New and emerging cosmetic allergens
Introduction
Allergic contact dermatitis (ACD) is a T-cell–mediated delayed-type hypersensitivity reaction that occurs upon a specific hapten challenge in previously sensitized individuals. The inflammatory response in classical ACD requires an initial sensitization phase as a result of hapten penetration of the epidermal skin barrier. This is followed by an elicitation phase that is responsible for the recruitment and activation of specific T cells at the site of the hapten skin challenge.1
The importance of the stratum corneum barrier function, as well as the signalling pathways that allow keratinocyte proliferation and generation of proinflammatory factors, is increasingly recognized.2 The association between filaggrin null mutations in ichthyosis vulgaris and atopic dermatitis,3 together with protease and lipid defects, highlights the primary role of barrier disruption in allowing increased access of environmental toxins, microbes, and allergens.
The clinical appearance of ACD can be very similar if not identical to other types of dermatitis. Redness, scaling, and vesiculation can be present, with only the distribution giving a clue to an allergic etiology. Some allergens regularly produce clinically atypical reactions: acute facial swelling due to type IV hypersensitivity to the black hair dye paraphenylenediamine (PPD) is one of the most dramatic illustrations of how facial swelling may not always be a type I reaction.4
Human skin is exposed to a large variety of cosmetic allergens. Most ACD reactions occur after exposure to fragrance, preservatives, and hair dyes. Such reactions can often be occult. As a result, a high index of suspicion is needed in assessing the patient with facial or cosmetic dermatitis.5 A review of patients patch tested in the US reported that of women with a positive patch test reaction, 24% were due to a documented cosmetic source.6
Section snippets
So why is such a wide range of these potentially allergenic compounds necessary?
To improve usability for the consumer, cosmetics often have high water content. This leaves the preparation at a risk of being contaminated by pathogenic microorganisms such as Staphylococcus aureus and Pseudomonas aeruginosa. Bacterial contamination can alter the composition of the product or pose a health risk to the consumer. To prevent this, preservatives, including biocides, are added to cosmetic products. Varying concentrations of the same preservative are found in related products,
Sodium metabisulfite
The sulfites are a ubiquitous group of chemicals. Sodium metabisulfite is present in food and drink as a preservative and antioxidant, where it is labelled as E223.10 In addition, it is found as a component of photographic chemicals, is used in rubber manufacture, in leather tanning, in mineral extraction, and as a bleaching agent in fabric treatments.10 Sodium metabisulfite is present in certain local anaesthetic preparations to prevent oxidation of adrenaline and has been described as causing
Propolis
Propolis is a resinous substance collected from poplars and processed by honeybees to use as a sealant to maintain the structure of the hive. It is a well-recognized cause of occupational contact dermatitis in apiarists.16 Propolis has a variable chemical composition and is regarded as a potent skin sensitiser.17 Cases of ACD to propolis began to emerge in the 1970s; indeed, Petersen predicted that cases of ACD to propolis would increase with the increasing use of propolis in self-medicating
Dicaprylyl maleate
Dicaprylyl maleate (DCM), also known as dioctyl maleate, is a good example of an emollient and solvent in which original chemical testing indicated that the compound did not cause ACD.22 Ten years after it was introduced into cosmetic products, it has been found to cause ACD in selected patients. DCM has been used as an ingredient in fake tanning lotions, moisturizers, foundations, and sunscreens.23 Recently, a series of 22 patients who were suspected of having DCM contact allergy were tested
Benzophenone 4
Many facial moisturizers, make-up, and hair care products25 now incorporate ultraviolet light (UV) filters to protect the skin against photoaging and also to protect the product itself from UV degradation to prolong shelf life. Historically, benzophenone 3 was widely used in sunscreen for its UVA filter properties. In a retrospective series of 2715 patients undergoing photopatch testing between 1983 and 1998, benzophenone 3 was the most common UV filter photoallergen.26 Benzophenone 4
Artificial fragrances
Considering the ubiquitous occurrence of fragrance materials, the risk of allergy is small. In absolute numbers, however, fragrance allergy is common,28 and the prevalence of ACD due to fragrance in the general population has been estimated as 1.8% to 4.2%.29 Fragrance is the second most common cause of ACD after nickel.30 The distribution is classically axillae, facial (including the eyelids) and neck, although well-circumscribed patches in areas of “dabbing-on” perfumes (wrists, behind the
Iodopropynyl butylcarbamate
Iodopropynyl butylcarbamate (IPBC) is a biocide originally developed for use in an industrial context, initially in metalworking and subsequently as a wood preservative, where concentrations of up to 4% are permitted.39 ACD to IPBC in these industrial settings is well described.40 In a series of 251 German metalworkers with suspected ACD, 0.5% had a positive reaction to IPBC.41 Because of its usefulness as a biocide, IPBC has more recently been incorporated into cosmetic products and cleansing
Conclusions
Contact allergy is an ever-changing area of dermatology due to the evolving nature of the chemical, and more specifically, cosmetics industry. Links between dermatology and industry have become increasingly important to allow early identification of allergenic compounds and to enable patch testing of chemicals not yet commercially available. Links between dermatologists and legislators have strengthened significantly,8 especially in the European Community. This has led to the publication of the
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Sodium metabisulfite—a marker for cosmetic allergy?
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