CUTANEOUS REACTIONS FROM COSMETICS 175 Hair lacquers are innocuous when proper lacquers are used. On occa- sion various synthetic resins have been substituted and some of these have proved to be potent sensitizers. The usual bleaches by and large have no particular risk, either from the point of view of toxicity or sensitization. These remarks concerning hair products of course apply to the potential effects of the products on the skin or system as a whole, and th4 discussion was not intended to consider deleterious effects to the hair itself. Eye Cosmetics. The various cosmetics used about the eye are by Federal statute prohibited from containing coal tar colors. Hence, there is a rather severe restriction as to the range of coloring materials that can be employed. Most of these are mineral pigments or carbon black in one or another form. These products are quite innocuous from the point of view of irritation and sensitization. The ammoniacal silver salts which are used to dye the lashes may produce a mild irritation if they get into the eye but apparently there is little risk beyond that. Eye washes and lotions that are sold over the counter do not have any particular sensitizing potentiality but it is well to remember that drugs that are used by physicians for the eye, such as attopine and some of its relatives, and penicillin and other antibiotics, have strong sensitizing potentialities, and should these ever be permitted to be incorporated in over-the-counter products it probably would result in a large number of dermatoses. Face creams and powders are unimportant from the point of view of causing reactions. Lipsticks. Considering the vast number of lipsticks sold, the incidence of difficulty with lipsticks is very low. Yet, by virtue of the fact that so many lipsticks are sold, even a very small percentage incidence will yield a fair number of actual cases of cheiliris. The usual reaction from a lip- stick is an allergic sensitization, and the ingredient of the stick that is ordinarily responsible is a bromo acid. In a given case it is usually possible to construct a stick without the specific allergen, and though such a stick is as a rule cosmetically less elegant than the original product to most women it is better than no stick at all. Nail Cosmetics. Nail cosmetics, as a class, are among the more frequent causes of cosmetic reactions. Obviously, the most important product in this group is ordinary polish. The principal trouble produced is an allergic eczematous sensitization, and the responsible ingredient is usually a resin such as toluene sulfonamide resin. In view of the fact that this type of resin is in most nail polishes, regardless of color, a person who is sensitive may have considerable difficulty in obtaining a polish that can be used. One of the peculiarities of the allergic reaction to nail polish is that the dermatitis practically never involves the fingers, and nearly always affects

176 JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS the neck and face. Streaks of erythema may be seen on the neck and cheeks. No reasonable explanation can be given as to why the fingers are so seldom affected apparently the nail plate and the nail bed are not involved be- cause the polish does not penetrate the hard keratin of the nail plate. On the other hand, when a sensitization develops to a base coat it seems to be confined to the nail bed, presumably because an ingredient of the base coat penetrates the nail plate and sensitizes the underlying tissue. Sen- sitization to such a material can produce unsightly and painful lesions in that, by virtue of the locus of the allergic reaction, pressure develops. Hemorrhage may ensue and the nail may become loosened from its bed and ultimately slough off. Fortunately, as far as I know, the damage to the nail bed is reversible, so that when contact with the offending material is stopped the nail finally regrows normally. As is well known, some years ago there was quite a bit of difficulty with the products of this type that were then on the market. It is my understanding that one of the current products of this type has produced similar cases (5). Jxc•cnt•y an aunesxve type of color was oes•gneo which consisted nail of an adhesive backing over which different colors were placed. The adhe- sive was then applied to the nail. Unfortunately, the product yielded nail damage. In my opinion--and it so happens that I saw many of these persons--the damage was produced not because of a sensitization but rather because the adhesive quality of the material was such that it bonded itself to the lamellae of the nail plate, so that upon its removal fragments of the nail plate were taken with it, which ultimately resulted in longitudinal cracks, and sometimes the nail broke off at its free edge. In all cases that were followed by me the nails regrew perfectly normally. Nail polish removers are seldom a cause of trouble but occasionally a person may become sensitized to some ingredient contained therein. It has been suggested that these damage the nails by their defatting effects, but I know of no substantial evidence to support this. ?lntiperspirants and Deodorants. I shall consider these two together, as, from the commercial point of view they are usually so treated although, physiologically and pharmacologically a differentiation should be made. The usual product contains aluminum in one or another form. The most common reaction consists of a mild inflammation based on primary irrita- tion and not on a sensitization to any of the contained ingredients. Occa- sionally, especially when the antiperspirant is applied after shaving, a few bacteria may be sealed into a hair follicle and a mild folliculitis develop but this rarely assumes any consequential importance. Recently in the search for new antiperspirants zirconium salts of one or another kind were tried, the sodium zirconium lactate salt apparently being the most popular. Unfortunately, however, granulomas with a sarcoid architecture have de- veloped after the use of such a product. Clinically, the lesions consisted