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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 37  |  Issue : 1  |  Page : 7-10

Cosmetic contact sensitivity among beauticians and hairdressers: a clinicoepidemiological study


Treatwell Skin Centre, Jammu, Jammu and Kashmir, India

Date of Submission23-Oct-2016
Date of Acceptance25-Dec-2006
Date of Web Publication2-Jun-2017

Correspondence Address:
Mrinal Gupta
Treatwell Skin Centre, Jammu, Jammu and Kashmir 180019
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-6530.207494

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  Abstract 

Background
The increased use of cosmetics has lead to an increased prevalence of allergic contact dermatitis to cosmetics, with an estimated 1–5.4% of the general population suffering from allergic sensitivity to one or more cosmetic components. As beauticians and hairdressers have recurrent exposure to several cosmetics as a part of their occupation, the incidence of cosmetic dermatitis among this group is bound to be high.
Objectives
The aim of this study was to study the patterns of cosmetic dermatitis among beauticians and hairdressers and to identify the most common allergens and cosmetic products causing dermatitis using patch testing.
Patients and methods
Thirty consecutive patients (beauticians and hairdressers) (M : F=11 : 19) with suspected cosmetic dermatitis were examined, detailed history regarding the use of different cosmetics was taken, and the pattern of dermatitis was noted. All of them were subjected to patch testing using the Indian Cosmetic Series and eight antigens of the Indian Standard Series.
Results
The study included 11 (36.67%) men aged between 23 and 54 years and 19 (63.33%) women aged between 28 and 49 years. The majority of the patients were in the 21–40 (86.67%; n=26) years age group. The most common sites of cosmetic dermatitis observed were hands in 18, face and neck in nine, and disseminated dermatitis in three patients. The most frequently used cosmetics were hair dyes (76.66%), soaps (76.66%), face creams (70%), shampoos (63.33%), perfumes (53.33%), and shaving creams (30%). Patch test positivity was seen in 22 (73.33%) patients, and the most common allergens were paraphenylenediamine in 13 (43.33%), fragrance mix in six (20%), thiomersal in four (13.33%), and cetrimide in two (6.66%) patients.
Conclusion
The incidence of cosmetic dermatitis is high among beauticians and hairdressers, with hands and face being the most commonly affected sites. Hair dyes and creams are the most commonly implicated agents, whereas paraphenylenediamine, fragrance mix, thiomersal, and cetrimide are the most common causative allergens.

Keywords: beauticians, cosmetic dermatitis, hair dye, hairdressers, occupational dermatoses, paraphenylenediamine


How to cite this article:
Gupta M. Cosmetic contact sensitivity among beauticians and hairdressers: a clinicoepidemiological study. Egypt J Dermatol Venerol 2017;37:7-10

How to cite this URL:
Gupta M. Cosmetic contact sensitivity among beauticians and hairdressers: a clinicoepidemiological study. Egypt J Dermatol Venerol [serial online] 2017 [cited 2017 Oct 18];37:7-10. Available from: http://www.ejdv.eg.net/text.asp?2017/37/1/7/207494


  Introduction Top


‘Cosmetics’ are defined as ‘articles intended to be rubbed, poured, or sprayed on, introduced into, or otherwise applied to the human body or any part thereof for cleansing, beautifying, promoting attractiveness, or altering the appearance without affecting the body’s structure or functions’ [1]. With increasing westernization and enhanced media exposure, the use of cosmetics has increased manifold among the general population. Nowadays, almost everyone uses cosmetic products like soaps, creams, shampoos, and deodorants, and make-up products like hair dyes, lip, and nail paints. Most of these substances contain ingredients capable of causing sensitization of the skin, thus leading to cosmetic dermatitis. Various researchers have reported the prevalence rates of cosmetic dermatitis ranging from 4 to 9% in the general population [2]. A recent study of cosmetic dermatitis in the USA has revealed that out of 10 061 patients, 23.8% females and 17.8% males have a positive patch test to at least one allergen from a cosmetic source [3]. The clinical picture of cosmetic dermatitis depends on the type of products used (and, consequently, the sites of application), exposure, and the patient’s sensitivity.

As beauticians and hairdressers have an increased occupational exposure to these cosmetics, the incidence of cosmetic dermatitis among this occupational group is bound to be high. Many studies have reported that hairdressers and beauticians are among the most commonly affected occupational groups with cosmetic dermatitis [4]. Commonly used cosmetics like soaps, creams, lipsticks, foundations, sunscreens, perfumes, and eye, hair, and nail cosmetics can cause allergic contact dermatitis.

This study was carried out to study the patterns of cosmetic dermatitis among beauticians and hairdressers and to identify the most common allergens and cosmetic products causing dermatitis using patch testing.


  Patients and methods Top


Thirty consecutive beauticians and hairdressers with suspected allergic contact dermatitis to cosmetics were included in the study after taking an informed consent. Pregnant or lactating women were excluded. Patients having acute dermatitis were patch tested after control of their dermatitis, when they were off systemic corticosteroids, or the dose of prednisolone was less than 20 mg/day. Details about age, sex, personal or family history of atopy (nasobronchial allergy, asthma, and childhood eczema), use of cosmetics and its duration, onset, duration, and distribution of dermatitis were noted. The enrolled patients were patch tested by using the Finn chambers method with the Indian Cosmetic Series and eight antigens of the Indian Standard Series recommended by the Contact Dermatitis and Occupational Dermatoses Forum of India ([Table 1]) [5]. Patches were applied on the upper back and the patients were asked to return for results after 48 h (day 2) and 72 h (day 3). The results were graded according to the International Contact Dermatitis Research Group criteria [6]. Only reactions persisting on day 3 were considered positive for the final analysis. Relevance of a positive patch test results was determined clinically.
Table 1: List of allergens used for patch testing

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Side effects such as adhesive tape reaction, discomfort and itching, flare of dermatitis, angry back phenomenon, active sensitization, and pigment alteration at test site, when they occurred, were recorded. A patch test for the suspected cosmetic agent itself and the photopatch test were not carried out.


  Results Top


The study included 11 (36.67%) men aged between 23 and 54 years and 19 (63.33%) women aged between 28 and 49 years. The majority of patients were in the 21–40 years age group (86.67%; n=26). The total duration of dermatitis was less than 1 year in 22 (73.33%) patients, 1–5 years in five (16.67%) patients, and more than 5 years in three (10%) patients. The minimum duration was 1 month and the maximum duration was 6 years, and the mean duration was 16 months. Eight (26.67%) patients had a history of atopy. The duration of cosmetic usage varied from less than 1 year in seven (23.33%) patients to more than 5 years in 15 (50%) patients. The other eight (26.67%) patients were using hair dyes for a variable period of 1–5 years.

Clinically, characteristic acute (erythematous, edematous, oozy, crusted eczematous plaques), subacute, and chronic dermatitis (hyperpigmented, lichenified eczematous lesions) involving multiple sites such as face, hands, scalp, neck, upper back, and feet were observed in all cases. The most common patterns of cosmetic dermatitis observed were contact dermatitis localized to hands in 18, followed by dermatitis of face and neck in nine, and disseminated dermatitis in three patients ([Figure 1] and [Figure 2]). Itching was the most common symptom present in 24 (80%) patients and the most common clinical manifestation was erythema and papules in 22 (73.33%) patients. Hyperkeratosis and fissuring of hands was present in six (20%) patients.
Figure 1: Pigmented contact dermatitis in a patient with patch test positivity to thiomersal.

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Figure 2: (a) Hand eczema due to paraphenylenediamine (PPD). (b) Patch test shows 3+ reaction to PPD.

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The most frequently used cosmetics were hair dyes (76.66%), soaps (76.66%), face creams (70%), shampoos (63.33%), perfumes (53.33%), and shaving creams (30%).

On performing a patch test, 22 (73.33%) patients showed positive reaction to one or more allergens, thus confirming the diagnosis of allergic cosmetic dermatitis. The most common allergens giving a positive patch test were paraphenylenediamine (PPD) in 13 (43.33%), fragrance mix in six (20%), thiomersal in four (13.33%), and cetrimide in two (6.66%) patients. Positive patch test to gallate mix, formaldehyde, paraben, and Kathon CG were seen in one patient each.


  Discussion Top


The use of cosmetics has increased exponentially over the last few decades because of increased societal pressure and changing fashion trends. Most allergic reactions are caused by those cosmetics that remain on the skin: ‘stay-on’ or ‘leave-on’ products such as skincare products (moisturizing and cleansing creams, lotions, milks, tonics), hair cosmetics (notably hair dyes), nail cosmetics (nail varnish), deodorants and other perfumes, and facial and eye make-up products. ‘Rinse-off’ or ‘wash-off’ products, such as soap, shampoo, bath foam, and shower foam, less commonly induce or elicit contact allergic reactions [7].

Occupational contact dermatitis is under-recognized and underdiagnosed, leading to undertreatment. Beauticians and hairdressers are a high-risk occupational group for the development of cosmetic dermatitis. In a study by Warshaw et al. [8], hairdressers and beauticians were the most common patient group, constituting 43% of the total patients, followed by healthcare workers and students (16.5 and 4.2%, respectively). This patient group comes in contact to a variety of cosmetic antigens that may act as irritants or allergens; moreover, trauma comprising rubbing and scrubbing accounts for breaking the barrier system of skin, enabling the antigens to penetrate in the skin and cause reactions.

Allergic contact dermatitis occurs at the site of contact with an allergen. More than half of the reported cases of cosmetic sensitivity occur on the face and the periocular area [4]. The site of eruption usually indicates the causative agent. In a prospective study of 2660 patients of allergic cosmetic dermatitis, face (46 · 9%), hands (23 · 5%), neck (17 · 9%), and axillae (12.3%) were the most common sites of involvement [9]. In our study, the most common sites of cosmetic dermatitis observed were hands in 18, followed by dermatitis of face and neck in nine patients, which can be attributed to recurrent occupational exposure of cosmetics over these sites.

Atopic dermatitis is the major predisposing factor for eczemas. In our study, history of atopy was present in only 26.67% of the patients. Atopics have an irritable skin that is vulnerable to common irritants like soaps and detergents, and environmental factors like hot humid weather, which can precipitate the disease. Warshaw et al. [4] found a significant correlation between atopy and cosmetic dermatitis, with a majority of patients with cosmetic dermatitis having atopic diathesis in their study.

Mehta and Reddy [10], in his study on the pattern of cosmetic sensitivity in Indian patients, reported that bindi, hair dye, and face creams were the most commonly suspected cosmetics in contact dermatitis due to cosmetics. The most frequently implicated cosmetics in our study were hair dyes (76.66%), soaps (76.66%), face creams (70%), shampoos (63.33%), perfumes (53.33%), and shaving creams (30%).

Cosmetic dermatitis can present with variable manifestations. It may acutely present with pruritic papules, vesicles, or bullae. Chronic exposure may result in eczematous dermatitis. Because most cosmetic ingredients are relatively weak allergens, chronic eczematous dermatitis is more common than is acute vesicular eruptions. In our study, the total duration of dermatitis was less than 1 year in 22 (73.33%) patients, 1–5 years in five (16.67%) patients, and more than 5 years in three (10%) patients, and the most common presenting symptoms were itching and erythema with papules.In our study, the most common allergens showing a positive patch test were PPD in 13 (43.33%), fragrance mix in six (20%), thiomersal in four (13.33%), and cetrimide in two (6.66%) patients. Positive patch test to gallate mix, formaldehyde, paraben, and Kathon CG were seen in one patient each. Minamoto [11] studied the causative agents for cosmetic dermatitis in a sample of Japanese population and patch tested 805 patients of cosmetic dermatitis. PPD (hair dyes) was the most common allergen in 7.9%, followed by fragrance mix (4%), colophony (3.2%), lanolin (2.7%), and formaldehyde, parabens, and Kathon CG (2.7, 1.9, and 1.0%, respectively). In the study by Warshaw et al. [4], the most frequent occupationally related allergens among hairdressers were glyceryl thioglycolate, PPD, nickel sulfate, 2-hydroxyethyl methacrylate, and quaternium-15, and furthermore, hair dyes, permanent wave solutions, and other hair products were common sources of allergens.

Contact sensitivity from cosmetics is becoming a prevalent health problem. In a growing economy like ours, where the demand of cosmetics is increasing manifold, there is an urgent need to increase awareness among consumers regarding the adverse effects of cosmetics, the available safer alternatives, and the significance of performing sensitivity testing before actual use, in adherence to the usage instructions.

Limitations

Cosmetics contain a wide variety of chemicals other than those available in the Standard Cosmetic Series, which could have led to cosmetic dermatitis. Unavailability of these allergens, unavailability of the photopatch testing, the small number of patients, and not testing with patients’ own cosmetics may have resulted in our missing some cases of cosmetic dermatitis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Larsen WG, Jackson EM, Barker MO, Bednarz RM, Engasser PG, O’Donoghue MN et al. A primer on cosmetics. J Am Acad Dermatol 1992; 27:469–484.  Back to cited text no. 1
    
2.
Warshaw EM, Maibach HI, Taylor JS, Sasseville D, DeKoven JG, Zirwas MJ et al. North American contact dermatitis group patch test results: 2011-2012. Dermatitis 2015; 26:49–59.  Back to cited text no. 2
    
3.
Orton DI, Wilkinson JD. Cosmetic allergy: incidence, diagnosis, and management. Am J Clin Dermatol 2004; 5:327–337.  Back to cited text no. 3
[PUBMED]    
4.
Warshaw EM, Wang MZ, Mathias CG, Maibach HI, Belsito DV, Zug KA et al. Occupational contact dermatitis in hairdressers/cosmetologists: retrospective analysis of North American contact dermatitis group data, 1994 to 2010. Dermatitis 2012; 23:258–268.  Back to cited text no. 4
    
5.
Sharma VK, Sethuraman G, Garg T, Verma KK, Ramam M. Patch testing with the Indian standard series in New Delhi. Contact Dermatitis 2004; 51:319–321.  Back to cited text no. 5
[PUBMED]    
6.
Wilkinson DS, Fregert OS, Magnusson B, Bandmann HJ, Calnan CD, Cronin E et al. Terminology of contact dermatitis. Acta Derm Venereol 1970; 50:287–292.  Back to cited text no. 6
    
7.
de Groot AC. Contact allergens − what’s new?. Clin Dermatol 1997; 15:485–492.  Back to cited text no. 7
    
8.
Warshaw EM, Buchholz HJ, Belsito DV, Maibach HI. Allergic patch test reactions associated with cosmetics: retrospective analysis of cross-sectional data from the North American Contact Dermatitis Group, 2001-2004. J Am Acad Dermatol 2009; 60:23–38.  Back to cited text no. 8
    
9.
Wohrl S, Hemmer W. The significance of fragrance mix, balsam of Peru, colophony and propolis as screening tools in the detection of fragrance allergy. Br J Dermatol 2001; 145:268–273.  Back to cited text no. 9
    
10.
Mehta SS, Reddy BSN. Pattern of cosmetic sensitivity in Indian patients. Contact Dermatitis 2001; 45:292–293.  Back to cited text no. 10
    
11.
Minamoto K. Skin sensitizers in cosmetics and skin care products. Nihon Eiseigaku Zasshi 2010; 65:20–29.  Back to cited text no. 11
    


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