Adverse reactions to cosmetics Hassan Seirafi M.D. Razi Hospital

Cosmetics Objective irritation Subjective irritation

Objective irritation Irritant dermatitis Acute or corrosive Mechanical irritation Pustular eruption Phototoxic reaction Acneiform eruption Cumulative Irritation

Subjective irritation Sensory irritation Stinging Prickling Tingling BurningItching

Allergic contact dermatitis Cosmetics A relation to cosmetics was suspected by the dermatologist or patient initially in fewer than half of the cases. Incidance:5% Site:59% in Face Sex:79% in Women

Allergic contact dermatitis to cosmetics Colophony Fragrance mix Paraphenylendiamine Lanolin alcohol (Wool alcohol) Quaterium-15 Formaldehyde Balsam of peru Paraben mix Thimerosal

Cosmetics Not safely applied in closed patch tests Shampoo Soaps Detergent Hair bleach Mascara Nail polish Depilatories Bleaching cream Hair dyes Hair spray Perfumes Nail polish removers

Tests for Dignosis Thin-layer rapid use epicutaneous test (T.R.U.E) Repeat open application test (ROAT)

Fragrances Fragrance allergy Incidence: 1% Incidence: 1% Sites Sites Face, Neck, Hands, Axillae or Generalized Face, Neck, Hands, Axillae or Generalized Test Test Fragrance mix: 86% Positive Fragrance mix: 86% Positive Allergy to fragrances and coal tar dyes Allergy to fragrances and coal tar dyes Epidemics of bizarre facial pigmentation in Japanese women ( ) Epidemics of bizarre facial pigmentation in Japanese women ( )

Sensitive skin Cosmetic intolerance syndrome Facial burning & discomfort with application of most skin care products Facial burning & discomfort with application of most skin care products Overt inflammatory changes or only subjective symptoms Overt inflammatory changes or only subjective symptoms Over the past two decades, most of these individuals have been recognized to have organic basis rather than a functional basis for their complaints Over the past two decades, most of these individuals have been recognized to have organic basis rather than a functional basis for their complaints

Causes of facial skin intolerance to cosmetics Exogenous: Subjective irritation Objective irritation Contact urticaria Allergic contact dermatitis Photo allergic contact dermatitis Endogenous: Seborrhea/Seborrheic dermatitis Psoriasis Rosacea/Perioral dermatitis Atopic dermatitis Dysmophobia

Contact urticaria Non immunologic: Benzoic acid Cinnamic acid Cinnamal Immunologic: Methyl paraben Henna Ammonium persulfate

Preservatives Approximately 60 chemicals are commonly used in cosmetics Parabens rarely sensitize but may do so when applied to eczematous skin Parabens rarely sensitize but may do so when applied to eczematous skin Propylen glycol is a mild irritant, occasionally sensitizes Propylen glycol is a mild irritant, occasionally sensitizes Formaldehyde may sensitize Formaldehyde may sensitize Tocopherol and t-butyl hydroquinone as antioxidants may sensitize Tocopherol and t-butyl hydroquinone as antioxidants may sensitize UV light-absorbing agent UV light-absorbing agent Lanolin Lanolin

Moisturizers The mechanism of action and biology are highly complex Petrolatum is not a primary or cumulative irritant & can protect against irritant effects of detergents Lanolin is esthetically acceptable & is allergenic in 2 % to 5% Cholesterol & Free fatty acids & Ceramides are being used to formulate moisturizers

Diagnosis & Treatment Examine every cosmetics & skin care product Administer patch and photo patch test to rule out occult allergic and photo allergic dermatitis Test for contact urticaria Do careful repeat open application testing (ROAT) Treat endogenous inflammatory disease Do not use soap or detergent Lip cosmetics as desired if lips are clear Eye cosmetics if eyelids are asymptomatic Face powder if necessary Glycerin & rose water as a moisturizer if necessary Avoiding other cosmetics for 6 to 12 months