"Slime" May Not be so Benign: A Cause of Hand Dermatitis

Abstract

A 9-year-old girl with no significant past medical history presented with a pruritic hand dermatitis of 5 months' duration. The onset of the dermatitis coincided with her playing with homemade Borax-containing "slime," and as a consequence of this eruption, she switched to detergent-containing slime. Her dermatitis persisted despite frequent emolliation. She was treated empirically for scabies and for culture-positive Staphylococcus aureus infection with a complete course of cephalexin and mupirocin ointment, without complete resolution of her skin findings, which prompted a dermatology referral. Physical examination at the time of her evaluation demonstrated erythematous, scaly plaques on the palmar surfaces of both hands, most prominent on the volar fingertips (Figure). In addition, her fingernails had onychomadesis and longitudinal ridging. Mineral oil preparation was negative for scabies. Given that the onset of her hand dermatitis followed contact with homemade slime, we considered her dermatitis to be due to an irritant or allergen in the slime. Treatment consisted of slime avoidance, a brief course of high-potency topical corticosteroids, and frequent application of bland emollients. We have evaluated additional children with new-onset hand dermatitis coinciding with homemade slime use and have reviewed reports in the lay Internet literature suggesting cutaneous reactions to slime in children.1Picard C. Parents everywhere are worried about DIY slime after multiple kids are burned.http://www.goodhousekeeping.com/life/parenting/news/a43500/slime-safety/Date accessed: March 20, 2018Google Scholar We present this case to increase awareness of this treatable dermatitis. Homemade slime, which has become popular among young children and adolescents, is made with household ingredients that may contribute to an irritant or allergic contact dermatitis (ACD). Irritant contact dermatitis (ICD) is mediated by the innate immune system and is more frequent than ACD, a type IV–mediated hypersensitivity reaction. ACD is diagnosed with patch testing.2Zug K.A. Pham A.K. Belsito D.V. DeKoven J.G. DeLeo V.A. Fowler Jr, J.F. et al.Patch testing in children from 2005 to 2012: results from the North American contact dermatitis group.Dermatitis. 2014; 25: 345-355Crossref PubMed Scopus (80) Google Scholar Allergens and irritants are more likely to cause dermatitis at higher concentrations, with prolonged use or when the cutaneous barrier is impaired. Clinical manifestations mimic atopic dermatitis or eczema and include erythema, scaling, vesicles, and, in more chronic cases, lichenification and nail dystrophy, including onychomadesis. Treatment includes avoidance of the causative agent, a short course of topical corticosteroids, and frequent emollient application. Because ACD was the most common diagnosis in a series of children with hand eczema,3Toledo F. García-Bravo B. Fernández-Redondo V. De la Cuadra J. Giménez-Arnau A.M. Borrego L. et al.Patch testing in children with hand eczema. A 5-year multicenter study in Spain.Contact Dermatitis. 2011; 65: 213-219Crossref PubMed Scopus (24) Google Scholar it is important to consider this diagnosis, as well as ICD, in children presenting with new-onset hand dermatitis. Online recipes for slime often include a form of Borax, a boric acid salt also known as sodium borate, as a stand-alone ingredient of slime or as a component of household laundry detergents or contact lens solution.4Woods W.G. An introduction to boron: history, sources, uses, and chemistry.Environ Health Perspect. 1994; 102: 5-11Crossref PubMed Scopus (234) Google Scholar Although Borax has only been reported to cause ICD,5Jiráková A. Rajská L. Rob F. Gregorová J. Hercogová J. Dermatitis toxica faciei after boric acid.Dermatol Ther. 2015; 28: 52-55Crossref PubMed Scopus (6) Google Scholar contact lens solution and liquid laundry detergent contain known contact allergens including myristamidopropyl dimethylamine,6Cressey B.D. Scheinman P.L. Systemic allergic dermatitis of the lips resulting from allergy to an antimicrobial agent in a contact lens disinfecting solution.Contact Dermatitis. 2012; 67: 239-240Crossref PubMed Scopus (7) Google Scholar propylene glycol,7Jacob S.E. Scheman A. McGowan M.A. Allergen of the year: propylene glycol.Dermatitis. 2017; (in press)Google Scholar methylchloroisothiazolinone/methylisothiazolinone,8Aerts O. Goossens A. Lambert J. Lepoittevin J.P. Contact allergy caused by isothiazolinone derivatives: an overview of non-cosmetic and unusual cosmetic sources.Eur J Dermatol. 2017; 27: 115-122Crossref PubMed Scopus (73) Google Scholar and fragrance. Shaving cream, which is used in some slime recipes may contain sodium lauryl sulfate, another known contact allergen. Many slime recipes also include polyvinyl acetate glue that, along with Borax, have been associated with irritation and not ACD although additional ingredients of polyvinyl acetate glues are proprietary information and not readily available. We are unable to determine whether these ingredients are contributing to an ICD or ACD.