Allergic contact dermatitis caused by topical herbal remedies: importance of patch testing with the patients' own products

Diagnostic Workup in IgE-Mediated Allergy to Asteraceae Weed Pollen and Herbal Medicine Products in Europe

Anemophilous weeds from the Asteraceae family are highly allergenic and represent a significant source of aeroallergens in late summer and autumn. Ragweed and mugwort pollen allergies have become a significant health burden in Europe. Some people with respiratory allergies to weed pollen may also suffer hypersensitivity reactions to herbal medicines obtained from certain cross-reactive plants in the Compositae family, such as chamomile, marigold, and purple coneflower. General physicians, ear, nose, and throat (ENT) specialists, and pulmonologists need to be familiar with the diagnostic tests used by allergists in clinical practice to support accurate diagnosis in such patients. Allergists must also be aware of the suggestions of the European Medicines Agency (EMA)'s Herbal Medicinal Products Committee and the broad spectrum of herbal therapies to educate their patients about potential risks.

Results of Patch Testing to Botanicals: Review of the Mayo Clinic Experience Over 2 Decades (1997-2017)

Background: Botanicals are increasingly incorporated into skincare products. Although allergic contact dermatitis due to botanicals is recognized, data describing the prevalence of positive patch tests to botanicals are sparse. Objective: To report the Mayo Clinic experience of patch testing to selected botanical products in the standard, extended standard, fragrance, and plant series. Methods: IRB-approved retrospective study of the Mayo Clinic experience with patch testing to botanicals from 1997 to 2017. Results: In total, 12,169 people were patch tested to botanicals in the standard, extended standard, fragrance, and plant series; 4032 were men and 8137 were women. The mean age of the population tested was 54 (standard deviation 17.7) years. Almost 11% (1320/12,169) of the patch-tested population exhibited positive reactions to at least 1 botanical agent. Myroxylon pereirae resin 25% was the most common positive allergen in the series. Patients who had positive reactions to at least 1 botanical agent were more (19.8%) likely to have a positive reaction to at least 1 additional botanical than those patients who did not have any positive tests. Most patients presented with generalized involvement (334) or involvement of the hands (284) or face (232). Conclusion: Physicians should be aware of the high prevalence of allergic contact dermatitis and patch test positivity associated with botanical products.

In a Preliminary Study on Human Subjects, a Cosmetic Cream Containing a Harungana madagascariensis Plant Extract Induces Similar Anti-Aging Effects to a Retinol-Containing Cream

Retinoids are the most effective anti-aging ingredients. Yet, their use can result in adverse reactions. Even bakuchiol, a natural functional analog, can lead to contact dermatitis. We previously showed that a Harungana madagascariensis (Lam. ex Poir.) plant extract (HME) presents retinol-like properties in vitro. Therefore, we performed a preliminary analysis of the anti-aging potential of a cream containing HME on 46 subjects. The participants applied a HME cream on half of their face and one forearm. The effects induced were compared to those produced by a retinol cream applied to the contralateral side. Clinical evaluations indicate that the two creams rapidly (28 days) improve wrinkles underneath the eyes, ptosis, color homogeneity, smoothness, plumpness, firmness, and elasticity of the facial skin. The improvement of crow's feet is only significant after 56 days. For all clinical signs, the effects of both creams are indistinguishable. Instrumental measurements of silicon replica from the eye contour region indicate that the wrinkle surface reduction is already noticeable after 28 days with the HME and retinol cream, while it takes 56 days to have a significant depth decrease. Only the retinol cream improves wrinkle length after 56 days. Ultrasound assessment of forearm skin revealed that the HME cream improves superficial dermis density as early as 28 days with further improvement at day 56, timepoint at which improvement is at the limit of significance with the retinol cream. These preliminary results indicate that HME has similar in vivo functional properties to retinol for reducing the severity of aging signs. Future works, including a bona fide clinical study, are needed to confirm these findings.

Spreading Allergic Contact Dermatitis to Tea Tree Oil in an Over-the-Counter Product Applied on a Wart

Tea tree oil is an essential oil obtained by distillation from the leaves and terminal branchlets of Melaleuca alternifolia and is now present in numerous products for body care and self-medication. We report a case of allergic contact dermatitis to tea tree oil in a young man who was applying a lotion containing tea tree oil on a wart localized on the plantar aspect of the right big toe, which had previously been treated with cryotherapy. He developed a severe eczematous eruption on the right foot and the right leg, with subsequent id reactions affecting the right thigh, the contralateral lower limb, the trunk and the upper limbs. The lotion was discontinued, and the dermatitis resolved after topical corticosteroid therapy. Patch testing with the aforementioned lotion 10% pet. and oxidized tea tree oil 5% pet. identified tea tree oil as the culprit agent of the dermatitis. This case report confirms that products made of natural ingredients, often perceived to be harmless, can cause allergic reactions.

Facial contact dermatitis caused by cosmetic-relevant allergens

BACKGROUND

Facial allergic contact dermatitis caused by cosmetic products is common. New allergens in cosmetics continuously emerge.

OBJECTIVES

To investigate characteristics of patients with facial dermatitis (FD) between 2010 and 2019 including patch test results from cosmetic-related allergens and a new test series with cosmetic-relevant natural ingredients (CRNIs).

METHODS

This is a retrospective study analysing demographics, clinical characteristics according to MOAHLFA index (male; occupation; atopic dermatitis; hand; leg; face; age ≥ 40 years), and patch test results to 27 cosmetic-relevant allergens in FD patients. A prospective study evaluating a screening test series with CRNIs in consecutive FD patients for 1 year was also conducted. These patients received a questionnaire for collecting extra characteristics (eg, concerning quality of life).

RESULTS

Of 8740 tested patients, 2292 (26.2%) had FD. Of these, 30.6% had cosmetic-induced FD. The most common cosmetic-related allergens were fragrances and preservatives. The most common patch test-positive CRNIs were hydroperoxides of limonene and linalool, and propolis. Potato and peanut were rare, but the most common prick test-positive CRNIs, however, without any relation to the use of cosmetic products. FD affected nearly all patients' quality of life and caused limitations to their daily life.

CONCLUSIONS

Updated management and quick diagnosis of FD is important to avoid negative impact on patients' quality of life.

Iatrogenic allergic contact dermatitis in the (peri)anal and genital area

BACKGROUND

Allergic contact dermatitis (ACD) from topical medication often occurs in occluded areas, for example, with wound treatment, but also in certain body locations, such as the anogenital area.

OBJECTIVES

To investigate the demographics and specific lesion location of patients with ACD from topical drugs applied onto the (peri)anal/genital area, and to identify the respective causal topical pharmaceutical products and ingredients involved.

METHODS

From January 2000 to December 10, 2018, 532 patients were tested with the baseline series, sometimes with additional series, and the topical medication used along with the ingredients. The relevant data were extracted from our electronic databases developed in-house.

RESULTS

Forty-four patients (9%) out of 473 patients suffering from lesions in the (peri)anal/genital area had positive patch test results to topical drug preparations and/or their ingredients, sometimes in association with cosmetics for intimate hygiene. The most frequent sensitizing active principles were local anaesthetics and corticosteroids, while wool alcohols and to a minor extent benzoic acid were the most frequent culprits among the vehicle components and preservative agents, respectively.

CONCLUSIONS

The local conditions (eg, occlusion, sweating, moist) in the anogenital area may favour skin sensitization to topical medication used to treat various skin diseases.

Usefulness of Patch Testing With Patient's Own Products in the Diagnosis of Allergic Contact Dermatitis

BACKGROUND

The usefulness of using patient's own products in patch tests for the diagnosis of allergic contact eczema is well known. However, most of the literature is based on case series published decades ago, and they are focused on cosmetics and fragrances.

OBJECTIVE

The aim of the study was to evaluate the usefulness of using patient's own products in patch tests for the diagnosis of contact eczema in a contact dermatitis unit, describing the most frequently positive own products, as well as the most frequently responsible allergens.

METHODS

In a 17-year period, 3514 patients were patch tested in our department. In 2429 patients, patch testing with the patients' own products was performed.

RESULTS

We found that 363 patients (10.33%) reacted to their own products. In 131 cases (3.81%), reacting to their own product was the only clue for detecting the responsible allergen for allergic contact eczema. Most reactions were found for topical medications, moisturizers, and adhesives. Fragrance mix I, methylchloroisothiazolinone/methylisothiazolinone, ketoprofen, and colophony were found to be the allergens most often responsible.

CONCLUSIONS

It is essential to include patient's own products in the study of allergic contact eczema to make a correct diagnosis. In our series, 3.81% of the patients would not have been correctly diagnosed if their own products had not been included in patch tests.

Natural ingredients in cosmetic products-A suggestion for a screening series for skin allergy

BACKGROUND

Naturally derived cosmetic product ingredients of both plant and animal origin are being included increasingly in product formulations in order to cater to consumer preferences. They may be an overlooked cause of reactions to cosmetic products in some patients with dermatitis.

OBJECTIVES

To identify naturally derived cosmetic product ingredients with allergenic potential (type I and type IV) and propose a cosmetic screening test series.

METHODS

The study was conducted in two steps. The first step was a market survey using a nonprofit application helping consumers avoid problematic substances in cosmetic products. The application contained 10 067 cosmetic products that were label checked for naturally derived cosmetic product ingredients. The second step was a literature search to examine how frequently the naturally derived ingredients were described and related to allergic reactions in cosmetics or other topically administered products.

RESULTS

We identified 121 different naturally derived cosmetic product ingredients that were included in at least 30 cosmetic products. In total, 22 ingredients were selected for a screening test series.

CONCLUSIONS

We propose a supplemental patch test and a prick test screening series with naturally derived cosmetic product ingredients for patients with skin reactions to cosmetic products, aiming to identify a cause in more patients than is currently possible.

Allergic Contact Dermatitis to Fragrances

Allergic contact dermatitis to fragrance is common. The prevalence of fragrance allergy in the general population is between 0.7% and 2.6%. In patch-test populations, the positive reaction rate to fragrances ranges from 5% to 11%. The most common fragrance screeners in most baseline series include fragrance mix 1, fragrance mix 2, and Balsam of Peru. The addition of hydroxyisohexyl 3-cyclohexene carboxaldehyde, hydroperoxides of limonene, and hydroperoxides of linalool to screening series can further aid in the diagnosis of fragrance allergy. In the proper clinical setting, supplemental patch testing with an additional fragrance or essential oil series should be considered.

Contact Allergy-Emerging Allergens and Public Health Impact

Contact allergy (sensitisation) and allergic contact dermatitis (ACD) resulting from it have a considerable public health impact. For the present review, all pertinent articles were systematically searched via Medline and Web of Science™; additionally, all available issues of the journals "Contact Dermatitis" and "Dermatitis" were manually searched, covering the years 2018-2019, thereby extending and re-focusing a previous similar review. New allergens, or previously described allergens found in a new exposure context or of other current importance, are described in sections according to substance classes, e.g., metals, preservatives, fragrances. As a common finding in many investigations, a lack of information on product composition has been noted, for instance, regarding a newly described allergen in canvas shoes (dimethylthiocarbamylbenzothiazole sulfide) and, most notably, absence of co-operation from manufacturers of glucose-monitoring devices and insulin pumps, respectively. These latter devices have been shown to cause severe ACD in a considerable number of diabetic patients caused by the liberation of isobornyl acrylate and N,N'-dimethylacrylamide, respectively, as demonstrated by an international collaboration between dermatologists and chemists. Improved and complete ingredient labelling for all types of products, and not just cosmetics, must be put on the legislative agenda.

Phytodermatitis in East and southeast of Turkey: A prospective study

OBJECTIVE

Some plants may cause cutaneous side effects called phytodermatitis due to skin contact. Plants that cause phytodermatitis vary according to countries and regions. The aim of this study was to examine the phytodermatitis cases seen in Turkey's east and southeast and compare them with phytodermatitis cases seen previously in the literature in these provinces and to revise the literature.

MATERIAL AND METHODS

In this study, 34 patients with phytodermatitis were prospectively evaluated. The demographic and clinical characteristics of the patients such as age, sex, affected areas, dermatitis type, and plant name were recorded.

RESULTS

Phytophotodermatitis (PPD) developed in 7 (20,5%) of 34 patients. PPDs occured after contact of Heracleum persicum, Ferula orientalis and Chaerophyllum macropodum Boiss. Two (5.8%) patients developed allergic contact dermatitis due to Xanthium strumarium. Irritant contact dermatitis (ICD) developed in 25 patients (73.5%). ICD was most frequently associated with Tragopogon porrifolius (8 patients). In other patients, ICD was developed due to Ranunculus arvensis, Mentha pulegium, Euphorbia helioscopia, Heracleum persicum, Malva sylvestris, Mandragora autumnalis, Plantago major, and Rheum ribes.

CONCLUSION

In our study, we determined the cases of PPD caused by F. orientalis and Chaerophyllum macropodum Boiss, which were not previously described in the literature, and ICD which was caused by R. ribes. Clinicians should be aware that cutaneous reactions due to these plants may develop. Our study is the first comprehensive and prospective study on phytodermatitis in Turkey. More studies are needed to determine causes and prevalance of phytodermatitis in Turkey.

Safety of a formulation containing chitosan microparticles with chamomile: blind controlled clinical trial

OBJECTIVE

to evaluate the safety of a topical formulation containing chamomile microparticles coated with chitosan in the skin of healthy participants.

METHOD

phase I blind, controlled, non-randomized, single-dose clinical trial with control for skin, base formulation, and formulation with microparticles. The variables analyzed were irritation and hydration by the Wilcoxon and Kruskall-Wallis tests.

RESULTS

the study started with 35 participants with a mean age of 26.3 years. Of these, 30 (85.71%) were female, 29 (82.90%) were white skinned and 32 (91.40%) had no previous pathologies. One participant was removed from the study reporting erythema at the site of application, and four other participants for not attending the last evaluation. In the 30 participants who completed the study, the tested formulation did not cause erythema, peeling, burning, pruritus or pain; there was an improvement in cutaneous hydration in the site of application of the formulation with microparticles. In the evaluation of the barrier function, there was an increase in transepidermal water loss in all sites.

CONCLUSION

the formulation with chamomile microparticles is safe for topical use, not causing irritation and improving skin hydration over four weeks of use. Its effects on barrier function need further investigation. No. RBR-3h78kz in the Brazilian Registry of Clinical Trials (ReBEC).