Cosmeceutical Contact Dermatitis—Cautions To Herbals

The global appeal of cosmetic products to the consumer is unmistakable, with a reach that extends virtually across every household in the USA. There has been increasing interest in natural remedies containing plant-based ingredients, popularly perceived to be less harmful than products made from synthetic chemical ingredients. The true prevalence of allergic reactions to cosmetics in the general population remains unknown, as reactions are often not reported because those affected simply discontinue use of the agent instead of seeking medical care. Herbal ingredients in cosmetics may be associated with allergic contact dermatitis, a type IV hypersensitivity reaction resulting in inflammatory skin eruptions characterized by pruritis, erythematous vesicles, and papules. Preservatives and fragrances are responsible for many cases of allergic contact dermatitis, but it is important for clinicians to recognize less common allergens and be suspicious of certain ingredients in plant-based products. This article aims to emphasize risks associated with use of cosmetics marketed as “natural” and to review specific botanical allergens implicated in causing allergic contact dermatitis. Key points 1. Allergic contact dermatitis (ACD) is a type IV (delayed) hypersensitivity reaction which can occur to naturally derived products.2. Extracts derived from Compositae plants, propolis, and limonene, along with a number of essential oils and waxes, are popular in cosmetics and serve as botanical sources increasingly implicated in causing adverse skin reactions.3. Pinpointing the allergen through patch testing and instituting avoidance measures is the definitive treatment for ACD.