CD16 Melamine formaldehyde: the missing thread in textile contact dermatitis?

Abstract

A 38-year-old woman presented with a 15-year history of recurrent bilateral dermatitis of the palms and fingertips predominantly affecting the left hand. She was right handed and worked as a warehouse embroidery machine operator. Her symptoms were worse at work. She had applied acrylic nails for many years, with associated red, itchy fingers, but the dermatitis persisted upon cessation. Patch testing was performed according to British Society for Cutaneous Allergy (BSCA) guidelines to both the British baseline series and the textile colours and finishes series (Table). We retrospectively audited patients patch tested over 12 months; Six of 238 had positive reactions to formaldehyde and formaldehyde releasers in the British baseline series. However, 33% (n = 2) were positive to ethylene urea melamine formaldehyde (EUMF) in the absence of a formaldehyde reaction. Formaldehyde resins are used as starching agents in crease-resistant textiles and these resins can contain high levels of free formaldehyde. Our patient developed an occupational allergic contact dermatitis (ACD) to several formaldehyde resins from chronic textile handling. Importantly, she was negative to formaldehyde 2% in petrolatum, yet positive to EUMF and MF, which were detected only in the extended series. Relying on reactions to formaldehyde can miss ACD to formaldehyde resins, particularly to EUMF and melamine formaldehyde (MF) in the extended series, as our case supports (Aalto-Korte, Jolanki R, Estlander T. Formaldehyde-negative allergic contact dermatitis from melamine formaldehyde resin. Contact Dermatitis 2003; 49: 194–6). Our case emphasizes the possibility of underdiagnosis of ACD to EUMF and MF and we call for consideration of their inclusion in the British baseline series.TableDay 2 and 4 positive results in our patientHaptenDay 2Day 4Quaternium-15 1% pet.+++Imidazolidinyl urea 2% pet.−±Melamine formaldehyde 7% pet.++Ethylene urea melamine formaldehyde (EUMF) 5% pet.−++Limonene 0.3% pet.±+2-Hydroxyethyl methacrylate (HEMA) 2% pet.++Pet., petrolatum.