The Federal Food, Drug, and Cosmetic Act (FD&C Act, sec. 201(i)) defines cosmetics¹ as “articles intended to be rubbed, poured, sprinkled, or sprayed on, introduced into, or otherwise applied to the human body…for cleansing, beautifying, promoting attractiveness, or altering the appearance“.

These products include moisturizers, lipsticks, eye, and facial makeup, nail polish, cleansing shampoos, deodorants, and even hair color. Almost all women and most men use one or more of them on a daily basis. Most do not experience any problems. However, some predisposed individuals develop an annoying and unsightly skin allergy, called allergic contact dermatitis, to some of the ingredients.

This article examines the causes, treatments, and prevention of allergic skin reactions to cosmetics.

Allergic reactions to cosmetics

An allergic reaction is an overreaction of the immune system to a substance that, in most people, is harmless. Many of us are familiar with seasonal allergies, such as the development of itchy red eyes and a runny nose caused by aerosolized pollen from ragweed or other grasses.

Allergic reactions from cosmetics occur on the skin where the product has been applied to the skin – thus the name “contact” dermatitis. It often appears as a red itchy, sometimes weepy rash. In some cases raised red welts, known as hives, may appear and localized swelling.

The most common types of ingredients that cause contact dermatitis from cosmetics include the following:

1. 1. • Fragrances
      • Preservatives
      • Dyes & color additives
      • Rubber or latex

Let’s examine each of these in turn.

–Fragrance

Fragrance is the term used to describe natural or synthetic substances used in cosmetics and skincare products to give the product a distinct scent. It is the most common cause of allergic contact dermatitis from a cosmetic being responsible for 30-45% of all reactions to cosmetic products.²

They are found in most types of cosmetics including moisturizers, shampoos, conditioners, facial cosmetics, perfumes, and deodorants. More often than not, there is more than one fragrance ingredient in any given product. Individual products may contain up to several hundred fragrance compounds.

The word fragrance, therefore, often represents a cocktail of many fragrance compounds. Because the exact composition of a fragrance is considered proprietary information, or “trade secrets”, the FDA does not require the manufacturer to list the individual ingredients that constitute the fragrance. Instead, the Ingredient listing may just say fragrance.

• • Other names for “fragrance”

To make matters more confusing, fragrance may also be listed as:

• • • • Perfume
      • Cologne
      • Flavor
      • Parfum
      • Essential oils

  • Common fragrance allergens

The European Union has conducted extensive research on fragrance allergens. They also mandate that twenty-six of the most commonly recognized fragrance allergens be listed individually when used in concentrations greater than 0.001% for leave-on products or 0.01% for rinse-off products.

These ingredients include:

• • • • • Amyl cinnamal
        • Amylcinnamyl alcohol
        • Anisyl alcohol
        • Benzyl alcohol
        • Benzyl benzoate
        • Benzyl cinnamate
        • Benzyl salicylate
        • Cinnamyl alcohol
        • Cinnamaldehyde
        • Citral
        • Citronellol
        • Coumarin
        • Eugenol
        • Farnesol
        • Geraniol
        • Hexyl cinnamaladehyde
        • Hydroxycitronellal
        • Hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC), (also known as Lyral)
        • Isoeugenol
        • Lilial
        • d-Limonene
        • Linalool
        • Methyl 2-octynoate
        • g-Methylionone
        • Oak moss extract
        • Tree moss extract

–Preservatives

Preservatives are the second most common cause of allergic contact dermatitis from cosmetics. All water-based cosmetics must include a preservative to prevent the overgrowth of microorganisms. Without one, bacteria, fungus, and mold will begin to grow in the product within two weeks.

The preservative on the ingredient listing will be listed by name, not by the word preservative, as is the case for fragrance. The most common preservatives include:

• • • Methylisothiazolinone³
    • Methylchloroisothiazolinone
    • Formaldehyde and formaldehyde-releasing ingredients:
      • Bronopol
      • Bronidox
      • Diazolidinyl urea
      • DMDM hydantoin
      • Imidazolidinyl urea
      • Sodium hydroxymethylglycinate
      • Quaternium-15
    • Para-hydroxybenzoic esters also known as parabens. Despite all the media attention, they are relatively weak allergens.⁴

Related Content from Dr. Frey: 
Formaldehyde: What Is It and Why Is It in My Cosmetics?
Skincare Products: Are You Being Deceived?

–Dyes and color additives

The third most common ingredient that causes allergic contact dermatitis from cosmetics is paraphenylenediamine (PPD). It is commonly used in permanent hair dyes as well as in some semi-permanent hair dyes. PPD is a popular hair dye ingredient as it results in a very natural hair color.

Unlike other ingredients used in cosmetics, all color additives used in cosmetics, except for coal-tar hair dyes, are subject to strict approval guidelines under US law.⁵ Failure to meet these requirements causes a cosmetic to be adulterated and is prohibited to be transported in interstate commerce. 

Color additives, regardless of their concentration, may be listed in any order after the listing of all other ingredients, which are not color additives.

Ingredient listing may also identify color additives⁶ as:

• • • p-phenylenediamine (PPD)
    • coal tar
    • Or by the specific additive: 

–Rubber or latex

Roughly 1-6% of the general population is allergic to rubber or latex.⁷ It is easy to recognize and avoid a rubber balloon or latex gloves. However, many people are not aware that latex may be found in your eyeliner, eyelash adhesive, or beauty mask.  And, there is no requirement for the manufacturer to include a warning on the label that clearly states that the product contains latex. Latex allergic individuals must check the ingredient listing.

Manufacturers must include a list of ingredients in order of decreasing concentration on all cosmetics. Latex may be listed as any of the following:

• • • Natural Rubber Latex
    • Natural Latex Rubber
    • Rubber Latex
    • Natural Latex
    • Latex Rubber
    • Natural Centrifuged Latex
    • Natural Liquid Latex
    • Aqueous Latex Adhesive
    • Latex

Diagnosing the cause of allergic contact dermatitis

Identifying and avoiding the allergen, the ingredient that is causing the allergic reaction is the primary goal in the management of allergic contact dermatitis. Once identified, the patient must learn to read the labels of cosmetics and other personal care products to avoid exposing themselves to the causative ingredient.

Often times a detailed history alone may result in the identification of the allergen. When this is not possible, diagnosing allergic contact allergies is possible by performing patch tests. The skin is exposed to suspected allergy-causing ingredients.

---

♦♦Love Our Content?♦♦

Sign up for our Newsletter Here

---

 

The area is then observed over a 72 to 96 hour period of time looking for signs of redness, hives, or inflammation that would indicate an allergic reaction. Patch tests can be done on both adults and children but should always be done under the guidance of a medical professional.

Treatment of allergic contact dermatitis

There are a variety of treatments, both topical and oral, that can be employed to reduce unpleasant signs and symptoms of allergic contact dermatitis.

–Topical steroids

To help reduce the inflammation and itching associated with the allergic reaction, topical corticosteroids are the mainstay of treatment. Non-prescription anti-itch cream containing at least 1 percent hydrocortisone applied once or twice daily may temporarily relieve symptoms and can be tried at home. If the rash persists or worsens, a medical professional can prescribe more potent topical steroids.

–Oral corticosteroids

In severe cases of allergic contact dermatitis, especially involving the eyelids, hands, feet or genitalia, oral steroids are often prescribed.

–Topical Immunomodulators

When topical corticosteroids are not an option, topical immunomodulators are often prescribed for chronic cases of allergic contact dermatitis. Topical tacrolimus (Protopic) is especially helpful when the allergic reaction involves the eyelids. Pimecrolimus (Elidel) may be helpful for mild cases that involve the face.

–Oral antihistamines

Non-prescription antihistamines such as diphenhydramine (Benadryl) may help relieve severe itching.

–Cool, wet compresses

The application of a moistened washcloth for 15-20 minutes to the rash may be soothing. Topical soaks with cool tap water, saline (1 tsp/pint) or Burow solution (1:40 dilution) can all be helpful. This can be repeated several times daily.

–Calamine lotion

If the rash is oozing or weeping, calamine lotion may help dry the rash.

–Antibiotics

Allergic contact dermatitis can become infected. If redness, pain or discomfort persists, seek medical attention, as treatment for bacterial infection may be necessary.

The bottom line

For individuals with known allergies or sensitive skin, read the ingredient listing of the cosmetic carefully. Although selecting products with the marketing terms on product labels like hypoallergenic or dermatologist tested may be a good place to start, there is no guarantee that these products won’t cause a skin reaction.

Before applying a cosmetic to a large surface area, apply the product to a small test area behind the ear or inside your elbow for several days to ascertain whether or not the product is safe for you. And when in doubt, consult your dermatologist or medical professional for guidance.

References:

---

1. US Food and Drug Administration – Cosmetic Laws and Regulations Current 8/24/2020
2. National Eczema Association – Fragrance and Perfume Allergy and Eczema FAQ
   current 5/29/2013
3. SGS – European Commission Tightens Permitted Limit for MIT in Cosmetics 
   7/20/2017
4. Fayne Frey, M.D. – Skincare Products: Are You Being Deceived?  9/20/2020
5. US Food and Drug Administration – Color Additives  Current 9/18/2018
6. US Food and Drug Administration – Color Additives Approved for Use in Cosmetics Current 11/15/2017
7. US Food and Drug Administration – 1-6% of the general population is allergic to rubber or latex Note 1, Current 8/24/2020