Cosmetic allergies

FDA Consumer, Nov, 1986 by Dori Stehlin

Cosmetic Allergies

Whether or not a permanent improves a person's appearance is a matter of opinion. But when Carolyn, a secretary in Rockville, Md., arrived at her wedding shower one May evening, it was easy to see that the permanent she got at a beauty salon the day before had not produced the desired results. While the chemical treatment did give her curly hair, it also gave her a red, swollen face.

"I tried to cover it up with makeup,' she said, "but it didn't help much. I was so embarrassed at the shower. Thank goodness I didn't wait until right before the wedding.'

Carolyn had a care of cosmetic contact dermatitis--an acute allergic inflammation of the skin caused by contact with various substances found in cosmetics. In addition to the redness and swelling, her skin was weeping and covered with papules (small, solid elevations of the skin)-- all classic symptoms of contact dermatitis.

Cases of contact dermatitis from cosmetics are rarely painful or life-threatening, but they sometimes can be so uncomfortable the unhappy victim will seek a doctor's care. The frequency of adverse reactions to cosmetics that require a physician's care is approximately 210 per 1 million cosmetic products purchased, according to information from a Food and Drug Administration survey and a study of cosmetic reactions conducted by the North American Contact Dermatitis Group, a task force of the American Academy of Dermatology.

Skin-care products, such as facial cleansers and moisturizers, were associated with the largest number of cosmetic allergic reactions in the study, which ran from September 1977 to August 1983. Hair preparations in general, including hair dyes, formed the second largest group, and facial makeup, such as foundation and blusher, was third. Other problem products included nail preparations and fragrance products.

As for the types of ingredients that cause the allergic reactions, the study found that fragrances and fragrance ingredients were responsible for the greatest number. Preservatives were next, followed by pphenylenediamine (found in hair dyes), lanolin, the hair-waving ingredient glyceryl monothioglycolate, and propylene glycol (a skin softener).

What caused Carolyn's reaction? It may have been a chemical in the permanent itself or one of the many ingredients in the other products she used before and after the permanent--the shampoo, conditioner, neutralizer. She never did find out, and she's still worried that the ingredient will be in some other products she may use.

"It is important to find out which ingredient causes an allergic reaction, so a consumer can look for that ingredient in other products,' said Heinz Eiermann, director of FDA's Division of Colors and Cosmetics. Yet half of the patients and their dermatologists in the contact dermatitis group study did not at first realize that a cosmetic was responsible for the dermatitis. Dr. Robert M. Adams, clinical professor of dermatology at Stanford University and a member of the contact dermatitis group, called that an important--and surprising--finding.

Why don't the patients or doctors suspect a cosmetic? One possible reason is that a product can be used without a reaction for years before "suddenly' causing an allergic problem. Repeated exposure to the offending ingredient can build up sensitivity.

"A lot of people can walk through poison ivy without any kind of reaction, but after a while their cells start to recognize this antigen and they start to react to it,' said John Sanders, a dermatologist with FDA's Center for Drugs and Biologics. "The same thing can happen with cosmetics. Patients will tell me "I've been using this product for several years; it can't be.' But there's always a first time.'

What should be done if a reaction occurs? First, stop using all cosmetics. To help relieve the itching, 0.5 percent hydrocortisone cream can be applied, several times a day if needed. Other treatments include wet compresses and Aveeno (an oatmeal preparation). (See "The Itch of the Great Outdoors' in the June 1986 FDA Consumer.)

A mild reaction should clear up in seven to 10 days. For severe reactions or ones that last longer than 10 days, a doctor may prescribe a stronger topical steroid preparation or oral medication.

Once the reaction is completely over, cosmetics can be tested, one by one, to find the guilty party. "Before putting a product all over the face and breaking out, place a little on the forearm and watch it for at least 24 hours,' FDA's Eiermann advises.

Since consumers use an average of 12 cosmetic products, more or less, at the same time, it may take a while before the offending product is found. But there are a few things to watch for to make the detective work easier. Was a new product used only a few times before the reaction occurred? It should be tested first. Although sensitivity to an ingredient has to build up before a reaction occurs, just two applications of that ingredient may be enough. Even a new bottle or jar of a product used before can be the cause of the problem. Manufacturers are constantly reformulating cosmetics--a new ingredient may have just been added.