Cosmetic dermatitis reactions comprise of mainly irritant and allergic
contact dermatitis, contact urticaria and photo allergic reactions. Most
cases are of irritant contact dermatitis.
Skin care products and facial make up are the most common causes. The
most common responsible allergens are fragrances and preservatives. It
is important to monitor the adverse effects of cosmetics, due to their
widespread and increasing use.
The development of contact dermatitis depends on nature of the responsible
substance, contact site, skin barrier condition, contact duration and
frequency of contacts. Cosmetic dermatitis often occurs after repeated
applications or application on damaged skin.
Though the use of cosmetics is widespread, the prevalence of cosmetic
dermatitis is relatively low. Nevertheless, it is significant because
it is often not detected.
Latest studies show that contact dermatitis is prevalent in 1% of the
US. and European populations. Actual prevalence is probably higher since
many cases are not reported. In a patch tested study the prevalence was
9.8%. The prevalence is increasing, probably due to increasing use of
cosmetics and allergenic ingredients and better accessibility to patch
testing. Risk factors are mostly related to increased use of cosmetics.
Most people affected are between the ages 20 and 55 and are women.
Contact dermatitis occurs at the site of allergen contact and shows pruritic
papules, vesicles or bulae and eczematous dermatitis. Chronic eczematous
dermatitis is more common than other features since most cosmetic allergens
are relatively weak. In more than half the cases, the face and the area
around the eye are affected. It is possible that a cosmetic applied on
the face may affect only the region around the eye, since the skin is
thinner at that site.
The site of occurrence usually indicates the culprit allergen. The offending
allergen may not be obvious in cases where the cosmetic dermatitis is
induced by contaminated articles of use, such as, towels, pillows and
Fragrances: Fragrances have consistently proved to be the most common
cause of cosmetic dermatitis, indicating the high presence of fragrances
in commercial products. Most reactions are due to fragranced skin care
products. Actual fragrance products, such as, perfumes, toilet water and
colognes rarely cause contact dermatitis. A study found that women are
1.3 times more likely to be allergic to fragrance products than males,
probably because they are more exposed to fragrances in cosmetics and
Preservatives: Preservatives prevent the overgrowth of microorganisms
and are essential because many cosmetics are multiuse products and come
into repeated contact with the environment and the human skin. Preservatives
can be antimicrobials, antioxidants or ultra violet absorbers. Preservatives
have been repeatedly shown to be one of the two most common causes of
Formaldehyde: Formaldehyde is an inexpensive preservative having good
antimicrobial properties. It is rarely used in cosmetics because it is
a frequent sensitizer. But formaldehyde sensitization levels remain high
due to its use in cleaning agents and in formaldehyde releasing products.
Formaldehyde sensitive patients often have chronic cosmetic dermatitis
because the product is difficult to avoid, being present in many products
which are frequently encountered. These products may have, instead of
formaldehyde, products which release or degrade into formaldehyde.
Formaldehyde releasers: These preservatives include 2-bromo 2-nitropropane
1, 3-diol DMDM hydantoin and diazolidinil urea. By themselves they are
basically antibacterial and antifungal but also act by releasing formaldehyde.
Allergic reactions can be caused by the preservatives, formaldehyde or
Antioxidants: Antioxidants protect products by preventing the deterioration
of unsaturated fatty acids present in them. Deterioration can produce
a rancid odor and discoloration. Antioxidants are used in lipsticks, lip
balm and salves. They can be found in creams and lotions also.
UV absorbers: Chemicals which are UV absorbers are used in cosmetics
to prevent product deterioration and to function as a sunscreen. This
sunscreen causes cosmetic dermatitis. Oxybenzone is the most common sunscreen
in use today.
Pigments: Agents used for coloring cosmetics can also cause contact dermatitis.
They are called D&C colors referring to their use in drugs and cosmetics.
These colors can cause adverse reactions. Iron oxides, as pigments, are
also used in lipsticks and eye makeup, but have rarely been reported for
any adverse reactions.
Noncosmetic allergens: Gold, nickel and rubber are three important noncosmetic
allergens, which mimic cosmetic allergy. Gold causes patchy facial or
eyelid dermatitis, nickel, used in eye cosmetics causes eyelid dermatitis
and rubber used in cosmetic applicators causes eczematous reactions.
Avoidance of sensitizing allergens is the key to successful management
of cosmetic dermatitis. In the US, the FDA has taken a significant step
in helping consumers avoid these allergens by requiring all ingredients
to be listed on all direct cosmetic products.