Allergic contact dermatitis caused by sorbitan sesquioleate imitating severe glove dermatitis in a patient with filaggrin mutation

Use of sorbitan sesquioleate in patch test preparations and patch testing with the substance-What do our results mean?

BACKGROUND

Sorbitan sesquioleate (SSO) is a sorbitan fatty acid ester, an emulsifier used in topical products and certain patch test preparations. SSO may affect the patch test results. It has been debated whether to include the substance in the baseline series to avoid misinterpretation of the results.

OBJECTIVES

To report the prevalence and simultaneous reactions of SSO with other patch test preparations containing SSO as an emulsifier.

MATERIALS AND METHODS

A retrospective analysis of 3539 dermatitis patients who underwent patch testing from 2016 to 2020 was performed.

RESULTS

The 5-year SSO contact allergy prevalence was 0.48%, and 1.3% had a doubtful reaction. Patients with a stronger positive reaction (2+, 3+) were more likely to react simultaneously to other allergen preparations containing SSO (p value = 0.018). One patient with a strong reaction to SSO reacted positively to all SSO-containing patch test preparations. Definite fragrance allergens could not be identified in the patients who had simultaneous reactions to SSO and fragrance mix (FM) I.

CONCLUSIONS

Patch testing with allergen preparations containing SSO affected the patch test interpretation. Fragrance contact allergy could not be ruled out when a patient simultaneously reacted to SSO and FM I. Changing emulsifiers in patch test preparations would be advantageous.

Safety Assessment of Sorbitan Esters as Used in Cosmetics

The Cosmetic Ingredient Review Expert Panel (Panel) assessed the safety of 20 sorbitan esters; this report included sorbitan esters that were reviewed in 1985 and 2002, as well as 3 previously unreviewed sorbitan esters (sorbitan undecylenate, sorbitan sesquicaprylate, and sorbitan palmate). Most of the sorbitan esters are reported to function in cosmetics as surfactant-emulsifying agents. The Panel reviewed the data from previous sorbitan ester reports, as well as additional data included in this report, to determine the safety of these ingredients. The Panel concluded that the sorbitan esters included in this safety assessment are safe in cosmetics in the present practices of use and concentration.

Sorbitan sesquioleate; a rare cause of contact allergy in consecutively patch tested dermatitis patients

BACKGROUND

Sorbitan sesquioleate (SSO) has been added to fragrance mix I (FM I) as an emulsifier since the 1990s. Being a contact allergen itself, SSO has the potential to cause false-positive reactions to FM I. Recent results obtained with selected FM I-positive patients have shown that 5% have concomitant positive reactions to SSO.

OBJECTIVES

To investigate the 5-year prevalence of contact allergy to SSO and evaluate the importance of SSO allergy when patch test results for FM I are interpreted.

METHODS

This was a retrospective database study of consecutively patch tested eczema patients (n = 4,637) from 2010 to 2014. All patients were tested with our baseline series including FM I and SSO 20% in pet.

RESULTS

Sensitization to SSO was identified in 9 (0.2%) patients. The proportion of FM I-positive patients with concomitant positive reactions to SSO was 1.4%.

CONCLUSIONS

SSO is a rare cause of contact allergy, with a 5-year prevalence of 0.2% in consecutively tested patients. Contact allergy to the emulsifier does not play a major role when the overall frequency of contact allergy to FM I is evaluated. However, to correctly diagnose individual patients, concomitant patch testing with FM I and SSO is encouraged.