title: Tolerance to different toilet paper preparations: toxicological and allergological aspects.
abstract: METHODS
  A controlled open trial was performed in 40 individuals suffering from chronic perianal eczema. Various toilet paper preparations representing the conventional type made of pure cellulose, the recycled and the moist type were investigated using the patch test as were allergens possibly related to toilet paper. In addition, a chronic use test and a repeated rubbing test were performed with a conventional and a recycled toilet paper preparation.
  
  
  RESULTS
  A total of 20 patients could be evaluated in full. A variety of reactions were seen in the patch test, most of which were of the allergic type. Allergens included many different chemical entities, e.g. preservatives used in moist toilet paper such as Kathon CG and Euxyl K 400. In a volunteer allergic to Euxyl K 400, allergy to the moist toilet paper regularly used by him was established. After discontinuation of its application, perianal dermatitis disappeared. In the repeated rubbing test at the forearm, 10 volunteers showed a reaction with the recycled paper preparation while no such reaction was seen upon the application of the conventional type of toilet paper. The validity of these findings was corroborated by corresponding results in the use test.
  
  
  CONCLUSIONS
  There is clearly a potential for allergic reactions to components of moist toilet paper and reactions to recycled toilet paper presumably irritant by nature. These irritant reactions are probably caused by the rough texture of current paper types and do not reflect the presence of potentially toxic ingredients such as metal salts.
authors.affiliation: Department of Dermatology, Ludwig Maximilian University, Munich, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Blecher
authors.forename: H C
authors.initials: HC
authors.lastname: Korting
mesh_terms: D000328:Adult; D000485:Allergens / Q000009:adverse effects*; D001004:Anus Diseases / Q000209:etiology*; D002482:Cellulose / Q000009:adverse effects; D017449:Dermatitis, Allergic Contact / Q000209:etiology; D017453:Dermatitis, Irritant / Q000209:etiology; D004485:Eczema / Q000209:etiology*; D005260:Female; D017276:Friction; D006801:Humans; D008297:Male; D009570:Nitriles / Q000009:adverse effects; D010209:Paper; D010328:Patch Tests; D011310:Preservatives, Pharmaceutical; D011446:Prospective Studies; D015203:Reproducibility of Results; D017592:Skin Care; D013844:Thiazoles / Q000009:adverse effects; D014116:Toxicology
chemical_list: D000485:Allergens; D009570:Nitriles; D011310:Preservatives, Pharmaceutical; D013844:Thiazoles; C037057:Kathon 886; D002482:Cellulose; C039411:1,2-dibromo-2,4-dicyanobutane