Dermatologic Therapy, Vol. 14, 2001, 181±187 Copyright # Blackwell Science, Inc.

, 2001
Printed in the United States
All rights reserved
DERMATOLOGIC THERAPY
ISSN 1396-0296

Cosmetics and contact dermatitis

RONNI WOLF, DANNY WOLF, BINNUR TUÈZUÈN, & YALCIN TUÈZUÈN
Department of Dermatology, Tel Aviv Sourasky Medical Center, and the Sackler Faculty
of Medicine, Tel Aviv University, Tel Aviv, Israel
Pediatric Outpatient Clinic, Hasharon Region, Kupat Holim, Israel
Department of Dermatology, Trakya University, Medical Faculty, Edrine, Turkey
University of Istanbul, Cerrahpasa Medical Faculty, Istanbul, Turkey

ABSTRACT: Modern cosmetic and skin care products are safe for most users and adverse reactions
to them are very rare considering the number of people in contact with numerous products over a
lifetime of use. Improvements in safety, tolerance, and skin compatibility will not prevent cosmetic
product side effects from increasing in the future because of the continuing goals of intensifying
their biological activity and therapeutic efficacy. Therefore, now more than ever, dermatologists
should be familiar with all possible untoward reactions to cosmetics. Adverse reactions include an
extreme variant of sensitive skin, called ``cosmetic intolerance syndrome,'' describing individuals
who are no longer able to tolerate a wide range of cosmetic products. ``True'' allergic reactions to
cosmetics occur much less commonly than irritant reactions. These are of great importance to the
dermatologist because they are more serious, more difficult to treat, and require absolute abstention
from the causative agent. Eczematous, damaged skin is especially prone to develop allergies.

KEYWORDS: allergic contact dermatitis, cosmetic intolerance syndrome, fragrance-free, fragrance,

hypoallergenic, natural, pigmented cosmetic dermatitis, photocontact dermatitis.

Cosmetics and skin care products are integral
parts of daily grooming, with the average Amer-
ican adult using at least seven different skin care
products each day. There are about $500 worth of
cosmetics in the average American home.
Although this includes products that have been
tried once and discarded, many of them are in
regular use. There are more than 2000 companies
that manufacture and/or distribute cosmetics in
the United States. The vast amount of space
provided for them in stores, the extensive discus-
sion of skin care issues in popular magazines, and
prime-time television coverage of appearance-
related topics are further testimony to the popu-
larity and marketing value of cosmetics. Fortu-
nately adverse reactions to cosmetics are very
rare, considering the number of people in contact
with so many products over a lifetime of use.
These cases occupy a significant part of the daily
patient load of most dermatologists.
In general, cosmetics are safe and well toler-
ated by most users since reputable companies
invest heavily in safety, quality control, and
product testing prior to releasing a cosmetic on
the market. In spite of these precautions, side
effects to cosmetics do occur. It is expected that,
despite improvements in safety, tolerance, and
skin compatibility, side effects to cosmetic pro-
ducts will not decrease because of the continuing
efforts to intensify their biologic activity and
therapeutic efficacy. It is imperative for dermatol-
ogists to become familiar with all possible side
effects and untoward reactions of cosmetics. The
following article provides this fundamental in-
formation.

Sensitive skin and cosmetic

Address correspondence and reprint requests to: Ronni intolerance syndrome
Wolf, MD, Department of Dermatology, Tel Aviv Sourasky
Medical Center, 6 Weizman St., Tel Aviv, Israel, or e-mail: Although the term ``sensitive skin'' is widely used
wolf_r@netvision.net.il. both by consumers and cosmetic chemists, there

181
Wolf et al.
is no precise definition for it. It is largely agreed
that this is a lay term used by individuals who
consider themselves to be more intolerant of
topical preparations than the general population.
This intolerance manifests itself as burning,
itching, stinging, or tightness with or without
objective symptoms. The onset or exacerbation of
the condition is temporally correlated with the
application of the offending product.
An extreme variant of sensitive skin Ð ``cos-
metic intolerance syndrome'' (1) or ``status
cosmeticus'' (2) Ð describes individuals who are
no longer able to tolerate a range of cosmetic
products. Cosmetic intolerance syndrome is not a
single entity, but rather a clinical condition
resulting from one or more exogenous and/or
endogenous factors (1). Some of the underlying
exogenous factors are subjective (sensory) and
objective irritation, allergic or photoallergic con-
tact dermatitis, and contact urticaria. Among the
relevant endogenous factors are seborrheic der-
matitis, rosacea, atopic dermatitis, perioral der-
matitis, acne, status eczematicus, diminished
barrier function, xerotic skin, heightened neuro-
sensory input, and dysmorphobia.
This group of patients challenges diagnostic
skills, since it is impossible to delineate the
culpable etiologic factor based on morphologic
characteristics and objective cutaneous signs.
Furthermore, the objective symptoms and com-
plaints, which are very similar among these
patients, do not necessarily reflect the severity of
objective findings.
The management of patients with sensitive
skin syndrome is not clear-cut. Some experts
(1,2) suggest identifying the causative ingredient
or mechanism as the first step, while we agree
with other authorities (3,4) who contend that
treatment in the form of adherence to a specific
cosmetic elimination program is the first and
most important step that should be taken. We
do not suggest conducting any diagnostic pro-
cedure, such as patch or photopatch tests, facial
lactic acid sting test, etc., during the acute phase
of the disease because it would not have
immediate consequences. Moreover, it might
lead to false-positive results and, more signi-
ficantly, may cause an exacerbation of the
disease. Furthermore, it is our experience that
many of these patients react to a wide range of
substances and need a vigorous cosmetic elim-
ination program. Maibach and Engasser (1)
suggested the elimination of all cosmetics for a
period of 3±6 months, except for glycerin and
rose water as a substitute for commercial
182
moisturizers, lip and eye cosmetics, and face
powder. Draelos (3,4) permits the use of a mild
synthetic detergent soap (e.g., Oil of Olay), facial
cleanser, shampoo, and a bland facial moistur-
izer (Cetaphil cream) and/or a moisturizer with
sunscreen (Oil of Olay Complete Daily UV
Protectant). It is our personal experience that
at least some of the patients will not tolerate any
detergent or moisturizer, even the very mild
ones, during the acute phase. We use Maibach
and Engassers very demanding approach, but for
a shorter period of time (2±4 weeks), after which
the patient can add one facial cosmetic of low
allergic and irritant potential each week. The
dermatologist should not be surprised, however,
at the strenuous resistance of the patient to
what would seem to be such an effortless
protocol. With few exceptions, a woman feels
stripped bare when denied the touches of color
and glow that she has adopted over time to
create her best ``look.'' A practical approach
must be taken to achieve compliance.
The above are only general guidelines that
might give the reader an idea of how to approach
this specific group of patients. As mentioned
earlier, sensitive skin is not a single entity, but a
heterogeneous syndrome, and each patient will
have to be evaluated and treated with individually
tailored management.
Finally, the ``upper eyelid dermatitis syn-
drome'' coined by Maibach et al. (5) is similar in
its etiologies, mechanisms, and therapeutic ap-
proaches to the cosmetic intolerance syndrome,
except that it manifests itself mainly (but not
exclusively) on the upper eyelids.
Allergic contact dermatitis
``True'' allergic reactions to cosmetics occur
much less commonly than irritant reactions.
They are nevertheless of great importance to
the dermatologist because they are more serious,
more difficult to treat, more widespread, and
often signal an intolerance to many different
types of products with related ingredients.
Allergic contact dermatitis (ACD) requires abso-
lute abstention from the causative agent. Esti-
mates of the prevalence or incidence of allergic
reactions are always problematic since consu-
mers who experience untoward reactions to a
cosmetic product usually discard or discontinue
using it rather than consult a physician. While
this choice of action is probably most appro-
priate for the consumer, it hinders our ability to

quantitate the scope of the problem. Several
studies have tried to address this question. In
one from the Netherlands by De Groot et al. (6),
1609 individuals (838 men, 771 women) were
queried about adverse reactions to cosmetics
and toiletries. Although 196 (12.2%) of them
claimed to have suffered from side effects, none
of the 20 tested patients showed any cosmetic
allergy (6). In a related study performed by the
same group (7), 982 female clients of beauticians
were interviewed on cosmetic-related side effects
they had experienced in the preceding 5 years:
254 (25.9%) claimed to have experienced such
reactions. One-hundred and fifty women were
tested with the European standard patch test
tray and cosmetic series. Allergic reaction was
considered ``proven'' in 3 patients (2%) and
``possible'' in 7 (4.7%). The authors concluded
that allergy is responsible for less than 10% of all
reactions to cosmetics and toiletries. The major-
ity of reactions are due to irritation. It should be
emphasized, however, that in those patients
seen by dermatologists with eczema and tested
for suspected allergic contact dermatitis, the
incidence is about 10%.
The face and the eyelids are the most fre-
quently affected sites, with more than 50% of all
cases. Skin care products (moisturizers and
cleansers) account for more than half of all
adverse reactions, followed by hair preparations
(including dyes), nail cosmetics, perfumes, facial
makeup products, sun care products, shaving
preparations, and deodorants.
Fragrances, the most common
allergen in cosmetics
Fragrances are used in cosmetics specifically
designed for their smell (perfumes, aftershaves,
deodorants, etc.) and as a common additive.
Virtually all cosmetics and toiletries are scented,
even ``unscented'' cosmetics contain a ``masking''
perfume. Detergents, fabric softeners, laundry
products, oral hygiene products (toothpastes,
mouthwash, dental floss), sanitary pads, house-
hold cleaning products, solvents, polishes, and
waxes all contain fragrances. As a consequence,
contact with fragrance ingredients is common.
Fragrances are the leading cause of ACD
from cosmetics, accounting for more than 30%
of identified cases. The incidence of ACD
ranges from 6 to 14% of eczema patients seen
by dermatologists and comprises about 1% of
Cosmetics and contact dermatitis
the general population. Differences in preva-
lence between various countries occur because
of the differences in cultural and environmen-
tal factors, leading to different behaviors and
use of skin care products, as well as to
differences in patch test techniques, patient
selection, and interpretation of the results and
their relevance.
Fragrances are composed of 10±300 individual
ingredients, and details on their specific com-
positions are not generally available, being seen
as trade secrets by the fragrance industry.
Detecting a fragrance allergy and identifying
the causative component is thus a difficult and
complex matter.
In 1977 Larsen (8) introduced a fragrance
mixture as a screening patch test for fragrance
allergy. It originally contained eight fragrance
materials, each in a concentration of 2%. In 1984
the concentration was reduced to 1%. The
fragrance mix is part of the standard patch test
series, and together with balsam of Peru, serves as
a screening agent for fragrance contact allergy.
Although it is far from perfect because it can
cause both false-positive and false-negative re-
sults, it has been used for years with satisfactory
results and has been proven to be a very useful
tool. The fragrance mix includes the five most
frequent allergens, usually second after nickel
sulfate (9,10).
The problem of fragrance allergy is not so
much one of diagnosis (most patients are aware of
their allergy even without consulting a doctor),
but rather of persuading the patient of its
relevance and the need for strict avoidance. To
paraphrase the statement that was originally
intended for nickel, ``Fragrance is with you and
does things for you from the time you get up in
the morning until you go to sleep at night,'' thus
making avoidance an extremely demanding and
difficult task.
To complicate matters and add to the difficul-
ties of the fragrance allergic patient, use of
``fragrance-free'' products does not guarantee that
the product is actually free of fragrance. Since the
term fragrance is defined as a natural or synthetic
substance used solely to impart a scent to a
cosmetic product, many fragrances that have
more than one function, acting as preservatives,
emollients, fixatives, or disinfectants, can be
included in a fragrance-free product, since they
do not fulfill the criterion of fragrance, that is, a
substance functioning solely to provide a scent.
Furthermore, fragrance-free products may con-
tain ``natural'' plant extracts, flower extracts, and
183
Wolf et al.

essential oils (e.g., rose, chamomile, and sandal- Eczematous, damaged skin is easily
wood), all of which are actually fragrances.
Natural products are therefore no less problem-
sensitized
atic to fragrance-sensitive patients.
Patients should be informed that products Inflammation and eczema of the skin with the
designated as being fragrance-free (Table 1) may resulting diminished barrier function are impor-
not really be so, and labels such as unscented, tant predisposing factors in the development of
hypoallergenic, dermatologist-tested, for sensitive ACD. The following are examples relevant to the
skin, or dermatologist recommended are less than use of cosmetics.
worthless. Parabens are by far the most frequently used
preservatives in cosmetics and toiletries (99% of
the leave-on products and 77% of the rinse-off
Table 1. Representative fragrance-free products ones). Considering their wide use, the incidence
Cleansers of allergic reaction to these products is certainly
Aquanil cleanser very low. On the other hand, when they are used
Cetaphil gentle skin cleanser (liquid) in topical therapeutic agents, these same para-
Clinique bars bens sensitize about 1% of the population. This
CVS transparent facial bar soap Ð unscented has caused most pharmaceutical manufacturers
Neutrogena therapeutic facial bar Ð fragrance-free to remove parabens from topical therapeutics, but
Neutrogena nondrying cleanser not from cosmetic products. Indeed, even pre-
Oilatum AD
parations that are applied to the delicate skin of
Phisoderm Unscented skin cleansing bar
Vanicream bar
the eyelids, such as mascara, including the so-
Shampoos called hypoallergenic variety, also contain para-
DHS Clear shampoo and conditioning rinse bens and cause neither difficulties nor adverse
Free and Clear shampoo and conditioner reactions. The explanation for this apparent
Pentrax paradox is that while cosmetics are applied to
T/Sal shampoo normal skin, therapeutic agents are applied to
Moisturizers inflamed, eczematous, excoriated, or otherwise
Almay moisturizers damaged skin, which is much more readily
Eucerin original moisturizing cream sensitized than even the thinnest of healthy skin.
Lubriderm unscented This and several other puzzling aspects of the use
SBR Lipocream
of paraben preservatives is labeled ``paraben
Vaniderm cream and lotion
Vaseline petrolatum jelly
paradox'' (11,12).
Deodorants The use of lanolin is associated with similar
Almay unscented puzzling aspects for which the name lanolin
Almay clear gel fragrance-free deodorant paradox has been suggested in analogy to the
Ban Original roll-on paraben paradox (13). The lanolin found in
Keops (Rock) topical therapeutic agents sensitizes a high
Eyeliner/Eyebrow pencils proportion of patients, whereas the same lanolin
Any product is generally ``safe'' in cosmetics so widely used
Nails by millions of individuals. Furthermore, patients
Any product with an ACD to lanolin in a medication applied
Sunscreens
to a stasis ulcer can use lanolin-containing
Almay
Eucerin daily sun defense
cosmetics, even on the delicate skin of the face,
Neutrogena sensitive skin sunblock SPF 17 eyelids, and lips, and not experience any reac-
PreSun active clear gel SPF 30 tions (13). Lanolin-sensitive individuals often
Shade sunblock gel SPF 30 show false-negative patch test reactions. Next to
Solbar Avo formaldehyde, lanolin demonstrates the lowest
Hairsprays reproducibility in patch tests.
Allecreme unscented In summary, special care should be taken to
Almay protein conditioning hair spray extra avoid the application of sensitizing substances on
hold±Fragrance-free irritated, eczematous, or otherwise damaged skin.
Clinique serious hold Patients with sensitive skin, cosmetic intolerance
Jhirmack Salon Formula extra hold unscented
syndrome, seborrheic dermatitis, atopic dermati-
hairspray
tis, stasis dermatitis, xerotic dermatitis, and

184

intertriginous dermatitis are especially prone to
develop allergies and should avoid exposure to
topical allergens.
Hypoallergenic and natural
cosmetics
There are thousands of ingredients available to
cosmetic chemists involved in creating a wide
variety of products, and there is enormous
variability in human skin, as well as innumerable
and unexpected reactions to chemicals. A genu-
inely nonallergic product has yet to be invented.
Instead, we have many so-called hypoallergenic
cosmetics, a term that has been used to delineate
some products designed for patients with sensi-
tive skin. Hypoallergenicity literally means ``re-
duced allergy;'' in practical terms, these cosmetics
are supposed to produce fewer allergic reactions
than other cosmetic products (14).
Assessment of hypoallergenicity can be per-
formed by a variety of testing techniques that
examine the relative risk of a product to cause
sensitization. Currently there is no agreement
among experts as to which test is the most
reliable, appropriate, and relevant to consumers.
Far more important, there are no federal stan-
dards or definitions that govern the use of the
term ``hypoallergenic,'' and manufacturers of
these cosmetics are not required to submit
substantiation of their hypoallergenic claims to
the FDA. The term means whatever a particular
company wants it to mean, and cosmetic com-
panies determine when and where to apply the
term ``hypoallergenic.'' Thus, although the theo-
retical principles underlying the concept of
hypoallergy are generally beneficial, their practi-
cal performance de facto rendered the term
meaningless. Products for sensitive skin currently
comprise the largest and one of the fastest
growing segments of the skin care market. Where
does this situation leave consumers and their
dermatologists?
We have currently reached a stage where most
manufacturers use mainly mild ingredients that
have a low potential for causing allergies and/or
other adverse reactions. In reading the labels of
various cosmetic products, we have found no
differences between the ingredients of hypoaller-
genic cosmetics and those that do not claim to be
so. We know of no scientific, controlled study that
indicates hypoallergenic products cause fewer
allergies than ``conventional'' products. More-
Cosmetics and contact dermatitis
over, we have not seen many allergic individuals
who can tolerate hypoallergenic cosmetics any
more than they can other products. How then
should an allergic patient proceed with purchas-
ing and using cosmetics?
Regulatory authorities in the United States, and
more recently those in Europe, require an in-
gredient declaration listed in descending order of
quantity on every cosmetic product offered for
sale to consumers. Reading these labels and
avoiding substances that have caused problems
or allergies is the only way consumers can protect
themselves.
Natural botanical ingredients are not the
answer for sensitive-skin patients. There is a
current trend toward using ``natural'' (i.e., mostly
vegetable not animal) ingredients. In spite of there
being no functional rationale for the inclusion of
most plant extracts in cosmetics, they are added
to capture the interest of consumers for marketing
purposes.
Dermatologists should know that plant-derived
products are not safer or better tolerated than
synthetic ones. Botanicals are more complex skin
care additives than most dermatologists realize.
Many natural plant extracts are difficult to
characterize chemically, since more than 200
individual chemicals may be present in any one
plant extract and their chemical composition
depends on many factors, for example, the soil,
the season, and other environmental factors. For
this reason, when an adverse reaction or allergy to
such a material occurs, it is almost impossible to
determine the responsible ingredient.
Pigmented cosmetic dermatitis
Pigmented contact dermatitis is believed to be
induced by very small amounts of contact aller-
gens which are in almost daily contact with the
patients skin. This continuous exposure to low
doses of allergens does not result in erythema,
papules, swelling, or itching, as occurs in ordinary
contact dermatitis, but is often characterized
solely by hyperpigmentation. Histologically, pig-
mented contact dermatitis does not appear as
spongiosis which is typical of acute dermatitis,
but rather has basal liquefaction degeneration as a
dominant feature. In short, pigmented contact
dermatitis is actually a variant of contact derma-
titis in which inflammatory components are slight
and pigmentation dominates the clinical picture.
The term ``pigmented cosmetic dermatitis''
was introduced in 1973 for what had previously
185
Wolf et al.
been known as melanosis faciei feminae, or
erroneously, Riehls melanosis. During the late
1960s a research project was set up in Japan to
discover the nature, mechanism, and causative
agents of this disease. This study showed that
hyperpigmentation is a unique form of an allergic
process and, after testing nearly 500 cosmetic
ingredients, a number of contact sensitizers were
identified, including fragrance materials and pig-
ments such as jasmine absolute, ylang-ylang oil,
cananga oil, benzyl salicylate, hydroxycitronellal,
sandalwood oil, artificial sandalwood, geraniol,
geranium oil, D&C, and yellow no. 11. The
researchers introduced an ``allergen controlled
system,'' meaning that the patients exclusively
used cosmetics that were completely allergen-
free. The results were impressive, with a complete
cure in 30% and a remarkable improvement in an
additional 40% of the patients with a disease that
until then had been of unknown etiology and
difficult to treat (15,16).
Another Japanese group found that the me-
chanism of hyperpigmentation following allergic
contact dermatitis and the melanogenic factors
are different from that induced by UV radiation
(17). A recent study from Israel showed that 16 of
29 patients with pigmented contact dermatitis
reacted to one of the allergens of the European
standard series, whereas only 1 reacted to a
fragrance series (18).
The impressive achievements made by the
Japanese researchers (15) notwithstanding, there
are still areas in the pathogenesis of the disease
that remain obscure. We still have no explanation
for the most basic question of why some allergens
cause pigmented dermatitis while other very
similar ones cause ordinary contact dermatitis. It
is especially noteworthy that the main group of
allergens that cause pigmented cosmetic derma-
titis belong to botanical-derived ingredients.
Photocontact dermatitis
The term photocontact dermatitis refers to a
condition wherein UV radiation in combination
with an exogenous substance evokes a dermatitis
on sun-exposed skin. Although it often produces
pigmented dermatitis, this entity should be
separated from cosmetic pigmented dermatitis.
Photosensitivity can be divided into phototoxic
and photoallergic reactions. Since photoallergic
contact dermatitis plays a major role in cosmetic
dermatitis, we will discuss only this variant of
photocontact dermatitis.
186
Photoallergic contact dermatitis is a form of
cell-mediated hypersensitivity in which a photo-
activated chemical or a photoproduct acts as a
hapten or a complete antigen. The reaction is
based on the same immunologic mechanisms as
those of simple contact allergic reactions. Because
UV radiation transforms certain chemicals into
allergens, it is required both for inducing and
eliciting the immune response. As in allergic
contact dermatitis, photoallergic reactions are
elicited in only a small number of individuals
with a specifically altered immunologic back-
ground. The concentration of a chemical that will
elicit a reaction is much lower than that needed to
produce a phototoxic reaction; it is not dose
dependent, and there is no clinical reaction on
first exposure.
The most widespread outbreak of photoallergic
reactions to topically applied agents resulted from
the use of soaps and cleansers containing halo-
genated salicylanilides and related compounds. In
the 1960s photocontact dermatitis reached the
proportions of a miniepidemic, when thousands
of individuals were affected after exposure to
these agents. After removal of the responsible
ingredients in soaps and toiletries, the number of
photosensitivity cases decreased dramatically.
Among the antimicrobial agents, fenticlor has
currently taken a leading position as a photoaller-
gen, although positive reactions have also been
recorded for bithionol, hexachlorophene, and
trichlorocarbanilide. It should not escape notice
that all these compounds (based on chlorinated
phenol molecules) are chemically related, and
cross sensitivity between them has been recorded
as well.
In the late 1970s a group of investigators
identified musk ambrette found in toiletries as a
fragrance and fixative, as a photoallergen (19).
This synthetic chemical was widely used in the
1970s in aftershave lotions and colognes, as well
as in soaps, detergents, creams, lotions, and
dentifrice. It became the most commonly re-
ported photoallergen of that time, and of note,
most cases were recorded in men. Furthermore,
many patients sensitive to musk ambrette devel-
oped persistent photosensitivity (19,20).
While the frequency of contact photoallergy to
antibacterial agents, fragrance ingredients, and
topical medications has decreased over the years,
reactions to sunscreen products have increased.
The reason for this trend, which is probably not
going to change in the near future, is the
increasing awareness on the part of the public
and physicians of the carcinogenic potential of

sunlight and its effect on premature skin aging.
This has led not only to an increased use of
sunscreen products, but to the incorporation of
UV filters in a large variety of cosmetic products,
such as antiwrinkle creams, moisturizers, foun-
dations, eye creams, makeup, and lipsticks.
Furthermore, there is now a movement toward
sunscreens with a higher sun protection factor,
affording protection against a wider range of
wavelengths and requiring a larger variety of
ingredients at higher concentrations.
The earliest publications on photoallergy to UV
absorbers blamed para-aminobenzoic acid
(PABA) and its esters (21). Increasing awareness
of its sensitization potential and the possibility of
cross-sensitization with other compounds has
encouraged the use of ``PABA-free'' sunscreens
in the United States, Europe, Japan, and Australia.
Benzophenones have emerged as alternatives
to PABA, and they are now found in many PABA-
free sunscreens. The increased use of this agent
(which was initially considered to be a relatively
safe compound) brought about a parallel increase
in contact and photocontact allergic reactions.
This led to the introduction of ``oxybenzone-free''
sunscreens, which resulted in a third and a fourth
wave of photoallergy, this time to dibenzoyl-
methanes and recently to cinnamates.
The increased use of physical UV blockers (e.g.,
coated micronized TiO2 and microfine ZnO) as a
replacement for chemical absorbers is undoubt-
edly a welcome step toward reducing the in-
cidence of adverse reactions to sunscreens and
producing safe and well-tolerated products.
Conclusion
Cosmetics are an important cause of ACD and a
common cause of irritant contact dermatitis. The
practical dermatologist must recognize how to
diagnose and treat side effects related to the use of
cosmetics.
Acknowledgments
The opinions expressed herein are solely those of
the authors and do not necessarily reflect the
Cosmetics and contact dermatitis
opinions of the institutions with which the
authors are associated.
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