Slammed by slime
By Warren R. Heymann, MD
Sept. 16, 2020
Vol. 2, No. 37
Visiting Nickelodeon Studios in Orlando, Florida in the early 1990s was a religious experience for my family. Watching a live recording of Double Dare, my daughters were fervently praying to be among the chosen few to be slimed, while my wife and I were pleading to the slime gods to spare our children. Fortunately (from the parental perspective), the adults prevailed.
Slime’s appeal has been unrelenting, reaching new heights of popularity with the internet. If you Google search “How do you make slime?” you will instantly have more than 216 million options to learn from. According to Sharon Jacob: “Basically, slime is a mixture of borate ions (either from contact lens solution and baking soda or from Borax™ detergent added to polyvinyl acetate glue [such as common school glue]), leading to cross‐linking of the polymers in the glue to form a stretchy slimy green gel. To make it more attractive, food coloring, shaving cream, glitter, or cornstarch can be added. The variety of substances that can be used to make slime, including shampoo, can greatly increase the risk of irritant and allergic contact dermatitis.” (1)
Although the majority of cases of slime dermatitis are irritant in nature, allergic contact dermatitis to slime may occur, and can be diagnosed by patch testing. (2) The most common allergen in slime is methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) (e.g., Kathon CG). MCI/MI are preservatives mostly utilized in cosmetic and household products, notably wet wipes, cosmetics, and cleansing products. Since Borax may not be easily accessible for producing slime, contact lens solutions, detergents, washing liquids, shaving foams, shampoos, or liquid soaps are often used as substitutes. (3) The finding that MCI/MI is a contact allergen for cases of slime dermatitis has been confirmed in several cases of hand dermatitis in children. (4, 5)
In an intriguing report, Liang et al detailed longitudinal melanonychia in the right middle finger of an 8-year-old girl, two days after playing with green slime. The initial concern for a pigmented lesion was tempered when dermoscopy demonstrated that the colored substance was under the nail, not in the nail plate. The lesion resolved within two months. This case was unusual in that exogenous melanonychia does not characteristically form linear bands. The presumption was that some slime became embedded in the gap between the distal nail and hyponychium, entering the nail bed along the longitudinal ridge of the nail bed because slime is a non-Newtonian fluid. (6)
Children of all ages are probably not concerned a whit about the non-Newtonian viscoelastic fluid characteristics of slime — it is that property, however, that makes it flexible and fun! In conclusion, the ubiquitous nature of the slime fad may allow it to be hidden in plain site; if every one of your friends is playing with it, it is mundane, thereby mandating a high index of clinical suspicion, especially in cases of recalcitrant eczema.
Point to remember: The slime craze continues unabated. Slime usually causes an irritant contact dermatitis, although allergic contact dermatitis due to methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) may be responsible. Ask about slime in cases of recalcitrant hand eczema and consider confirmatory patch testing.
Our expert's viewpoint
Bruce A. Brod, MD
Clinical Professor of Dermatology
Director of Occupational and Contact Dermatitis
University of Pennsylvania Perelman School of Medicine
Attending Physician at Children’s Hospital of Philadelphia
The internet giveth and the internet taketh away. Homemade slime, as opposed to commercial slime, became popularized through the internet by way of social media. For example, Karina Garcia, known as the “slime queen,” among others, started the trend through her social media posts and online videos illustrating how to make homemade slime. These posts attracted significant commercial support and she was even featured in an article in the New York Times. Since then a myriad of recipes have been posted on social media and other platforms such as Etsy. The physical properties of slime are so intriguing that the American Chemical Society posted a scientific fact sheet on slime for children.
In Dr. Heymann’s thorough review he highlights methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) as the most common allergens in slime. Emeritus Penn Professor Dr. James Leyden once taught me that irritancy precedes allergy. Homemade slime then is the perfect storm because it contains irritants such as soap and detergent to create an irritant reaction along with a soupy broth of potential allergens. In a case report and review on homemade slime we conducted based at Children’s Hospital of Philadelphia we used the internet to identify the most common slime recipes and ingredients. The most common allergens we found in slime include MCI/MI, but also other common pediatric allergens including fragrance, cocamidopropyl betaine, propylene glycol, and others. Since that report Dr. Erin Warshaw at the University of Minnesota and her team uncovered the presence of MCI/MI and other isothiazolinones in numerous household and craft glues using ultra high-performance liquid chromatography and mass spectrometry. Shockingly, these allergenic elements are not even listed on the ingredient label of the glues.
There are days when I am nostalgic for a time when we only had commercial slime such as Ghostbusters and Teenage Mutant Ninja Turtle Slime, no smartphones or internet, and no cases of homemade slime induced allergic contact dermatitis.
Jacob SE. Homemade slime: A contact dermatitis “perfect storm.” Pediatr Dermatol; 2019: 338.
Anderson LE, Treat JR, Brod BA. “Slime” contact dermatitis: Case report and review of relevant allergens. Pediatr Dermatol 2019: 36: 335-337.
Salman A, Demir G. Apti O. “Slime”: A trending cause of isothiazolinone contact allergy in children. Contact Dermatitis 2019: 80: 409-411.
Kondratuk KE, Norton SA. “Slime” dermatitis, a fad-associated chronic hand dermatitis. Pediatr Dermatol 2019; 36: e39-e40.
Zhang AJ, Boyd AH, Asch S, Warshaw EM. Allergic contact dermatitis to slime. The epidemic of isothiozolinone allergy encompasses school glue. Pediatr Dermatol 2019; 36: e37-e38.
Liang Y, Han XF, Ma L. Exogenous pigmentation presenting as longitudinal melanonychia in a child. JAMA Dermatol 2019 Oct 30 [Epub ahead of print].
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