CUTANEOUS SYNDROMES DUE TO VARIOUS COSMETICS By CLEVELAND J. WHITE, M.D.* DERMATITIS DUE to sensitivity to external contacts, so-called dermati- tis venenata or contact dermatitis, seems to be becoming more common, both in numbers and in severity. This is perhaps to be expected, in view of the continued increase in the number of preparations contain- ing both new types and newer com- binations of chemicals. The charac- teristic manifestation of -the some- what unusual sensitivity to a-cos- metic is a dermatitis or patch of localised erythema and cederod at the site of application. The cosmetic factor then has to be considered in the differential diagnosis, in a case of suspected contact dermatitis, especially if on the face, dorsa of the hands, or the scalp, and more so if in a woman, as so many of the different cosmetic preparations are used almost exclusively by the female sex. The physician and the chemist who devotes his energy and skill to the manufacture of cosmetics have a common interest in this subject, the former to detect evidence of sensitivity to such a preparation * Professor and Chairman of tke Depart- ment of Dermatology, Stritch School of Medicine, Loyola University, Chicago, Ill. Paper read before the Chicago Section of the Society of Cosmetic Chemists, February 1951. and the latter to keep the index of ß sensitivity as low as possible. That this index of sensitivity is remarkably low, in view 'of the legion of prepara- tions used by so many people, is well known. With the introduction of newer preparations and newer chemi- cal combinations, however, this per- spective has to be continually evalu- - ated. The clinical description of the usual contact dermatitis syndrome?: and the vast numbe. r of possible ? specific agents are well illustrated in a number of textbooks. "3'4'* Austin Smith has pointed out • the.i:,: ) possibility of inhalant irritation and toxin absorption of certain toilet.li? •.. preparations and cosmetics. The::• list of the various types of cosmetic:• • to be considered is very long. As chemical constituents are quite well? i known to the workers in this field,?? only a few of the more bizarrei:./• manifestations will be cited in paper. The list itself inclgdes dyes, perfumes, deodorants, hydrotics, depilatories, creams ø{iil many types, lipsticks, face packS•!•ii wrinkle removers, rouges, nail ishes and bases, cuticle removerSi wave sets, bleaches, mascara, sunburn preventives, paints, hair tonics, hair curlers, 212

CUTANEOUS SYNDROMES DUE TO VARIOUS COSMETICS wigs, lacquer on cos- jewellery and hairpins, and preparations. Soaps and •ts are probably in this as well as dentifrices. detergent problem is one calls for especial attention cause clinical observations of many .ch cases seem to support the view •½•11that there are a goodly number of •½•!:•d•tergents which have a relatively '•ii•igh sensitivity index. This brings •'•?•-•!•0ut the value of the patch test as a ?•?Cønfirmatory test in attempting to •?.eValuate the etiological importance i? f all types of cutaneous sensitisers. '•[[:[i::::i•: CONCERNING PATCH TESTS •:[(!}!11i..The patch test is an attempt to [?:Produce the dermatitis in miniature. i?,It is usually employed to demon- i•:i[!strate the'presence or absence of skin !i!! hypersensitivity of the eczematous :?ype. To' prove that a skin is hyper- !['sensitive, it must be demonstrated i:"that any reaction produced in the -•:case under study will not be obtained ill!by the identical substance in the •'same identical concentration, when ..:applied in a similar fashion to a normal or non-sensitive skin. It is obvious that the exact duplication ,•: of all aspects of natural environment cannot be secured in many occupa- ?'riohal skin diseases of a possible ß contact nature. The performance and technique of the patch test are well known in this group. The patch test interpretation must be ß judged, of course, on the clinical picture and local findings beneath the test. It is • confirmatory test of marked importance when properly performed and expertly evaluated. As Sulzberger • points out, the patch test can produce untoward effects, both local and general. He emphasises that there are six obliga- tory precautions to be taken to avoid local damage: (1) Never test a case unless the indication is clear- cut avoid all useless testing. (2) Use only substances and con- centrations of which you are certain as to the effects. Be sure that the concentration employed does not act as a primary irritant. Test your- self, or your associates, if necessary with new substances. (3) Avoid applying tests in even the established, normally permissible concentrations whenever exceptional degrees of sensitivity are apparent or suspected in such cases, perform preliminary trial tests with dilutiong much lower than normal. (4) Warn the patient to remove the test application immediately, in the event of severe discomfort or pain. (5) If at all possible, avoid all testing during the active phase of an acute eruption. (6) Never test a site in which an ensuing cosmetic defect may be extremely disagreeable to the patient. SENSITIVITY TO I'qAIL LACQUERS One of the most pronounced reactions to hypersensitivity in recent years has been the change in nails due to certain nail undercoats, which apparently contain artificial resins. The ungual and subungual changes have taken the form of brownish-black discoloration of the 213