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'Poop' dermatitis linked to fashionable toilet seats, harsh chemicals

Considered a dermatological nuisance that was long gone, skin irritations caused by toilet seats appear to be making a comeback in pediatricians' offices, according to research led by Johns Hopkins Children's Center investigator Bernard Cohen, M.D.

"Toilet seat dermatitis is one of those legendary conditions described in medical textbooks and seen in underdeveloped countries, but one that younger pediatricians have not come across in their daily practice," says Cohen, director of pediatric dermatology at Hopkins Children's. "If our small analysis is any indication of what's happening, we need to make sure the condition is on every pediatrician's radar."

Analyzing five cases from the United States and India in the February issue of the journal Pediatrics, Cohen and colleagues said the culprits responsible for the reemergence of the condition are harsh cleaning chemicals and exotic wooden toilet seats — making a comeback as bathroom décor —especially seats covered with varnishes and paints.

Cohen says children can develop irritation after several uses of a wooden seat or repeated exposure to residue from harsh cleaning chemicals. He urges pediatricians to inquire about toilet seats and cleaners used both at home and at school any time they see a toddler or a young child with skin irritation around the buttocks or upper thighs.

The researchers say most cases are fairly benign and easy to treat with topical steroids, but because many pediatricians don't suspect the cause and don't treat it properly, the inflammation can persist and spread further, causing painful and itchy skin eruptions and unnecessary misery for both children and parents. Persistently irritated skin is vulnerable to bacteria and may lead to more serious infections requiring oral antibiotics. Indeed, missed and delayed diagnoses were a hallmark of every single case described in the review.

"Some of the children in our study suffered for years before the correct diagnosis was made," says lead researcher Ivan Litvinov, Ph.D., of McGill University in Montreal, and a student of Cohen's.

To prevent toilet-seat dermatitis, Cohen and colleagues recommend:

Use of paper toilet seat covers in public restrooms, including hospital and school restrooms
Replacing wooden toilet seats with plastic ones
Cleaning toilet seats and bowls daily
Avoiding harsh store-brand cleaners, which often contain skin irritants like phenol or formaldehyde.

Rubbing alcohol and hydrogen peroxide, effective and gentler on the skin, could be used instead.

Dermatologist Paramoo Sugathan, M.D., of Baby Memorial Hospital, Calicut, Kerala, India, was co-investigator in the study.

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