Adverse reactions to cosmetics

Introduction

Cosmetics are defined as articles - intended to be rubbed, poured or sprayed on, introduced into or otherwise applied to normal or previously altered (scar, birth mark) human skin or any other part thereof, for cleansing, beautifying, promoting _ attractiveness or altering the appearance and - are not intended to alter or interfere with _ physiological competence of human skin or body.[1]

The incidence of dermatitis from - cosmetics depends upon the degree of - sensitivity influenced by amount, potency and - persistence of allergen, duration of exposure and its irritant properties.[2] Since all cosmetics - and toiletries have to be protected against bacteriological contamination and decomposition and since most consumers require their cosmetics to smell nice, there are potentially sensitizing preservatives and fragrances in most cosmetics.[3]

Commonly used cosmetics on face are soaps, creams, lipsticks, bindi, face foundations, sunscreen, sindoor, etc. Eye cosmetics like eye shadows, eye liners, mascara, kajal, surma etc. Hair cosmetics like shampoo, hair colouring agents such as permanent, semi-permanent and metallic dyes, perming and waving solution, hair-bleach and depilatories. Nail cosmetics like nail polish, nail extensions, nail polish removers are common cause of adverse reactions.

The aim of the present study was to assess the role of commonly used cosmetics in causing adverse reactions and investigate the incidence of allergic contact dermatitis by clinical evaluation of all suspected cases and subjecting them to patch testing.

Materials and Methods

Fifty cases with suspected adverse reaction to cosmetics were included in the study to evaluate the incidence of allergic contact dermatitis clinically as well as with patch test.

Patch testing was performed with Finn Chamber designed by Pirila with cosmetic tray containing 32 basic ingredients provided by Systopic Laboratories, New Delhi and cosmetics of the type-hair dyes, shaving creams, soaps, shampoos, hair oils, lipsticks, bindis, eye makeup, face creams and nail preparation of various brands and colours [Table - 1] and [Table - 2]. The patients were inspected 48 hrs after the application of patches. Photopatch testing was done where patient gave history of photosensitivity and use of photosensitizer such as hair dyer, lipsticks, perfumes etc. Grading of dermatitis was done according to standard criteris.[4]

Observations

Out of 2065 patches applied, positive results were obtained in 3.2% (66/2065) patches with standard cosmetic kit and 3.3% (69/2065) patches with various cosmetics. Results of patch test performed with patients own cosmetics and standard cosmetic kit is shown in [Table - 3]. Some of the patients were suspected to be suffering from adverse effects to more than one cosmetic. The reactions were confirmed to be of allergic type by positive patch test [Table - 4] and non-allergic type as shown in [Table - 5].

Discussion

Rook (1998) estimated that 1-3% of the population is allergic to a cosmetic on their ingredients whereas De Groot (1987)[5] reported 3.4% positive patch tests (67/1781) with patients own cosmetic products. In our study the incidence of contact allergic dermatitis seen was 3.3% (69/2065 patches) with various cosmetics used by the patient.

The most common type of adverse reaction to cosmetics seen in the patients was contact allergic dermatitis in 59.2% (29/49 cases) mainly to hair dyes, shaving creams and lipsticks. Photoallergic dermatitis was seen in 35% (7/20 cases) only to hair dyes and lipsticks. The other less common reactions were contact irritant dermatitis (15 cases), hyperpigmentation (8 cases), hypopigmentation (6 cases), contact urticaria (5 cases), acneiform eruptions (4 cases), hair breakage (2 cases) and nail breakage (1 case).

Multiple sensitivities was seen with various cosmetics and their ingredients in few cases and positive correlation was obtained in some of these cases. PPD is a very strong sensitizer and a common contact allergen in hair dyes. Pasricha[6] has shown positive patch test with PPD in 42% cases (61/144) and 40% (57/144) with hair dyes. Similarly, Dogra et al showed 35% sensitivity with PPD in hair dyes.[7] In our study, 45% (9/20) patients of hair dye dermatitis developed reaction to PPD. Similarly with other cosmetics, few ingredients of the basic kit showed positive reaction and helped us to establish causal link such as shaving cream with isopropyl myristate and musk mix,[8] soaps with chloroxylenol,[9] jasmine absolute and synthetic; lipsticks with propyl gallate,[10] bindis with tertiary butyl hydroquinone[11] and face cream with bronopol, butyl hydroxy anisole, cetyl alcohol, isopropyl myristate, sorbitan mono-oleate, sorbitan sesquioleate, triethanolamine and various perfumes etc.

Adverse reaction to cosmetics is not commonly seen when compared to its vast usage as only severe type of reactions are reported to dermatologists or cosmetologists. It is important that labeling of the ingredients of the cosmetics with date of manufacture and expiry as well a: instructions of use should be written on packing sc that sensitive individuals are aware of any allergenic ingredient in the cosmetic prior to purchase.