1. Tosylamide/formaldehyde resin - a
consideration in the atopic toddler
Sarah Stechschulte B.A.^ & Sharon E. Jacob M.D.*
^MSIV, University of Miami
*Voluntary Clinical Associate Professor, University of Miami
Jacob SE, Stechschulte SA. Contact Dermatitis 2008 May;58(5):312-3.
May;58(5):312

2. What is Tosylamide/formaldehyde
Resin?
! A substance added to nail varnish to aid in
adhesion of varnish to the nail, while
improving rigidity, shine, and flow of
application (1).

3. Significance of TSFR
! Youths are experimenting more with nail
cosmetics at younger ages, allowing early
sensitization with the chemical (2).
! Prevalence of sensitization in young
children is not known

4. Case
! A 4-year old black Hispanic female
presented to the Contact Dermatitis Clinic
with eyelid dermatitis and worsening
atopic flexural dermatitis
! Older sister found to paint child’s toddlers
nails – on initial consultation eliciting
environmental history

5. Obtain detailed environmental history
! Personal hygiene products: shampoo, soaps,
lotions, creams, diaper balms, & diaper wipes (3).
! Medical & medicament history (3).
! Family member personal hygiene products,
frequent toys/playthings, housewares, and
household products (3).

6. Which children should be patch tested?
! Those with uncontrollable or worsening
chronic dermatitis of greater than two months
duration (3).
! Failure to improve following standard
treatment protocols (3).
! Those with eyelid/hand involvement (4).

7. Which chemicals should we patch
test with?
! Those with high clinical suspicion (prior
exposure to allergen definitively identified)
! A customized set of allergens is made for
each patient based on the child’s exposure
history (3).

8. Relationship to the case
! Based on the evaluation and failure of improvement
during the avoidance period, the child was patch
tested with selected chemicals from Umiami
Pediatric standard (3)
! A clinically relevant patch test reaction was found
to tosylamide/formaldehyde resin [1+]

9. Analysis of results
! The child’s nails regularly painted by her older sister
! The child used nails to scratch her eyelids & ‘atopic’ areas
! Discontinued use of TSFR products by all members of the
family resulted in considerable improvement of both the
child’s eyelids and ‘atopic’ areas.

10. Discussion points
! A statistically significant association between
TSFR and eyelid dermatitis has previously been
recognized (5,6).
! This case reveals the importance of considering
TSFR when evaluating a toddler.

11. Conclusion
! We believe that the patient’s scratching of her
atopic dermatitis with TSFR varnished nails
played a role in her reaction to the chemical.
! We recommend that children unable to
overcome the need to scratch should not have
their fingernails varnished.

12. References
1) Orton D I, Wilkinson J D. Cosmetic allergy: incidence, diagnosis,
and management. Am J Clin Dermatol 2004: 5: 327–337.
2) White I R. Allergic contact dermatitis. In: Textbook of Pediatric
Dermatology, 2nd edition, Harper J I, Prose N S, Oranje A P
(eds): Cambridge, Blackwell Publishing Inc, 2006.
3) Jacob SE, Burk CJ, Connelly EA. Patch testing: another steroid-
sparing agent to consider in children. Pediatr Dermatol 2008 Jan-
Feb; 25(1):81-7.
4) Beattie P E, Green C, Lowe G, Lewis-Jones M S. Which children
should we patch test? Clin Exp Dermatol 2007: 32:6–11.
5) Amin K A, Belsito D V. The aetiology of eyelid dermatitis: a 10-
year retrospective analysis. Contact Dermatitis 2006: 55: 280–
285.
6) Guin J D. Eyelid dermatitis: a report of 215 patients. Contact
Dermatitis 2004: 50: 87–90.