Dermatite de contato à metilisotiazolinona – estamos atentos a essa epidemia?
Contact dermatitis due to methylisothiazolinone – are we aware of this epidemic?
Paulo Eduardo Silva Belluco; Pedro Giavina-Bianchi
Resumo
Metilclorotiazolinona e metilisotiazolinona (MCI/MI) são os ingredientes ativos no Kathon CG®, um conservante de cosméticos no mercado desde os anos 80. Eles aparecem numa mistura de conservantes na proporção de 3:1. Metilisotiazolinona (MI) isolada tinha sido aprovada como conservante desde 2005, uma vez que foi considerada menos sensibilizante comparado à porção clorada. Entretanto, ela tem sido usada numa concentração muito maior para ser efetiva, e isso tem causado a atual epidemia de alergia a essa substância. O objetivo dessa revisão foi examinar o atual surto de casos de alergia de contato a metilisotiazolinona (MI) no mundo, um fenômeno que tem sido observado em vários países, inclusive no Brasil. As fontes de dados incluíram os principais artigos originais e revisões indexadas nos bancos de dados PubMed, MEDLINE, LILACS e SciELO que foram publicadas nos últimos anos. Os resultados mostram elevado grau de positividade de testes de contato tanto à associação MCI/MI quanto à MI isolada, e significativo aumento da prevalência de alergia a esta substância nos últimos anos. Em conclusão, alertamos que devemos estar atentos a esse importante conservante. Salientamos que a associação MCI/MI nos testes pode não diagnosticar casos de alergia à MI. Apesar dessa substância isolada não se encontrar na bateria padrão brasileira, a pesquisa de sua sensibilidade é fundamental.
Palavras-chave
Abstract
Methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI) are the active ingredients in Kathon CG®, a cosmetic preservative available in the market since the 80s. MCI and MI are mixed in a ratio 3:1. MI alone was approved for use as a preservative in 2005, as it was considered a less sensitizing agent compared to chlorine. However, it has been used at a much higher concentration to be effective and this has caused the current epidemic of allergy to this substance. This review aimed to examine the current outbreak of cases of contact allergy to MI observed in several countries, including Brazil. Data sources were major original articles and reviews indexed in PubMed, MEDLINE, LILACS and SciELO databases and published in recent years. The results showed a high rate of positive tests for allergy both to MCI/MI combination and to MI alone, as well as a significant increase in the prevalence of allergy to this substance in recent years. In conclusion, this common preservative requires attention. Importantly, MCI/MI combination tests may not diagnose cases of allergy to MI alone. Although this substance is not found alone in the Brazilian standard battery, research on its sensitivity is essential.
Keywords
Referências
1. Latheef F, Wilkison SM. Methylisothiazolinone outbreak in the European Union. Curr Opin Allergy Immunol. 2015;15(5):461-6.
2. Zirwas MJ, Hamann D, Warshaw EM, Maibach HI, Taylor JS, Sasseville D, et al. Epidemic of Isothiazolinone Allergy in North America: Prevalence Data From the North American Contact Dermatitis Group, 2013-2014. Dermatitis. 2017:28(3):204-9.
3. Schwensen JF, Uter W, Bruze M, Svedman C, Goossens A, Wilkinson M, et al. The epidemic of methylisothiazolinone: a European prospective study. Contact Dermatitis. 2016;76:272-9.
4. Scherrer MAR, Rocha VB. Increasing trend of sensitization to Methylchloroisothiazolinone/methylisothiazolinone. An Bras Dermatol. 2014;89(3):527-8.
5. Veverka KK, Hall MR, Yiannias JA, Drage LA, El-Azhary RA, Killian JM, et al. Trends in Patch Testing With the Mayo Clinic Standard Series, 2011-2015. Dermatitis. 2018;29(6):310-15.
6. Salman A. Methylchloroisothiazolinone and methylisothiazolinone contact allergy: a retrospective cohort study from a tertiary dermatology clinic in Turkey. Contact Dermatitis. 2018;80(3):193-4.
7. Hadžavdić SL, Uter W, Samošćanec MI. Methylisothiazolinone contact allergy in Croatia: Epidemiology and course of disease following patch testing. Contact Dermatitis. 2018;79(3):162-7.
8. Puangpet P, Chawarung A, McFadden JP. Methylchloroisothiazolinone/ methylisothiazolinone Allergy. Dermatitis. 2015;26(2):99-102.
9. Flury U, Palmer A, Nixon R. The methylisothiazolinone contact allergy epidemic in Australia. Contact Dermatitis. 2018;79(3):189-91.
10. Dendooven E, Foubert K, Naessens T, Pieters L, Lambert J, Aerts O. Periocular contact allergy from spectacle frames cleaned with methylisothiazolinone containing household detergents. J Eur Acad Dermatol Venereol. 2019. doi:10.1111/jdv.15718
11. Alwan W, White IR, Banerjee P. Presumed airborne contact allergy to methylisothiazolinone causing acute severe facial dermatitis and respiratory difficulty. Contact Dermatitis. 2014;70(5):320-1.
12. Johansen JD. Quick Guide to Contact Dermatitis. 1ª ed. Berlin: Springer; 2016.
13. Salman A, Demir G, Apti O. “Slime”: a trending cause of isothiazolinone contact allergy in children. Contact Dermatitis. 2019;80(6):409-11.
14. Tehrany YA, Quenan S, Bugey A, Piletta, P. Contact dermatitis caused by homemade “slime”: report of two cases with chemical analysis. Contact Dermatitis. 2019;80(6):407-8.
15. Aerts O, De Fré C, van Hoof T, Ghys K, Ortopelea RA, Lambert J. “Slime”: a new fashion among children causing severe hand dermatitis. Contact Dermatitis. 2018;79(6):385-7.
16. Yale K, Awosika O, Rengifo-Pardo M, Ehrlich A. Genital allergic contact dermatitis. Dermatitis. 2018;29(3):112-9.
17. Zirwas MJ. Contact dermatitis to cosmetics. Clinic Rev Allerg Immunol. 2019;56:119-28.
18. Tehrany YA, Quenan S, Bugey A, Piletta P. Allergic contact dermatitis caused by octylisothiazolinone in a leather sofa. Contact Dermatitis. 2018;79(3):188-9.
19. Sukakul T, Kanchanapenkul D, Bunyavaree M, Limphoka P, Kumpangsin T, Boonchai W. Methylchloroisothiazolinone and/ or methylisothiazolinone in cosmetic products - a market survey. Dermatitis. 2019;80:110-3.
20. Schwensen JF, Lundov MD, Bossi R, Banerjee P, Giménez-Arnau E, Lepoittevin JP, et al. Methylisothiazolinone and benzisothiazolinone are widely used in paint: a multicentre study of paints from five European countries. Contact Dermatitis. 2014;72:127-38.
21. Contact Dermatitis Brazilian Studying Group. Multicentric study for the development of a standard Brazilian patch test series. An Bras Dermatol. 2000;75:147-56.
22. La Forgia M, Cannavó A, Fortunato L, Infante L, Kvitko E, Russo JP; Sociedad Argentina de Dermatologia. Consenso “Dermatitis por Contacto”. Buenos Aires; 2015.
Submetido em:
03/06/2019
Aceito em:
07/06/2019
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email