leis Dosil V. Eczema alérgico de contacto por metil glucosa dioleato contenido en una crema bálsamo. Actas Dermosifiliogr. 2019;110:67–68.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1219 "Ancho" => 800 "Tamanyo" => 77544 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous, scaly plaques on the axillas.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 769 "Ancho" => 900 "Tamanyo" => 69716 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Positive patch test readings to methyl glucose dioleate 5% and balm cream as is, taken at 96<span class="elsevierStyleHsp" style=""></span>hours.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Allergic contact dermatitis due to an insect repellent: Double sensitization to picaridin and methyl glucose dioleate" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. 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Baeck" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/cod.12026" "Revista" => array:6 [ "tituloSerie" => "Contact Dermatitis" "fecha" => "2013" "volumen" => "68" "paginaInicial" => "315" "paginaFinal" => "316" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23601067" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011000000001/v1_201901030631/S157821901830413X/v1_201901030631/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011000000001/v1_201901030631/S157821901830413X/v1_201901030631/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901830413X?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 18 | 9 | 27 |
| 2024 Octubre | 165 | 43 | 208 |
| 2024 Septiembre | 172 | 36 | 208 |
| 2024 Agosto | 215 | 54 | 269 |
| 2024 Julio | 244 | 48 | 292 |
| 2024 Junio | 249 | 44 | 293 |
| 2024 Mayo | 204 | 38 | 242 |
| 2024 Abril | 210 | 39 | 249 |
| 2024 Marzo | 250 | 34 | 284 |
| 2024 Febrero | 230 | 30 | 260 |
| 2024 Enero | 263 | 30 | 293 |
| 2023 Diciembre | 208 | 14 | 222 |
| 2023 Noviembre | 220 | 30 | 250 |
| 2023 Octubre | 190 | 39 | 229 |
| 2023 Septiembre | 125 | 30 | 155 |
| 2023 Agosto | 98 | 23 | 121 |
| 2023 Julio | 116 | 40 | 156 |
| 2023 Junio | 69 | 26 | 95 |
| 2023 Mayo | 155 | 31 | 186 |
| 2023 Abril | 90 | 30 | 120 |
| 2023 Marzo | 104 | 31 | 135 |
| 2023 Febrero | 91 | 36 | 127 |
| 2023 Enero | 94 | 37 | 131 |
| 2022 Diciembre | 89 | 48 | 137 |
| 2022 Noviembre | 78 | 35 | 113 |
| 2022 Octubre | 67 | 27 | 94 |
| 2022 Septiembre | 92 | 50 | 142 |
| 2022 Agosto | 68 | 34 | 102 |
| 2022 Julio | 56 | 41 | 97 |
| 2022 Junio | 49 | 30 | 79 |
| 2022 Mayo | 95 | 29 | 124 |
| 2022 Abril | 85 | 47 | 132 |
| 2022 Marzo | 94 | 60 | 154 |
| 2022 Febrero | 73 | 41 | 114 |
| 2022 Enero | 82 | 48 | 130 |
| 2021 Diciembre | 62 | 51 | 113 |
| 2021 Noviembre | 66 | 49 | 115 |
| 2021 Octubre | 78 | 66 | 144 |
| 2021 Septiembre | 62 | 38 | 100 |
| 2021 Agosto | 51 | 35 | 86 |
| 2021 Julio | 51 | 21 | 72 |
| 2021 Junio | 45 | 27 | 72 |
| 2021 Mayo | 47 | 39 | 86 |
| 2021 Abril | 115 | 71 | 186 |
| 2021 Marzo | 68 | 39 | 107 |
| 2021 Febrero | 55 | 33 | 88 |
| 2021 Enero | 44 | 25 | 69 |
| 2020 Diciembre | 51 | 18 | 69 |
| 2020 Noviembre | 35 | 28 | 63 |
| 2020 Octubre | 50 | 23 | 73 |
| 2020 Septiembre | 47 | 19 | 66 |
| 2020 Agosto | 32 | 27 | 59 |
| 2020 Julio | 27 | 16 | 43 |
| 2020 Junio | 23 | 27 | 50 |
| 2020 Mayo | 41 | 13 | 54 |
| 2020 Abril | 30 | 7 | 37 |
| 2020 Marzo | 15 | 8 | 23 |
| 2020 Febrero | 4 | 0 | 4 |
| 2019 Mayo | 1 | 1 | 2 |
| 2019 Abril | 1 | 0 | 1 |
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