Case Report

Two cases of Contact dermatitis resulting from use of body wash as a skin moisturizer^B

Abstract

The use of liquid skin cleanser or body wash has become common in the United States. We report 2 cases of contact dermatitis secondary to the application of Dove Body Wash (Unilever US, Inc., Englewood Cliffs, NJ) with the consumer misconception that the product was a skin moisturizing cream.

The use of liquid skin cleanser or body wash (BW) has become very common during the past 5 years. Whereas most BW has a consistency that is distinct from that of common skin moisturizing creams, some possess character- istics that are more akin to moisturizers and can lead to confusion regarding intended product use. We report 2 cases of contact dermatitis secondary to the application of Dove Body Wash with the consumer misconception that the product was a skin moisturizing cream.

A 40-year-old white male physician noted skin dryness and a mild sunburn after a long-distance run the day before. He applied a liberal amount of Dove Deep Moisture Body Wash for Dry skin (Fig. 1) under the impression that the product was intended for use as a skin moisturizer. On his way to work, approximately 30 minutes after applying this product, he noted burning across his face where the product had been initially used. He reapplied the BW to his face at that time, believing that he was suffering effects from his sun exposure the day prior. At work he noted severe redness and continued burning (Figs. 2 and 3) and washed his face with copious amounts of water on at least 3 separate occasions without a significant decrease in symptoms. His medical history was noncontributory with no history of dermatitis, significant allergies, or current medication use. After leaving work, he discovered that the product was actually a BW rather than a skin moisturizer and was apparently intended to be washed off as soap rather than left on the skin. Treatment consisted of application of 1% hydrocortisone cream to the area bid for 3 days and Aloe vera gel tid for 5 days. At 72 hours postexposure, he had no signs or symptoms.

A 26-year-old white female medical student noted skin dryness while on a medical mission in Mexico. She applied a liberal amount of Dove Night Calming Body Wash also under the impression that the product was intended for use as a skin moisturizer. Her medical history was noncontrib- utory with no history of dermatitis, significant allergies, or current medication use. She noted burning across her face where the product was applied and then reapplied the BW on at least 5 occasio4ns throughout the next 24 hours because her face continued to feel quite irritated. She developed diffuse induration and erythema in the areas where she had applied the cream. She also noted later in the day that she apparently misused this product, leaving it on her skin for many hours rather than washing it off in less than 1 minute. Treatment consisted of washing her face, exfoliating the peeling skin, and topically applying hydro- cortisone 1% cream.

^B The opinions expressed in this article are those of the authors and do not necessarily reflect those of the Department of the Army, the Department

of Defense, or the United States Government. Fig. 1 Bottle of product use by the subject of Case 1.

0735-6757/$ – see front matter D 2008

246.e2 Case Report

Fig. 2 Erythematous papular eruption on the face of the subject of Case 1.

Fig. 3 Erythematous papular eruption on the face of the subject of Case 1.

We describe 2 cases of accidental misuse of a common skin care product leading to contact dermatitis. Both cases were noted in highly educated subjects with college degrees and, in one case, 6 years of postgraduate medical training to include a medical toxicology fellowship. The products involved contain chemicals including sodium lauryl sulfate, lactic acid, and urea, which may act as local skin irritants if left in place for prolonged periods [1-3]. Although consumers must be attentive to the products that they use, more effective product labeling may also help prevent cases such as these two. In the case of Dove Body Wash, the words for dry skin, hydratation profonde, and deep moisture appear prominently on the

front of the bottle. An additional issue contributing to the confusion in these 2 cases likely involves a tactile formulation that is very similar to most common skin moisturizers used in the United States. Finally, as seen in Fig.1, there are no instructions for use listed anywhere on this particular product, which is not unusual for BW products of all types.

Body wash, or liquid-based soap, is in common use today in the United States. We describe 2 cases of product misuse as a skin moisturizing cream leading to significant contact dermatitis. Contributing factors to this misuse include poor labeling, consumer inattention to detail, product formulation, and lack of instructions on the package. It is unclear as to what extent if any of these cases represent a more widespread problem. Industry attention to these issues as well as further research may help prevent such cases and further delineate this issue.

Michael A. Miller MD Department of Emergency Medicine Carl R. Darnall Army Medical Center

Ft. Hood TX 76544, USA

Central Texas Poison Center Temple, TX 76508, USA

E-mail address: michael.adam.miller@us.army.mil

Doug Borys PharmD Michele Riggins MS4 Central Texas Poison Center Temple, TX 76508, USA

David A. Masneri DO Marc E. Levsky MD

Department of Emergency Medicine Carl R. Darnall Army Medical Center

Ft. Hood, TX 76544, USA

doi:10.1016/j.ajem.2007.04.004

References

1. Branco N, Lee I, Zhai H, Maibach HI. Long-term repetitive sodium lauryl sulfate-induced irritation of the skin: an in vivo study. Contact Dermatitis 2005;53(5):278 – 84.
2. Zhai H, Willard P, Maibach HI. Evaluating skin-protective materials against contact irritants and allergens. An in vivo screening human model. Contact Dermatitis 1998;38(3):155 – 8.
3. Wigger-Alberti W, Elsner P. Petrolatum prevents irritation in a human cumulative exposure model in vivo. Dermatology 1997;194(3):247 – 50.