Multicenter study of preservative sensitivity in patients with suspected cosmetic contact dermatitis in Korea

Abstract

As many new cosmetic products are introduced into the market, attention must be given to contact dermatitis, which is commonly caused by cosmetics. We investigate the prevalence of preservative allergy in 584 patients with suspected cosmetic contact dermatitis at 11 different hospitals. From January 2010 to March 2011, 584 patients at 11 hospital dermatology departments presented with cosmetic contact dermatitis symptoms. These patients were patch-tested for preservative allergens. An irritancy patch test performed on 30 control subjects using allergens of various concentrations showed high irritancy rates. Preservative hypersensitivity was detected in 41.1% of patients. Allergens with the highest positive test rates were benzalkonium chloride (12.1%), thimerosal (9.9%) and methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) (5.5%). Benzalkonium chloride and chlorphenesin had the highest irritancy rate based on an irritancy patch test performed using various concentrations. Seven of 30 normal subjects had a positive irritant patch reading with 0.1% benzalkonium chloride and eight of 30 normal subjects had a positive irritant patch reading at 4 days with 0.5% chlorphenesin in petrolatum. Although benzalkonium chloride was highly positive for skin reactions in our study, most reactions were probably irritation. MCI/MI and thimerosal showed highly positive allergy reactions in our study. The optimum concentration of chlorphenesin to avoid skin reactions is less than 0.5%.

Patch Test Reactions Associated With Sunscreen Products and the Importance of Testing to an Expanded Series

“…Diazolidinyl urea is a formaldehyde releasing preservative that ranked as the fifth most common allergen in sunscreen-allergic patients in our study. 29,30 However, MI is becoming increasingly used by manufacturers as a single agent preservative. 6% of sunscreens contain diazolidinyl urea vs 5.8% containing quaternium-15).…”

Benzalkonium Chloride

“…27 Higher positive reaction rates occurred in patients tested with BAK 0.1% aq: 1.6% in a study examining patients with contact dermatitis 36 and 12.1% in another study of patients with potential contact dermatitis to cosmetics. 26 However, in a report comparing various concentrations and vehicles of BAK, a greater number of positive reactions was found with the use of 0.15% aq and 0.15% pet rather than solely 0.1% aq, although this may be secondary to the increase in concentration. 25 Further investigation regarding the optimal vehicle to minimize irritancy but capture allergenicity is needed.…”

“…37 The concentration of BAK that is often tested is 0.1% aq or pet. 10,18,21,22,26,27,36,42,47 However, concentration strength can cause irritant reactions, 16 which has led to recommendations for using a lower concentration of BAK, for example, 0.01% 5 or 0.05% 26 in ACD testing. If tested in studies as an irritant or nonsensitizer, concentrations are often higher.…”

Contact sensitization in patients with suspected cosmetic intolerance: results of the IVDK 2006–2011

“…33 An increase in sensitization to MCI/MI in patients with suspected cosmetic intolerance has also recently been reported from Korea, however, without investigating cross-reactivity with MI. 34 Remarkably, the frequency of sensitization to MDBGN is still relatively high (2.5% when tested at 0.2% pet.) although this preservative was banned from cosmetics and body care products in 2008.…”

“…Increasing frequency of sensitization to MI is also probably the cause of the recent increase in contact sensitization to MCI/MI by cross‐reactivity of MI‐sensitized patients to MCI . An increase in sensitization to MCI/MI in patients with suspected cosmetic intolerance has also recently been reported from Korea, however, without investigating cross‐reactivity with MI . Remarkably, the frequency of sensitization to MDBGN is still relatively high (2.5% when tested at 0.2% pet.)…”