Adverse reactions to Adverse reactions to cosmeticscosmetics

Hassan Seirafi M.D. Hassan Seirafi M.D. Razi HospitalRazi Hospital

CosmeticsCosmetics

Objective irritationObjective irritation Subjective irritationSubjective irritation

Objective irritationObjective irritation

Irritant dermatitisIrritant dermatitis

Acute or corrosiveAcute or corrosive

Mechanical irritationMechanical irritation

Pustular eruptionPustular eruption

Phototoxic reactionPhototoxic reaction

Acneiform eruptionAcneiform eruption

Cumulative IrritationCumulative Irritation

Subjective irritationSubjective irritation

Sensory irritationSensory irritation

StingingStinging PricklingPrickling TinglingTingling

BurningBurning ItchingItching

Allergic contact Allergic contact dermatitisdermatitisCosmeticsCosmetics

A relation to cosmetics was A relation to cosmetics was suspected by the dermatologist or suspected by the dermatologist or patient initially in fewer than half of patient initially in fewer than half of the cases. the cases.

Incidance:Incidance: 5%5% Site:Site: 59% in Face59% in Face Sex:Sex: 79% in Women79% in Women

Allergic contact dermatitis Allergic contact dermatitis to cosmeticsto cosmetics

ColophonyColophony Fragrance mixFragrance mix ParaphenylendiamineParaphenylendiamine Lanolin alcohol (Wool alcohol)Lanolin alcohol (Wool alcohol) Quaterium-15Quaterium-15 Formaldehyde Formaldehyde Balsam of peruBalsam of peru Paraben mixParaben mix ThimerosalThimerosal

CosmeticsCosmetics

Not safely applied in closed patch testsNot safely applied in closed patch tests

ShampooShampoo SoapsSoaps DetergentDetergent Hair bleachHair bleach MascaraMascara Nail polishNail polish DepilatoriesDepilatories Bleaching creamBleaching cream Hair dyesHair dyes Hair sprayHair spray PerfumesPerfumes Nail polish removersNail polish removers

Allergic contact dermatitis Allergic contact dermatitis to cosmeticsto cosmetics

Tests for DignosisTests for Dignosis

Thin-layer rapid use epicutaneous test (T.R.U.E)Thin-layer rapid use epicutaneous test (T.R.U.E)

Repeat open application test (ROAT)Repeat open application test (ROAT)

FragrancesFragrances

Fragrance allergyFragrance allergy

Incidence: 1%Incidence: 1% SitesSites

Face, Neck, Hands, Axillae or Generalized Face, Neck, Hands, Axillae or Generalized

TestTest Fragrance mix: Fragrance mix: 86% Positive86% Positive

Allergy to fragrances and coal tar dyesAllergy to fragrances and coal tar dyes Epidemics of bizarre facial pigmentation in Epidemics of bizarre facial pigmentation in

Japanese women (1960-1970)Japanese women (1960-1970)

Sensitive skinSensitive skin

Cosmetic intolerance syndromeCosmetic intolerance syndrome

Facial burning & discomfort with Facial burning & discomfort with application of most skin care productsapplication of most skin care products

Overt inflammatory changes or only Overt inflammatory changes or only subjective symptomssubjective symptoms

Over the past two decades, most of these Over the past two decades, most of these individuals have been recognized to have individuals have been recognized to have organic basis rather than a functional organic basis rather than a functional basis for their complaintsbasis for their complaints

Causes of facial skin Causes of facial skin intolerance to cosmeticsintolerance to cosmetics

Exogenous:Exogenous:

Subjective irritationSubjective irritation Objective irritationObjective irritation Contact urticariaContact urticaria Allergic contact Allergic contact

dermatitisdermatitis Photo allergic Photo allergic

contact dermatitiscontact dermatitis

Endogenous:Endogenous:

Seborrhea/Seborrhea/Seborrheic Seborrheic dermatitisdermatitis

PsoriasisPsoriasis Rosacea/Perioral Rosacea/Perioral

dermatitisdermatitis Atopic dermatitisAtopic dermatitis DysmophobiaDysmophobia

Contact urticariaContact urticaria

Non Non immunologicimmunologic::

Benzoic acidBenzoic acid Cinnamic acidCinnamic acid CinnamalCinnamal

Immunologic:Immunologic:

Methyl Methyl parabenparaben

HennaHenna Ammonium Ammonium

persulfatepersulfate

PreservativesPreservatives

Approximately 60 chemicals are Approximately 60 chemicals are commonly used in cosmeticscommonly used in cosmetics

Parabens rarely sensitize but may do so Parabens rarely sensitize but may do so when applied to eczematous skinwhen applied to eczematous skin

Propylen glycol is a mild irritant, Propylen glycol is a mild irritant, occasionally sensitizesoccasionally sensitizes

Formaldehyde may sensitizeFormaldehyde may sensitize Tocopherol and t-butyl hydroquinone as Tocopherol and t-butyl hydroquinone as

antioxidants may sensitizeantioxidants may sensitize UV light-absorbing agentUV light-absorbing agent LanolinLanolin

MoisturizersMoisturizers

The mechanism of action and biology The mechanism of action and biology are highly complexare highly complex

Petrolatum is not a primary or cumulative Petrolatum is not a primary or cumulative irritant & can protect against irritant effects irritant & can protect against irritant effects of detergentsof detergents

Lanolin is esthetically acceptable & is Lanolin is esthetically acceptable & is allergenic in 2 % to 5%allergenic in 2 % to 5%

Cholesterol & Free fatty acids & Ceramides Cholesterol & Free fatty acids & Ceramides are being used to formulate moisturizers are being used to formulate moisturizers

Diagnosis & TreatmentDiagnosis & Treatment Examine every cosmetics & skin care productExamine every cosmetics & skin care product Administer patch and photo patch test to rule out Administer patch and photo patch test to rule out

occult allergic and occult allergic and photo allergic dermatitisphoto allergic dermatitis

Test for contact urticariaTest for contact urticaria Do careful repeat open application testing (ROAT)Do careful repeat open application testing (ROAT) Treat endogenous inflammatory diseaseTreat endogenous inflammatory disease Do not use soap or detergentDo not use soap or detergent Lip cosmetics as desired if lips are clearLip cosmetics as desired if lips are clear Eye cosmetics if eyelids are asymptomaticEye cosmetics if eyelids are asymptomatic Face powder if necessaryFace powder if necessary Glycerin & rose water as a moisturizer if necessaryGlycerin & rose water as a moisturizer if necessary Avoiding other cosmetics for 6 to 12 monthsAvoiding other cosmetics for 6 to 12 months