Allergic patch test reactions associated with cosmetics: Retrospective analysis of cross-sectional data from the North American Contact Dermatitis Group, 2001-2004 - 08/08/11

Doi : 10.1016/j.jaad.2008.07.056

Erin M. Warshaw, MD, MS ^a,^⁎ , Heather J. Buchholz, MD ^a, Donald V. Belsito, MD ^b, Howard I. Maibach, MD ^c, Joseph F. Fowler, MD ^d, Robert L. Rietschel, MD ^e, Kathryn A. Zug, MD ^f, C.G. Toby Mathias, MD ^g, Melanie D. Pratt, MD ⁱ, Denis Sasseville, MD ^j, Frances J. Storrs, MD ^k, James S. Taylor, MD ^h, Vincent A. DeLeo, MD ^l, James G. Marks, MD ^m
^a Department of Dermatology, University of Minnesota, Veterans Affairs Medical Center, Minneapolis, Minnesota
^b American Dermatology Associates, LLC, Shawnee, Kansas
^c Department of Dermatology, University of California, San Francisco, California
^d University of Louisville, Louisville, Kentucky
^e Section of Dermatology, University of Arizona VA Health Care System, Tucson, Arizona
^f Division of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
^g Department of Dermatology, University of Cincinnati, Cincinnati, Ohio
^h Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
ⁱ Division of Dermatology, University of Ottawa, ON, Canada
^j Division of Dermatology, Royal Victoria Hospital, McGill University, Montreal, QC, Canada
^k Department of Dermatology, Oregon Health Science University, Portland, Oregon
^l Department of Dermatology, Columbia University, New York City, New York
^m Department of Dermatology, Pennsylvania State University, Hershey, Pennsylvania

Correspondence to: Erin M. Warshaw, MD, MS, Dermatology Department 111K, Veterans Affairs Medical Center, One Veterans Drive, Minneapolis, MN 55417.

Abstract

Background

Allergy to cosmetics is common.

Objectives

We sought to characterize patients with positive patch test reactions associated with a cosmetic source, to identify common allergens; and to explore gender and occupational associations.

Methods

We performed a retrospective, cross-sectional analysis.

Results

Of 6621 female and 3440 male patients, 1582 female (23.8%) and 611 of male (17.8%) patients had at least one allergic patch test reaction associated with a cosmetic source. Of “allergic” patients (>1 allergic reaction, n = 6815), females were 1.21 times more likely to have an allergic reaction associated with a cosmetic source than were male patients (p < .0001, 95% confidence interval [CI] 1.12-1.31). Within the “cosmetic allergic” group (n = 2243), head and neck involvement was significantly higher in female than in male patients (49.3% vs 23.7%, p < .0001). One hundred twenty-five patients had occupationally related allergic reactions associated with a cosmetic.

Limitations

This study is limited by its cross-sectional, retrospective design.

Conclusion

Of all patients studied, 21.8% had an allergic reaction associated with a cosmetic. Site of dermatitis, cosmetic categories, and specific allergens differed somewhat by gender.

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Abbreviations used : CAPB, DMAPA, FDA, MCI, MDBGN, MI, NACDG, NOS, PE

Plan

Overall prevalence of positive patch test reactions to cosmetic and non-cosmetic sources

“Allergic” patients

“Cosmetic allergic” patients: Females versus males

Cosmetic sources associated with NACDG standard screening allergens

Occupationally related cosmetic sources linked to NACDG screening allergens

Most common NACDG screening allergens associated with cosmetic sources

Cosmetic sources of non-NACDG screening allergens

Discussion

Formaldehyde-releasing preservatives

Fragrances and M pereirae (balsam of Peru)

Other preservatives

Other common cosmetic allergens

Non-NACDG standard allergens associated with cosmetics

Limitations

	Supported by a Women’s Dermatologic Society Academic Research Grant Program.
	Conflicts of interest: Drs Zug, Fowler, Belsito, Maibach, Marks, Mathias, Storrs, and Buchholz declared no conflicts of interest. Dr Rietschel has been a speaker for Coria Labs. Dr Warshaw has been a consultant for Shire and Noven Pharmaceuticals. Drs Sasseville and Pratt have been consultants for Spexell Pharma. Dr. Pratt has also been an investigator for Coria and Dormer/Chemotechnique. Dr Taylor has been a consultant for the National Institute for Occupational Safety and Health, Betco, Shire, Novartis Pharmaceuticals, Procter & Gamble, BASF, Regent Medical, AMA Press, Consumer Product Safety Commission, and ConvaTec Inc. Dr Taylor has been a speaker for Medicis, Hermal Labs, Aula Medica, and Watson Laboratories, Inc. Dr Taylor has also been an investigator for Mekos Laboratories and Guidant Corp. The Cleveland Clinic Department of Dermatology has received grants from Amgen, Astellas Pharma, Bristol-Myers Squibb, Genentech, Pfizer, Procter & Gamble, and Centocor. Dr Taylor holds stock in GlaxoSmithKline, Amgen, Johnson & Johnson, Keithley Instruments, Medco Health Solutions, Inc, Merck, Wyeth, and Renovo. Dr Taylor has been on the advisory boards for UnitedHealthcare and Connetics Corporation. Dr DeLeo has been a consultant for La Roche-Posay, Johnson & Johnson, Pfizer, and Orfagen. He has also been on an advisory board for Schering-Plough.
	Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.
	Reprints not available from the authors.