Paper-based products, including paper towels, facial tissue, toilet paper, and napkins, are not significant sources of contact dermatitis through formaldehyde exposure, according to new data presented at the annual meeting of the American Contact Dermatitis Society (ACDS). 

Formaldehyde may be used as a wet-strength additive in the manufacturing of paper-based products, and several countries outside the US have identified it in such products, but data on formaldehyde in commercial paper products in the US are limited, wrote Brailyn Weber, MD, medical student at the University of North Dakota School of Medicine, Grand Forks, North Dakota, and colleagues in their abstract.

The researchers used chromotropic acid testing to determine whether several common categories of paper products were likely to release formaldehyde and affect individuals with formaldehyde allergies. They tested a total of 128 samples of products, including paper towels (16), facial tissue (12), toilet paper (21), napkins (8), incontinence products (18), hygiene wipes (19), baby wipes (15), and makeup-removing wipes (19).

The level of formaldehyde exposure likely to elicit allergic contact dermatitis in most sensitive individuals has been reported as 30 ppm, they wrote. A total of seven of the tested samples released formaldehyde at mild levels (0-2.5 ppm); these included two incontinence products from healthcare-related manufacturers, two hygiene wipes, and three makeup-removing wipes. None of the products released formaldehyde at moderate levels (2.5-40 ppm) or strong levels (> 40 ppm).

The findings were limited by the relatively small sample size, the researchers noted. However, the results suggest that commercial paper-based products are not a significant source of formaldehyde exposure in the US, they concluded.

Findings Reassuring but Possibly Variable

Patients with formaldehyde allergies are often counseled that paper products may be a source of allergen exposure, but data measuring formaldehyde levels in these products are limited, Jennifer K. Chen, MD, clinical professor of dermatology at Stanford University, Stanford, California, told Medscape Medical News.

“I was surprised that none of the products released clinically meaningful amounts of formaldehyde,” said Chen, who was not involved in the study.

The results suggest that paper-based products may not be a significant source of formaldehyde exposure for formaldehyde-allergic patients, Chen said. However, the 128 products in the current study may not be representative of all commercial paper-based products in the US, she noted.

In addition, variations in formaldehyde release may vary across different batches of paper-based products, and further studies corroborating the current findings would be helpful, Chen said.

The study received funding from the ACDS Clinical Research Award. The researchers had no financial conflicts to disclose but acknowledged Javed Shaik, PhD, of the University of Minnesota, Minneapolis, for providing laboratory facilities and equipment for chromotropic acid testing. Chen disclosed having no relevant financial conflicts of interest.