Vitamin E Contact Allergy: A Controversial Subject

Allergic contact dermatitis from vitamins: A systematic review

Background and Aims

Vitamins are bioactive compounds naturally found in many different types of food and required by the human body for many biological functions and enzymatic activities. Due to their antioxidant properties, certain vitamin derivatives have been synthesized for inclusion in many cosmetics, thus leading to an increasing incidence of allergic contact dermatitis (ACD) cases. Therefore, the present review may be helpful to provide an insight into the sensitizing role of at least certain vitamins and may also offer possible patch test alternatives for definitive diagnosis.

Methods

This study was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Literature search regarding ACD cases to vitamins was performed using the Medline, PubMed, Scopus, EMBASE, and Google Scholar databases from January 1940 up to June 2021.

Results

A total of 4494 articles matched the keywords used for the researched. Records removed before screening included 15 duplicate articles and 3429 not eligible articles (e.g., not written in English, studies on animals, not relevant to the topic). A total of 1050 articles underwent the screening phase and 258 were therefore excluded as they were not primary studies. Subsequentially, 792 articles were considered eligible for the review and 688 of them were finally excluded as they did not report the outcome of interest. Therefore, 104 articles were definitely included in the present review.

Conclusion

ACD to vitamins is still probably an underestimated issue in cosmetology, as many vitamins are considered "natural" and therefore "safe" ingredients. On the contrary, according to current literature, almost all vitamins contained in topical products are able to induce allergic reactions, with the exception of vitamin B2 and vitamin B9. Patch tests are not standardized, thus leading to difficulties in diagnosis.

Patch Testing With Tocopherol and Tocopherol Acetate: The North American Contact Dermatitis Group Experience, 2001 to 2016

BACKGROUND

Vitamin E (tocopherol) a naturally occurring mixture of antioxidants commonly used in topical skin care products, may cause allergic contact dermatitis.

OBJECTIVE

The aim of this study was to characterize positive patch test reactions to tocopherol and tocopherol acetate.

METHODS

This is a retrospective analysis of North American Contact Dermatitis Group patch test data to tocopherols (DL-α-tocopherol 100% and/or DL-α-tocopherol acetate 100%) from 2001 to 2016.

RESULTS

Of the 38,699 patients patch tested to tocopherol and/or tocopherol acetate, 349 (0.9%) had positive reactions; of these, 87.6% were currently relevant. Most (51.4%) were weak (+) and/or not related to occupation (99.1%). Compared with tocopherol-negative patients, tocopherol-positive individuals were more likely to be female (72.5% vs 67.2%, P = 0.0355), have a final primary diagnosis of allergic contact dermatitis (74.2% vs 52.6%, P < 0.0001), and have dermatitis in a scattered generalized distribution (23.8% vs 18.2%, P = 0.0072); they were also less likely to have hand involvement (16.6% vs 22.3%, P = 0.0064). The most common source of tocopherol was personal care products, especially moisturizers.

CONCLUSIONS

Positive patch test reactions to tocopherols were relatively rare given their widespread use. When positive, current clinical relevance was high. Tocopherol-positive patients were more likely to be female and presented with dermatitis on the face or in a scattered generalized pattern.

Effect of Trust in Domain-Specific Information of Safety, Brand Loyalty, and Perceived Value for Cosmetics on Purchase Intentions in Mobile E-Commerce Context

In 2016, the safety issues of humidifier disinfectants and some other safety incidents in personal cares caused chemical phobia syndrome in the Korean society. This series of events has created a trend for cosmetic consumers to undermine brand confidence and to self-check the safety of commercial cosmetic formulations through mobile apps. The purpose of this study is to examine the influence of trust in domain specific information on the safety rating of cosmetic ingredients on the perceived value and the purchase intention of the cosmetics. The results of structural equation modeling showed that involvement of skin safety (ISS) had a positive effect on trust in domain specific information on safety (TDSI) and brand loyalty (BL). TDSI showed a positive effect on the perceived safety value (PFV) and the perceived social value (PSV), and BL had a positive effect on the PSV. ISS, TDSI, and PSV had a positive effect on the purchase intention (PI) of green-grade cosmetics (GGC). As hypothesized, BL had an adverse effect on PI of GGC. Given the results, utilizing the signal of the domain specific information may be recommended to new entrants to the cosmetic business or manufacturers with relatively weak brand power.

Safety Assessment of Tocopherols and Tocotrienols as Used in Cosmetics

The Cosmetic Ingredient Review (CIR) Expert Panel (Panel) assessed the safety of 14 tocopherols and tocotrienols and concluded these ingredients are safe as used in cosmetics. The tocopherols are reported to function in cosmetics as antioxidants or skin-conditioning agents; in contrast, tocotrienols are not reported to function as an antioxidants in cosmetics but as a light stabilizer, oral care agent, or skin-conditioning agent. The Panel reviewed the new and existing animal and clinical data to determine the safety of these ingredients and found it appropriate to extrapolate the existing information to conclude on the safety of all the tocopherols and tocotrienols.

The use of antioxidants in radiotherapy-induced skin toxicity

Radiation-induced skin damage is one of the most common complications of radiotherapy. In order to combat these side effects, patients often turn to alternative therapies, which often include antioxidants. Antioxidants such as those in the polyphenol chemical class, xanthine derivatives, tocepherol, sucralfate, and ascorbate have been studied for their use in either preventing or treating radiotherapy-induced skin damage. Apart from their known role as free radical scavengers, some of these antioxidants appear to alter cytokine release affecting cutaneous and systemic changes. We review the role of antioxidants in treating and preventing radiation-induced skin damage as well as the possible complications of using such therapy.