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COSMETIC DERMATITIS
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This brief discussion may be of help to give a brief idea about dermatitis due to cosmetics . Different and widespread cosmetics can cause contact dermatitis of the primary or the delayed allergic type. Perfumes Perfumes are the most common sensitizers , followed by antimicrobial agents. Perfume and formaldehyde may be present in any cosmetic. Balsams, flavoring agents and spices are also common sensitizers . Each natural perfume and spice contains a large number of different compounds representing a variety of reactive groups . Commercial perfumes are mixtures of essential oils and synthetic compounds. The mixture of volatile substances determines the scent. To delay evaporation, ‘fixatives‘ are added. Common ‘fixatives‘ are balsams, benzyl benzoate, benzyl salicylates and synthetic musk. Sensitivity to synthetic musk has been reported , and sensitivity to balsams is usually common . One of the many allergens in balsam of Peru is methyl cinnamate , which cross-reacts with the UV absorber methoxycinnamate . Balsams: Balsam of Peru, gum benzoin , balsam of spruce, balsam of Tolu and Storax (eugenol) contain cinnamic acid, benzoic acid, esters of these and resins which may cause sensitization. Balsam of peru is used as a fragrance in many cosmetics, perfumes, medical creams and ointments, some teas and flavoring agents in cough syrup, lozenges, chewing gum, and candies. It is also used to flavor colas, ice cream, baked products. Fragrance mix: are found in many toiletries, such as perfumes, soaps, aftershaves, cosmetics, shampoos and many scented household products, detergents, polishes, solvents, deodorizers, and cleaning fluids. The analysis of perfume sensitivity is laborious because of its numerous components. However, systematic studies of the sensitizers in modern perfumes have been published. Hypoallergenic products free from fragrance may be available to be used by persons allergic to fragrance. Certain types of food containing cinnamon, vanilla, cloves, cardamon and citrus fruits should be avoided in severely allergic children, where these may cross react with fragrance. Antioxidants: These include organic dyes, lanolin , emulsifiers and UV absorbers .
Creams as emollients , lanolin ,sunscreens , creams used for lightening of the skin containing ammoniated mercury, may cause skin sensitization . Face creams as Azo dyes, lanolin, paraben, Miranols, Germall 115, Germall II, Dowicil 200, Bronopol, and Kathon CG. Euxyl K400 and Phenyl mercuric salts may produce allergic contact dermatitis that is usually acute with vesiculation and bullae at the site of contact especially in young children.
Hand lotions: Different creams containing lanolin, coconut diethanolamide, quaternary ammonium compounds; Bronopol, Kathon CG, Liquid soaps, lauryl ether sulfate and coconut diethanolamide may cause contact dermatitis. Soap and shampoo Soap and shampoo containing perfumes or benzyl salicylates may also cause eczematous reaction especially in patients with sensitive skin. Anitperspirants Zinc and aluminum salts and zirconium preparations present in deodorants may elicit allergic granuloma.
Hair preparations : Different hair preparations may act as sensitizers. Some of these are: Hair dyes: phenylenediamine, toluenediamine, nitro-PPD, p-aminodiphenylamine, resorcinol and pyrogallol. Hair lacquers: shellac, benzoin, cyclohexanone-formaldehyde resin . Hair creams and gels: lanolin, paraben, musk, ambrette, Germall. Hair lotions: quinine, resorcinol, hexamidine isethionate. Hair detergents: azo dyes, hydroxyquinolines, zinc Pyrithium. Mascara, eyebrow pencils, dyes, and alcohol.
Nail preparations : Products which contain formaldehyde and sulfonamides are considered as a common cause of neck and eyelid dermatitis when these come in contact with skin. Eye preparations : These may contain perfumes , mascara eyeliner and eye shadow. Essential oils such as almond may cause contact dermatitis or photosensitization . Lip preparations Rouge azo dyes, Quinazoline yellow may cause allergic contact dermatitis. Lipsticks : Coloring or flavoring preparations may cause contact dermatitis. Other preparations such as azo dyes (Quinazoline yellow), carmine, lanolin, Oleyl alcohol , castor oil, propyl gallate , monotertiary butyl hydroquinone and amyldimethyl PABA . Almond, perfumes, color or other additives or Di and tetrabromofluorocin may cause contact lip dermatitis and may lead to painful fissuring of the lips.
Fig.184 Cosmetic dermatitis (Face cream containing photosensitizer) Flavoring agents Contact sensitivity to spices occurs mainly from occupational exposure, but sensitivity to mustard, cinnamon , vanilla , allspice, oil of juniper and cloves are not uncommon sensitizers, even among consumers. In the modern food industry a large number of synthetic flavoring agents are used. Adhesive tape Adhesive tapes contain colophony, dammar, rubber chemicals, lanolin, acrylates and diphenyl-thiourea, Stoma pouch plastic can contain epoxy resin. Topical medications Almost any topical medication may act as a skin sensitizer including such widely used agents such as benzoyl peroxide and parabens. Rubber, chemicals in the rubber bulbs of eye drop bottles have been described . Beeswax (propolis) has increasingly considered as sensitizers in ‘natural‘ ointments. Allylthiourea and royal jelly can also sensitize skin.
Tranquillizers, Phenothiazine sensitizes the skin when used as syrups or as crushed tablets when come in contact with the hands. Hydroxyquinolines These are mainly used as topical medications but may also be present in cosmetics, antidandruff agents, waterless cleansers, mouthwashes, etc. A wide spectrum of cross-sensitization occurs . Formaldehyde Free formaldehyde may be present in formaldehyde resins, e.g. in textiles. It may be used as a preservative in cosmetics, e.g. shampoos, detergents, floor polishes, cutting oils, glues and as a disinfectant for sugar processing. It is used as a deodorant, tanning agent for tissue fixation and the preservation of anatomical and pathological specimens . Paraformaldehyde is used in foot powders. Interest in the toxicity of formaldehyde has recently intensified for reasons including its release from certain heat-insulation materials into the internal environment of buildings . Tooth and mouthwashes : Fluorine ,antiseptics , essential oils and flavoring ingredients may cause eczematous reaction . Toothpaste containing flourin and flavoring agents as mints is common cause of mouth dermatitis. Diagnosis of cosmetic dermatitis Skin tests: patch testing with the suspected sensitizer. Treatment: The main line of treatment is to avoid contact with the suspected cosmetic. Topical and systemic preparation can treat the existing lesions, but will not prevent sensitization after repeated exposure to the sensitizers after healing of the previous ones. This is why it is of crucial importance to instruct the mother to watch her baby in order to spot the specific sensitizer and to stop completely exposure of her child to such irritants. Acute and weeping lesions: dryness by potassium permenganate 1: 9000 compresses applied several times. Mild corticosteroid cream is applied. Inflamed cases need topical antibiotic cream alone or in combination with topical steroid such as (decoderm) and oral antibiotic such as erythromycin suspension or Zithromax. Dry lesions responds to an emollient and topical steroid ointment. Antihistamine orally may be needed to relieve itching.
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