DIAGNOSIS OF COSMETIC DERMATITiS 51 Dermatitis among negroes from hair straighteners is not uncommon. The sulfides and alkalis used to soften the hair are primary skin irri- tants as are the hardening solutions among which are formaldehyde. DEPILATORIES Chemical depilatories have caused derma•itis among their makers and users. The inorganic sulfides of barium, calcium, sodium, and stron- tium, and the thioglycollates are the principal chemicals used and they are all primary skin irritants. The site of the dermatitis and the history of its appearance shortly after the use of the depilatory determine the etiologic diagnosis. Patch tests are not indicated. HAIR LACQUERS These are used to keep stray locks in place and are usually solutions of natural resins. During the war when shellac was not available for hair lacquers, a synthetic resin sub- stitute consisting of a combination of rosin with a glycol maleic an- hydride resin caused an outbreak of dermatitis on the face. It was a sensitization dermatitis proven by patch tests. HAIR To•Ics These usually contain an anti- septic, a rubefacient, an oil, and perfumed alcohol. Dermatitis oc- casionally occurs from their use. The forehead, sides of the face, be- hind the ears, and the eyelids are usually affected. The dermatitis is due to sensitization to one or more of the ingredients. Resorcinol, betanaphthol, and quinine are the principal sensitizers in hair tonics: Cantharides and capsicum may also be the cause. The diagnosis is established by the history of the dermatitis coming on after use of the tonic by the site of the lesions and by patch tests with the tonic and each of its ingredients in proper dilution. LIPSTICK When the kiss-proof or indelible lipsticks were first produced, cheiliris was not at all infrequent from their use. We even saw it in men who used lipstick when dressed as clowns. The principal cause was the tetra- bromfluorescin which induces a photosensitivity. Other dyes in the lipstick may cause sensitization cheiliris as may the perfume. The history of the onset after the use of a new lipstick, site of the lesions, and patch tests with the lipstick, and each of its ingredients estab- lishes the diagnosis. Areas of the skin patch tested with lipstick should always be exposed to light if, when the patch is removed, the skin shows no reaction. NAIL LACQUERS These have been and still are a frequent cause of dermatitis. The site of the lesions are usually on the face and neck. Only rarely do they occur on the arms or covered parts of the body. This because the dermatitis is due to touching the skin with the lacquered finger nails. The solvents, chiefly esther% evapo-

52 JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS rate quickly and cause no trouble. The chief offending ingredient has been the sulfonamide-formaldehyde resin. The dyes, especially the fluorescent ones have also been offenders. The lesions are usually of the type of lichenified eczema, but acute dermatitis with severe edema especially of the eyelids is occasionally encountered. When chronic eczematoid lesions occur on the face and neck of women who use nail lacquer, the diagnosis of nail- lacquer dermatitis must be con- sidered. The diagnosis is estab- lished by uncovered patch tests with the nail lacquer and each of its ingredients. PERFUME Perfumes are presented in most cosmetics. The fact that in the last 20 years we could only find 18 references to dermatitis from per- fumes attests to the rarity of its occurrence. As perfumes are complex mix- tures, it is often impossible to fix the blame on any one chemical com- pound. Linalool, methyl heptine c•,.,arbonate, oil of bergamot, oil of lavender, oil of o. rris, oil of mint, and benzylidene acetone have been re- ported as actual causes. The oil of bergamot and oil of mint cause photosensitization dermatitis. Methyl heptine carbonate and benz- ylidene acetate are synthetics. The diagnosis of allergic derma- titis from perfumes is established by uncovered patch tests. It may re- quire tracing .the perfume to its blender to find the actual ingredi- ents. If this can be done, patch tests may be performed with the in- gredients to find the actual irritant. POWDERS These rarely cause dermatitis. Only 4 cases of dermatitis have been reported from powders in the last 12 years. Two of these were due to the dyes and 2 were caused by the powder conveyors, in 1 instance a rubber powder conveyor and in the other instance a dirty one conveyed a bacterial infection. Orris root, the allergists bug-a- boo, has not been used by reputable cosmetic manufacturers as an in- gredient in powder ever since the notorious case in Massachusetts. When face powder is suspected as the cause of a dermatitis, patch tests should be performed with the powder, and if positive, with each ingredient in the powder. The drying effect of a p6wder containing an absorptive base such as kaolin, Kieselguhr, etc., must be consid- ered, as a cause of dermatitis if there are no reactions to the patch test. PRESERVATIVES While no cases of dermatitis have been reported from cosmetic pre- servatives, the possibility must not be overlooked. When patch tests are positive with a cosmetic and are negative with the ingredients of the cosmetic, the physician should ascer- taif• if it contains a preservative or anti-oxidant and if it does, he should perfc rm patch tests with it, using the same base and dilution as is contained in the cosmetic.