While browsing the beauty aisle you will most likely notice an impressive and overwhelming array of cosmetic products, each with an even greater number of individual ingredients. Unfortunately as the number of new products continues to rise, so does the rate of adverse skin reactions.
It is estimated that the average woman uses 12 personal care products daily, which comprise 168 unique ingredients. The average man uses six personal care products each day with 85 unique ingredients.1
Skin care products have been found to account for the majority of cases of allergic contact dermatitis to cosmetics, followed by hair care and nail cosmetics.2-5 The most common responsible cosmetic allergens are fragrances and preservatives.6
The prevalence of cosmetic allergy is estimated at less than 1% in the general population.7-9 However, since most people do not seek medical consultation for mild adverse reactions, the actual rates are likely much higher. Pooled data of seven different studies involving 30,207 patients patch tested for suspected contact dermatitis revealed that 9.8% of positive reactions were due to cosmetic allergens.10 The majority of patients affected with allergic contact dermatitis to cosmetic products are women between the ages of 20 and 55.2,7-9
Features of Allergic Contact Dermatitis
Allergic contact dermatitis occurs when something has come into contact with your skin, which causes your immune system to respond by triggering the activation and production of cells called lymphocytes. They are white cells that produce inflammation in the skin. Allergic contact dermatitis may have acute and chronic forms. Acutely, it presents with itchy red bumps (papules) and small fluid filled blisters. Chronic forms are more common and present with itchy, scaly papules and plaques distributed in areas of most contact with the offending allergen. Skin that is repeatedly affected by allergic contact dermatitis may become dry, thickened and scaly.
Classes of Allergens Responsible for Allergic Contact Dermatitis
Cosmetic ingredients can be classified into several categories: fragrances, preservatives, antioxidants, vehicles, ultraviolet absorbers, humectants, emollients, emulsifiers, acrylates, hair dyes, nail polish components, and others.
Preservatives and fragrances are the most frequently detected culprits; therefore, this review will primarily deal with these two classes of allergens.
Preservatives were identified as the most common cosmetic contact allergens in several recent studies.6,17,18 They can be classified into three broad categories: antimicrobials, antioxidants, and ultraviolet light absorbers. There are over 3000 different fragrances used in cosmetics today.20 Not surprisingly, fragrances represent the second most common group of cosmetic allergens.
Below is the North American Contact Dermatitis Group’s (NACDG) list of top screening allergens associated with cosmetics in females.
- Myroxylon pereirae (balsam of Peru)
- Fragrance mix 1
- Tosylamide formaldehyde resin
- Cocamidopropyl betaine
- Glyceryl thioglycolate
- Diazolidinyl urea
- DMDM hydantoin
- Lanolin alcohol
- Imidazolidinyl urea
- Methyl methacrylate
- Propylene glycol
- DMDM hydantoin
- Imidazolidinyl urea
Many of the specific fragrance ingredients are protected by the Fair Packaging and Labeling Act as they are considered trade secrets.19 It is important to keep in mind that many products labeled as ‘unscented’, ‘hypoallergenic’, or even ‘fragrance-free’ do, in fact, contain masking fragrances.
When shopping for cosmetics, it’s a good idea to be aware of the ingredients. Look at label to see what exactly is in it. If you have sensitive skin or a skin condition such as eczema or psoriasis, try to avoid any product that contains these known allergens.
Sometimes identifying what specifically causes the outbreaks may be difficult. If you are unsure about what is causing the allergic reaction, consult with a dermatologist. It is rewarding for both the affected individual and the physician if the responsible agent can be identified and subsequently removed from the patient’s environment. A dermatologist will also be able to provide detailed information on safe to use personal care products and skin care alternatives.
1. Environmental Working Group’s Skin Deep Cosmetic Safety Database. Available at: https://www.cosmeticsdatabase.com/research. Last accessed: March 1, 2011.
2. Eiermann HJ, Larsen W, Maibach HI, et al. Prospective study of cosmetic reactions: 1977-1980. North American Contact Dermatitis Group. J Am Acad Dermatol 6(5):909-17 (1982 May).
3. Adams RM, Maibach HI. A five-year study of cosmetic reactions. J Am Acad Dermatol 13(6):1062-9 (1985 Dec).
4. de Groot AC. Contact allergy to cosmetics: causative ingredients. Contact Dermatitis 17(1):26-34 (1987 Jul).
5. de Groot AC, Bruynzeel DP, Bos JD, et al. The allergens in cosmetics. Arch Dermatol 124(10):1525-9 (1988 Oct).
6. Wetter DA, Yiannias JA, Prakash AV, et al. Results of patch testing to personal care product allergens in a standard series and a supplemental cosmetic series: an analysis of 945 patients from the Mayo Clinic Contact Dermatitis Group, 2000-2007. J Am Acad Dermatol 63(5):789-98 (2010 Nov).
7. Romaguera C, Camarasa JM, Alomar A, et al. Patch tests with allergens related to cosmetics. Contact Dermatitis 9(2):167-8 (1983 Mar).
8. Adams RM, Maibach HI. A five-year study of cosmetic reactions. J Am Acad Dermatol 13(6):1062-9 (1985 Dec).
9. Kohl L, Blondeel A, Song M. Allergic contact dermatitis from cosmetics. Retrospective analysis of 819 patch-tested patients. Dermatology 204(4):334-7 (2002).
10. Biebl KA, Warshaw EM. Allergic contact dermatitis to cosmetics. Dermatol Clin 24(2):215-32 (2006 Apr).
11. Nielsen NH, Linneberg A, Menne T, et al. Allergic contact sensitization in an adult Danish population: two cross-sectional surveys eight years apart (the Copenhagen Allergy Study). Acta Derm Venereol 81(1):31-4 (2001 Jan-Feb).
12. Cohen DE, Rao S, Brancaccio RR. Use of the North American Contact Dermatitis Group Standard 65-allergen series alone in the evaluation of allergic contact dermatitis: a series of 794 patients. Dermatitis 19(3):137-41 (2008 May-Jun).
13. Uter W, Balzer C, Geier J, et al. Patch testing with patients’ own cosmetics and toiletries–results of the IVDK*, 1998-2002. Contact Dermatitis 53(4):226-33 (2005 Oct).
14. Wilkinson DS. Connubial photodermatitis. Contact Dermatitis 1:58 (1975).
15. Fisher AA. Consort contact dermatitis. Cutis 24(6):595-6, 668 (1979 Dec).
16. Morren MA, Rodrigues R, Dooms-Goossens A, et al. Connubial contact dermatitis: a review. Eur J Dermatol 2:219-23 (1992).
17. Warshaw EM, Buchholz HJ, Belsito DV, et al. Allergic patch test reactions associated with cosmetics: retrospective analysis of cross-sectional data from the North American Contact Dermatitis Group, 2001-2004. J Am Acad Dermatol 60(1):23-38 (2009 Jan).
19. Laguna C, de la Cuadra J, Martin-Gonzalez B, et al. [Allergic contact dermatitis to cosmetics]
. Actas Dermosifiliogr 100(1):53-60 (2009 Jan-Feb).
20. Scheman A, Jacob S, Zirwas M, et al. Contact Allergy: alternatives for the 2007 North American contact dermatitis group (NACDG) Standard Screening Tray. Dis Mon 54(1-2):7-156 (2008 Jan-Feb).
21. Devos SA, Constandt L, Tupker RA, et al. Relevance of positive patch-test reactions to fragrance mix. Dermatitis 19(1):43-7 (2008 Jan-Feb).