title: Children with atopic dermatitis and frequent emollient use have increased urinary levels of low-molecular-weight phthalate metabolites and parabens.
abstract: BACKGROUND
  Parabens may be added to cosmetic and personal care products for preservation purposes. Low-molecular weight (LMW) phthalate diesters function as plasticizers, fixatives or solvents in such products, but may also be found in small quantities as contaminants from plastic containers.
  
  
  OBJECTIVE
  To evaluate the association between emollient use, atopic dermatitis and FLG mutations, respectively, with urinary concentrations of phthalate metabolites and parabens in Danish children.
  
  
  METHODS
  Eight hundred and forty-five Danish children 4-9 years of age were studied. Urinary concentrations of phthalate metabolites and parabens were determined, and children were genotyped for common FLG loss-of-function mutations. Information about atopic dermatitis and use of emollients was obtained from questionnaires completed by parents.
  
  
  RESULTS
  The prevalence of atopic dermatitis was 16.1%. Phthalate metabolite and paraben levels were generally higher in children with frequent use of emollients compared to uncommon users, reaching statistical significance for some LMW phthalates and parabens. While there was no association with common FLG mutations, children with atopic dermatitis had significantly higher urinary levels of one LMW phthalate and two parabens, respectively, when compared to children without atopic dermatitis.
  
  
  CONCLUSIONS
  Emollient use and atopic dermatitis were associated with modestly increased internal LMW phthalate and paraben exposure in 4-9 year old children. It is unknown whether the difference is explained by increased use of the specific emollients that are used to treat pruritic and inflamed skin, and/or whether the impaired skin barrier allows chemicals to penetrate more easily. Moreover, the putative toxicological burden is unknown.
authors.affiliation: Dermatology and Allergy, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark.
authors.forename: L E K
authors.identifier: http://orcid.org/0000-0002-6727-4984
authors.initials: LEK
authors.lastname: Overgaard
authors.affiliation: Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.|International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: K M
authors.initials: KM
authors.lastname: Main
authors.affiliation: Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.|International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Frederiksen
authors.affiliation: Department of Clinical Biochemistry, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Stender
authors.affiliation: Department of Clinical Biochemistry, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark.
authors.forename: P B
authors.initials: PB
authors.lastname: Szecsi
authors.affiliation: Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK.
authors.forename: H C
authors.initials: HC
authors.lastname: Williams
authors.affiliation: Dermatology and Allergy, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark.|The National Allergy Research Centre, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark.
authors.forename: J P
authors.initials: JP
authors.lastname: Thyssen
mesh_terms: D002648:Child; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000139:chemically induced* / Q000209:etiology; D004643:Emollients / Q000009:adverse effects*; D000091344:Filaggrin Proteins; D005838:Genotype; D006801:Humans; D009154:Mutation; D009426:Netherlands; D010226:Parabens / Q000032:analysis*; D010795:Phthalic Acids / Q000652:urine*; D011310:Preservatives, Pharmaceutical; D051496:Receptor, Fibroblast Growth Factor, Type 1 / Q000235:genetics
chemical_list: D004643:Emollients; C000717249:FLG protein, human; D000091344:Filaggrin Proteins; D010226:Parabens; D010795:Phthalic Acids; D011310:Preservatives, Pharmaceutical; C032279:phthalic acid; D051496:Receptor, Fibroblast Growth Factor, Type 1
keywords: atopic dermatitis; emollients; filaggrin; paraben; phthalate