Non‐occupational allergic contact dermatitis from epoxy resin in children's games

Abstract

With the emergence of social networking children are engaging in new activities that expose them to contact allergens unusual for their age. We report a young girl who developed severe allergic contact dermatitis (ACD) after making objects using epoxy resins, a technique which she discovered on TikTok. A 12-year-old atopic girl suffered from dermatitis on her right upper limb which had rapidly spread to her face, ears, and neckline. After approximately 3 days she developed a severely itchy voluminous oedema of the face and eyelids for which her general practitioner prescribed her oral antihistamines and corticosteroids. The facial oedema worsened (Figure 1A), and she was referred to the emergency department of the Children's Hospital. Blood analysis and chest x-ray did not detect any abnormalities but given the presence of severe palpebral oedema and facial pain, together with fever (38.5°C), she was admitted to a paediatric unit for 48 h. A tentative diagnosis of an upper respiratory infection was put forward, and intravenous antibiotics were administered, yielding no improvement after 48 h. Subsequently, dermatological advice suggested the possibility of an acute contact eczema and following the application of topical corticosteroids (fluticasone propionate 0.05%) the dermatitis finally settled (Figure 1B). History revealed the application of an Aloe vera-containing cream on the face the day before the eruption had occurred, and the use of an ‘anti-stress’ lavender essential oil on the wrists. Moreover, recent painting work had been done at home, raising the possibility of an airborne ACD from isothiazolinones. Furthermore, this child being a ‘2020 generation’ teenager using social networks had discovered on TikTok, thanks to the ‘influencers’ that she follows, the possibility of making objects from epoxy resins. For the past 6 months she had made various objects (e.g., bowls, cutting boards) whilst protection herself with vinyl gloves and an FFP-2 mask during the mixing of a specific type of resin (‘bottle A’) with a hardener (‘bottle B’). The epoxy resin-containing products had been purchased on the internet, where they are readily available, also on Amazon.com, the leading e-commerce website in France, without any warning regarding potential skin sensitization risks. She had been practicing this recreational activity for 48 h before the skin reaction occurred. Patch tests were carried out with the European baseline series, cosmetic series, plastic & glues series, and epoxy series (Chemotechnique Diagnostics, Vellinge, Sweden), using IQ Ultra chambers, together which the Aloe vera cream (‘as is’) and, the lavender essential oil (5% pet.). The epoxy resin bottle A (1% aq.) and hardener bottle B (1% aq. and 1% pet.) were tested according to published recommendations.1 Patch tests were occluded for 48 h, and readings—performed on day (D) 2 and D3 showed a ++ reaction to epoxy resin 1% pet. from the baseline series, and a ++ reaction to bottle B 1% pet, yet no reaction to bottle B 1% aq. (Figure 2A,B ). An irritant patch test was observed to 2 phenylglycidylether 0.25% pet. Pertinent negatives were the Aloe vera cream and the lavender essential oil, as well as bottle A (1% aq.), the latter potentially overdiluted in a less appropriate vehicle, hence likely resulting in a false-negative test result. Direct and airborne non-occupational ACD from an epoxy resin system in a children's game was eventually diagnosed. Occupational ACD from epoxy resins is well-known.2 However, the use of epoxy resins in recreational activities is increasing, especially with the emergence of social networks promoting such activities. Consequently, recreational ACD from epoxy resins has been reported 3 times since 2020.3, 4 Although epoxy resin-containing occupational products are well-known allergenic products, there are no regulations regarding their sale to, or use by, the general public, including minors. In our case, these products were obtained from the internet without any difficulties, which is worrisome. We advised this young girl to completely avoid the handling of any epoxy resin-containing product. This contact allergy may impact later career choices, that is, could restrict access to occupations such as aeronautics, building work and painting. In conclusion, this case demonstrates the importance of careful anamnesis, also about recreational activities, and shows that ACD from epoxy resins should nowadays also be considered outside a professional context. Particularly children can become affected, through recreational activities promoted on social networks, possibly jeopardizing future career choices. It is necessary to regulate access to epoxy resins for hobbyists who are not always aware of the risks, and who do not know how to adequately protect themselves when using epoxy resins. Magalie Coco-Viloin: Investigation; writing – original draft. Maella Severino-Freire: Investigation. Françoise Giordano-Labadie: Validation; supervision; methodology; formal analysis. The authors declare no conflicts of interest. Patient's written consent was obtained.

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