Contact allergy to cosmetics: causative ingredients

Of 1781 patients with contact dermatitis seen during a period of 6 years (1981-1986), 75 (4.2%) had allergy to cosmetic products. The face was most frequently affected. In many cases, the dermatitis was limited to the eyelids (18.7%) or the face (40.0%). Skin care products (moisturizing and cleansing cream/lotion/milk) accounted for more than half (52.3%), followed by nail cosmetics (8.0%), shaving preparations (8.0%) and deodorants (6.8%). The ingredients most often responsible were fragrances (45.1%), followed by the preservative Kathon CG (11.0%) and the emulsifier oleamidopropyl dimethylamine (9.8%). In 14 patients (18.7%), patch tests with the responsible cosmetic product were negative. In them, the diagnosis was made by use tests and/or repeated open application tests. Compulsory declaration of ingredients on cosmetic product labels in the EEC, analagous to the USA situation, would be of great benefit both to patients and to physicians.     

Adverse effects of cosmetics and toiletries reported to the Swedish Medical Products Agency 1989–1994

In Sweden, a cosmetic control system was introduced in 1989 at the Medical Products Agency (MPA) It consists of a register of importers, manufacturers and their products, and a voluntary adverse reaction reporting system identical to that concerning drugs. Between 1989 and 1994, MPA evaluated 191 reports concerning adverse effects of 253 cosmetics and toiletries. 90% of the reports concerned women and the top-ranking product category was moisturizers, followed by hair care products and nail products. The majority of the adverse effects reported involved only the skin, and 90% were eczematous reactions. 70% of the eczemas were classified as contact allergic, as patch tests were positive to the product as is, and in 1/2 of these products, 1 or more relevant allergens could be identified when tests were made with individual cosmetic ingredients. The most common offending ingredients were fragrances, toluenesulfonamide- formaldehyde resin and preservatives. The number of reports is small in relation to the expected number of cosmetic adverse effects, which can he explained, by under-reporting. Efforts are being made to persuade Swedish physicians to report more often.     

658例化妆品皮肤不良反应临床分析

目的:明确化妆品引起皮肤各种不良反应的特征和致敏物.方法:对658例化妆品皮肤不良反应患者进行临床分析,并对部分患者进行可疑致病化妆品斑贴或光斑贴试验.结果:患者中女性占86.9％;21～45岁占76.7％.临床表现主要为接触性皮炎597例(90.7％),其他依次为化妆品痤疮15例,化妆品毛发损害5例,化妆品色素异常7例,化妆品甲损害2例,化妆品光感性皮炎5例,另外化妆品激素依赖性皮炎27例.大部分(59.8％)是由护肤类引起,其次为护发美发类(23.3％)、芳香类(7.2％).308例患者做了可疑化妆品原物斑贴试验,有165例阳性,阳性率达53.6％.部分阳性者行标准过敏原斑贴试验,过敏原阳性比例依次为对苯二胺占18.5％、硫酸镍占14.8％、硫柳汞占13.0％、重铬酸钾占11.1％,芳香混合物、甲醛、卡巴混合物各占7.4％等.结论:化妆品不良反应多发于中青年女性;化妆品接触性皮炎是最常见的化妆品皮肤病;护肤类为主要致病化妆品;标准过敏原斑贴试验阳性者依次为对苯二胺、硫酸镍、硫柳汞、重铬酸钾、芳香混合物、甲醛、卡巴混合物等.     

Contamination versus preservation of cosmetics: a review on legislation, usage, infections, and contact allergy

Cosmetics with high water content are at a risk of being contaminated by micro-organisms that can alter the composition of the product or pose a health risk to the consumer. Pathogenic micro-organisms such as Staphylococcus aureus and Pseudomonas aeruginosa are frequently found in contaminated cosmetics. In order to avoid contamination of cosmetics, the manufacturers add preservatives to their products. In the EU and the USA, cosmetics are under legislation and all preservatives must be safety evaluated by committees. There are several different preservatives available but the cosmetic market is dominated by a few preservatives: parabens, formaldehyde, formaldehyde releasers, and methylchloroisothiazolinone/methylisothiazolinone.
Allergy to preservatives is one of the main reasons for contact eczema caused by cosmetics. Concentration of the same preservative in similar products varies greatly, and this may indicate that some cosmetic products are over preserved. As development and elicitation of contact allergy is dose dependent, over preservation of cosmetics potentially leads to increased incidences of contact allergy. Very few studies have investigated the antimicrobial efficiency of preservatives in cosmetics, but the results indicate that efficient preservation is obtainable with concentrations well below the maximum allowed.     

The influence of shaving method on perfume allergy

Among men, the most frequent contact allergens are perfumes (fragrance mix and balsam of Peru). Considering that the main cause of nickel allergy is ear-piercing, shaving with a razor blade might be the cause of perfume contact allergy, by creating small wounds that increase the penetration of applied perfume substances derived from soaps, shaving foams and after-shave lotions. 19 males with contact allergy to fragrance mix and/or to balsam of Peru were interviewed about their shaving habits by letter. 17 responded (89%), of whom 12 (71%) had been using razor blades continuously for a period of at least 1 year. At our clinic, the frequency of razor blade usage was found to be 45% in patch tested men without perfume contact allergy. When comparing the frequencies of razor blade usage among patch tested men with and without perfume contact allergy, there was a statistically significant over-representation ( p = 0.047) among those with perfume allergy. The risk of perfume allergy when using razor blades was found to be 2.9 (odds ratio).     

Rosacea and contact allergy to cosmetics and topical medicaments--retrospective analysis of multicentre surveillance data 1995-2002

The role of contact allergy in rosacea has rarely been investigated. In this retrospective study, 361 out of 76,697 patients tested and documented by the Information Network of Departments of Dermatology between 1995 and 2002 had rosacea. Patch tests included standard series and constituents of cosmetics and topical medicaments. 118/361 had additionally been patch tested with their own cosmetics/medicaments. Positive reactions occurred to nickel (II) sulfate in 9.3%, fragrance mix in 8.8%, thimerosal in 6.9%, Myroxylon pereirae resin in 5.9%, potassium dichromate in 4.6% and propolis in 2.8%. Whereas rosacea patients had a significantly higher risk of contact allergy to propolis compared to the remaining patients, in an age- and sex-adjusted analysis, contact allergy to nickel was significantly less frequent in this group. For Lyral, the risk was elevated, albeit not significantly. Only 2/329 patients were positive to neomycin sulfate and 1/100 to gentamicin sulfate, among the panel of (topical) antibiotics tested. Among 118 patients tested with their own products, 3 were tested to metronidazole, 1 reacting positively. Irritant or doubtful patch test reactions were provoked by various substances (vehicles, oxidants and preservatives of various creams), which might also be clinically important, considering the heightened sensitivity of rosaceous skin.     

The role of 3-dimethylaminopropylamine and amidoamine in contact allergy to cocamidopropylbetaine

Since it has been found that all subjects with contact allergy to cocamidopropylbetaine (CAPB) have positive reactions to 3-dimethylaminopropylamine (DMAPA), and reports have appeared in literature of the sensitizing action of amidoamine in products containing CAPB, we aimed to verify the possibility that pure amidoamine may have a sensitizing role in subjects with positive reactions to CAPB. To this end, in 10 patients with contact allergy to a commercial CAPB, we tested DMAPA 1% aq. and a pure amidoamine in concentrations ranging from 0.5% aq. to 0.1% aq. The study showed that all patients with positive reactions to DMAPA reacted to amidoamine at 0.5% and 0.25% aq., while 4 of the 10 also had positive reactions to amidoamine at 0.1% aq. We consider that simultaneous allergic reaction to DMAPA and amidoamine represents cross-reactivity and hypothesize that DMAPA is in fact the true sensitizing substance, while amidoamine, which may in any case release DMAPA in vivo as a result of enzymatic hydrolysis, may favour the transepidermal penetration of the sensitizing agent. In addition, we advise that testing of CAPB be suspended, because, as suggested by chemico-structural analyses and demonstrated in vivo, when thoroughly purified, it no longer has a sensitizing action.     

Are opera-house artistes afflicted with contact allergy to colophony and cosmetics?

The frequencies of cosmetics intolerance and contact allergy to colophony were investigated among 116 singers and dancers and 16 make-up artists. Participants were interviewed, examined and patch tested with a standard series and materials from the opera house. Common skin lesions were found in 1/3 of participants and more than 50% had a history of intolerance to cosmetics. Colophony gave positive patch test reactions in only 3 subjects. The prevalence of positive patch test reactions to fragrance mix and balsam of Peru was about the same as among dermatitis patients generally. Contact allergy to colophony did not seem to be a problem regarding cosmetics.     

Prevalence and cause of methylisothiazolinone contact allergy

Background: Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) has been one of the most frequent sensitizers since the 1980s. In 2005, the use of MI alone was approved for the preservation of cosmetic and household products in the EU. Before that, MI was used in industrial products, and the first cases of isolated MI contact allergy were published. Objectives: To present the prevalence and causes of MI contact allergy. Materials and methods: Patch test results from 2536 dermatitis patients tested with MI at Gentofte University Hospital between May 2006 and February 2010 were analysed. A retrospective investigation of medical records from MI‐allergic patients was performed to reveal the causes of their MI contact allergy. Results: Of patch‐tested patients, 1.5% had MI contact allergy. It was associated with occupational dermatitis, hand eczema and age above 40 years. Exposure to MI in cosmetic products was found in 12 (32%) cases, and exposure to MI in occupational products was found in 11 (30%) cases; 5 of the 11 were painters. Conclusions: The prevalence of MI contact allergy is already at the same level as that of other sensitizing preservatives, which have been on the market for several years, but no rising trend was identified. MI contact allergy was associated with both occupational and consumer products.     

Contact allergy to ingredients of hair cosmetics in female hairdressers and clients--an 8-year analysis of IVDK data

Not only hairdressers, but also their clients or home-users of hair cosmetic products may become sensitized to one of the product constituents. The present analysis addresses the question whether the pattern of sensitization is different in these 2 groups and includes female patients who consulted with the participating centres of the IVDK (http://www.ivdk.org) between 1995 and 2002, and in whom hair cosmetics have been considered as being causative of their contact dermatitis. Among these, 2 subgroups were identified: (i) patients, currently or previously working as hairdressers, diagnosed with occupational skin disease (H, n = 884) and (ii) patients who never worked as hairdressers, i.e. clients (C, n = 1217). Previous atopic eczema was twice as common among H, who were also much younger (median age 24 versus 46 in C). Analysis of sensitization frequencies and patterns showed the well-known decline of contact allergy to glyceryl monothioglycolate (GMTG) in H from 31.2% to 8.5%. Among the C, 1.7% were allergic to GMTG. Concerning p-phenylenediamine, a steady decline from 27.6% to 17.2% was observed in H, while no trend was found in C (12.6% and 16.6% in the first and the last 2-year period, respectively). Conversely, a very slight decline of p-toluenediamine sensitization was observed in H (from 29.5% to 24.8%), while at the same time a significant increase was noted in C (from 8.7% to 16.7%). A slighter increase was also noted with ammonium persulfate in C (3.1-6.8%), while the proportion of H sensitized remained largely constant at about 26%.     

Cheilitis caused by contact allergy to anethole in spearmint flavoured toothpaste

A 63-year-old woman presented with a 6-year history of persistent cheilitis. Minimal improvement was achieved with therapeutic measures. Patch testing was positive to anethole, a flavouring used in her toothpaste. Her cheilitis resolved after cessation of the flavoured toothpaste. This case demonstrates the importance of considering contact allergy to toothpaste flavours in patients with cheilitis.     

Methylisothiazolinones elicit increased production of both T helper (Th)1- and Th2-like cytokines by peripheral blood mononuclear cells from contact allergic individuals

BACKGROUND: Delayed-type hypersensitivity reactions to nickel (Ni2+) in humans are associated with increased production of both T helper (Th) 1- and Th2-like cytokines. Cytokine responses to the major group of contact allergens, i.e. organic compounds, have been less extensively studied. We have investigated here the cytokine production induced by a mixture of methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI), the active ingredients in common preservatives that are capable of eliciting allergic contact dermatitis. OBJECTIVE: To characterize the immune response induced by MCI/MI in terms of the production of Th1- and Th2-like cytokines in peripheral blood mononuclear cells (PBMC) from allergic and non-allergic subjects. METHODS: Ten subjects with a history of contact allergy to MCI/MI and nine age-matched non-allergic volunteers participated. Their actual status was confirmed by patch testing. PBMC were cultured in the presence or absence of MCI/MI; cell proliferation was measured employing [3H]thymidine incorporation; and the number of cytokine-producing cells was determined using the enzyme-linked immunospot (ELISpot) assay and the levels of soluble cytokines in culture media by the enzyme-linked immunosorbent assay (ELISA). RESULTS: The proliferative response of PBMC to MCI/MI was significantly greater in the case of the allergic group than for the non-allergic group, as was the production of interleukin (IL)-2 and IL-13 (as determined by ELISpot and/or ELISA). PBMC from three of the allergic individuals with increased production of IL-2 and IL-13 responded to MCI/MI with elevated numbers of cells producing IL-4 and IL-5. The increases in the production of IL-2, IL-4, IL-5 and IL-13 were positively correlated. CONCLUSION: MCI/MI elicited concomitant production of both Th1- and Th2-like cytokines by PBMC from subjects with contact allergy to these substances. This finding indicates that the organic compounds MCI/MI elicit a mixed Th1- and Th2-type of response, similar to that elicited by the metal ion Ni2+ in Ni2+-sensitized individuals.     

Trend of contact allergy to cosmetic ingredients in Thais over a period of 10 years

Background. Contact allergy to cosmetic ingredients is common. However, there are no recent comprehensive studies on contact allergy to cosmetic ingredients in Asia. Objectives. To identify positive patch test reactions in patients tested at Siriraj Hospital, Bangkok, Thailand to allergens present in cosmetics. Methods. A retrospective review of medical records from the outpatient contact dermatitis clinic was conducted from January 1999 to December 2008. Patients with at least one positive patch test reaction to allergens associated with cosmetic ingredients were studied. The results were evaluated using Pearson's χ²‐test with Yates' continuity correction or Fisher's exact test where appropriate,and a p‐value <0.002 was considered to be statistically significant by Bonferroni correction. Results. There were 1247 cases (239 males and 1008 females; mean age 38.5 years). Fragrance chemicals and preservatives were the most commonly recognized cosmetic allergens. Ammoniated mercury was the only allergen that showed a significantly increased frequency over the 10‐year period (p = 0.0008). Conclusions. Our study showed that ammoniated mercury is an emerging cosmetic allergen, showing an increased prevalence in recent years in Thailand. A focus is required on emerging cosmetic allergens and what may account for the upward trend of cosmetic contact dermatitis.     

Patch testing with patients' own cosmetics and toiletries--results of the IVDK*, 1998-2002

Patch test results with products brought in by the patients collected by the members of the Information Network of Departments of Dermatology (IVDK) between 1998 and 2002 were analysed. 5911 patients were patch tested with their own cosmetics and toiletries during this period. The 34 082 single test preparations applied to these 5911 patients were manually assigned to 1 of 26 categories, based on the EU Classification Annex I to 76/768/EEC, which had been further refined. The leave-on product category most commonly tested was 'creams, emulsions, lotions, gels and oils for the skin' (n = 3621 tested, n = 312 positive). The rinse-off product type most commonly tested was 'bath and shower preparations' (n = 1333 tested, n = 71 positive). In one-third of patients tested positive to these products, no other positive test result was observed. In the remainder, positive reactions to the fragrance mix, Myroxylon pereirae resin, methyldibromo glutaronitrile, (chloro-)methylisothiazolinone, 2-bromo-2-nitropropane-1,3-diole and further ingredients of cosmetics and toiletries were more common than in product-negative patients. However, in view of the potential for false-positive reactions mainly to rinse-off products, the results must be interpreted with caution. In conclusion, testing of patients' own products can be regarded as efficient and safe, if in accordance with current recommendations.     

Nickel,cobalt and chromium in consumer products: a role in allergic contact dermatitis?

In spite of the improved awareness of the potential for nickel, cobalt and chromium to en use skin allergy, the incidence of serialization to them is generally on the increase, especially for nickel. We review data from the literature and industry on transition metal contamination of consumer products and assess the hazard to man. Consumer products are defined as personal care items and detergent/cleaning products used regularly in domestic York. The analytical data demonstrate that consumer products are a relatively minor source of contact with nickel, cobalt or chromium. The traces found in consumer products will not be the primary cause of sensitization to these metals: levels will be too low and exposure too brief. A person sensitized to these metals has many other more significant sources of daily contact such as earrings, jewellery and metal objects. It is therefore necessary to focus on decreasing the high exposure to these transition metals from other sources rather than on possible trace amounts found in consumer products. Current good manufacturing practice ensures that trace nickel, cobalt and chromium concentrations in consumer products are less than 5 ppm of each metal, it is recommended that this be accepted as a standard for maximum concentrations and that the target should be to achieve concentrations as low as 1 ppm.