Wooden toilet seats, especially those cleaned with harsh chemicals, can take their toll on children, leading to skin rashes that can become infected, a small study suggests.

Researchers analyzed five cases of toilet seat dermatitis in the U.S. and India after several uses of a wooden toilet seat or repeated exposure to residue from harsh cleaning chemicals on a toilet seat. The findings appear in the February issue of the journal Pediatrics.

"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," said Dr. Bernard Cohen, director of pediatric dermatology at Johns Hopkins Children's Center.

"If our small analysis is any indication of what's happening, we need to make sure the condition is on every pediatrician's radar."

In the past wooden toilet seats were sometimes found to cause allergic reactions because of the varnish, lacquer or paint used, which prompted many manufacturers to switch to plastic, the study said.

If a toddler or a young children shows up at a doctor's office with skin irritation around the buttocks or upper thighs, pediatricians should inquire about what type of toilet seats and cleaners are used at home and at school, Cohen said.

Most cases are benign and can be treated with steroidal creams. But some cases go undiagnosed — in sometimes for years, the study suggested.

If not treated properly, irritation can persist and spread, causing painful and itchy skin eruptions. Skin that is persistently irritated is vulnerable to bacterial infections that need to be treated with antibiotics, the researchers said.

To prevent toilet seat dermatitis, the researchers suggested:

• Use paper toilet seat covers in public restrooms, including those in hospitals and schools.
• Replace wooden toilet seats with plastic ones.
• Clean toilet seats and bowls daily.
• Avoid harsh store-brand cleansers that often contain skin irritants like phenol or formaldehyde. Instead, use rubbing alcohol and hydrogen peroxide, which are effective and gentler on the skin.