Allergic contact dermatitis caused by alkyl glucosides

Occurrence of alkyl glucosides in rinse-off cosmetics marketed as hypoallergenic or for sensitive skin

Rinse-off cosmetic products, primarily shampoos, are frequently implicated in the onset of allergic contact dermatitis (ACD) caused by alkyl glucosides (AGs). AGs are increasingly popular surfactants and known contact allergens. Glucoside-induced ACD was most frequently observed with shampoos and skin-cleansing products in both consumer and occupational settings. Thereby, studies have shown that atopic individuals are the most susceptible to ACD. Also, several investigations have indicated that individuals with sensitive skin might be more prone to skin allergies. This is why the presence of AGs was investigated in shampoos and body cleansers marketed as hypoallergenic or for sensitive skin. For this purpose, the website of Amazon.com was surveyed. Four groups of cosmetics were obtained by using the following keywords: "hypoallergenic shampoo for adults," "sensitive skin shampoo for adults," "hypoallergenic body cleanser for adults," and "sensitive skin body cleanser for adults." The first 30 best-selling cosmetics in each group were investigated for the presence of AGs, by analyzing the product information pages. The results showed that as much as 56.7% of hypoallergenic shampoos contained AGs, as ingredients, whereas the percentage was somewhat lower for other product categories. Even though decyl and lauryl glucoside were nearly ubiquitously used AGs in cosmetics over the past decade, the most commonly present AG in our analysis was coco-glucoside. The results of this study indicated a necessity to include coco-glucoside in the baseline series of patch testing allergens. Industry, regulators, and healthcare providers should be made aware of the frequent presence of AGs in rinse-off cosmetic products marketed as hypoallergenic or for sensitive skin to ensure the safety and well-being of consumers and patients.

Investigation of the constituents of commercially available toothpastes

OBJECTIVES

Toothpaste plays a pivotal role in oral and dental hygiene. This cross-sectional study not only investigates the constituents of toothpastes available in the market and their frequency across different brands but also delves into the potential side effects, irritations, or unfavourable outcomes of these constituents, emphasizing the broader health and environmental implications.

METHODS

The largest of the five major chain markets in each district of Istanbul was visited, and adult toothpastes were included in this study. All the constituents that make up the toothpaste were individually recorded in an Excel database. Subsequently, literature regarding the purposes, toxic and potential side effects of each ingredient was gathered using databases such as Google Scholar, PubMed and ScienceDirect. The percentages of these ingredients' occurrence among all the toothpastes were calculated, and the ingredients were categorized into 15 distinct groups based on their usage purposes.

RESULTS

There were 160 different varieties of toothpaste belonging to 19 different brands on the market shelves. Although a total of 244 different ingredients were identified, only 78 of them were included in the study. Among the analysed toothpaste types, 105 of them were found to contain 1450 ppm fluoride, whilst 26 toothpaste variants were discovered to have fluoride levels below this value. Among the various ingredients analysed, particular attention was drawn to commonly debated compounds in oral care products. Specifically, titanium dioxide was found in 68% (n = 111) of the varieties, sodium lauryl sulphate in 67% (n = 108) and paraben in 2% (n = 4), respectively.

CONCLUSION

Whilst certain ingredients may raise concerns for potential side effects and health considerations within the human body, the toothpaste has long been regarded as an indispensable tool for maintaining optimal oral and dental health. However, gaining a deeper understanding and conducting research on each constituent that comprises the toothpaste, as well as raising awareness in this regard, holds significant importance for human health.

Patch testing with glucosides: The North American Contact Dermatitis Group experience, 2009-2018

BACKGROUND

Alkyl glucosides are nonionic surfactants that are increasingly used in personal care products.

OBJECTIVE

To characterize positive patch test reactions to decyl glucoside (5% petrolatum, tested 2009-2018) and lauryl glucoside (3% petrolatum, tested 2017-2018).

METHODS

Retrospective analysis of patients tested by the North American Contact Dermatitis Group.

RESULTS

Of 24,097 patients patch tested to decyl and/or lauryl glucoside, 470 (2.0%) had positive reactions. Compared with glucoside-negative patients, glucoside-positive patients had higher odds of occupational skin disease (13.4% vs 10.1%; P = .0207), history of hay fever (38.5% vs 31.6%; P = .0014), atopic dermatitis (39.0% vs 28.6%; P < .0001), and/or asthma (21.8% vs 16.5%; P = .0023). Most glucoside reactions (83.9%) were currently relevant. The most common source was personal care products (63.0%), especially hair products (16.5%) and skin cleansers (15.2%). Of 4933 patients tested to decyl and lauryl glucoside, 134 (2.7%) were positive to 1 or both; 43.4% (43 of 99) of decyl-positive patients were also positive to lauryl glucoside and 55.1% (43/78) of lauryl glucoside patients were also positive to decyl glucoside.

LIMITATIONS

The cohort predominantly reflects a referral population, and follow-up after testing was not captured.

CONCLUSION

Glucoside positivity occurred in 2.0% of the tested patients. Reactions were often clinically relevant and linked to personal care products. Cross-reactivity was >40%.

Allergic Contact Dermatitis of the Scalp Associated With Scalp Applied Products: A Systematic Review of Topical Allergens

ABSTRACT

Hair products are commonly used to maintain hair health or cosmesis. Products applied to the scalp and hair contain multiple active and inactive ingredients that can potentially cause irritant and/or allergic contact dermatitis. The objectives of this study were to identify and to discuss the most common allergens in scalp and hair applied products causing scalp allergic contact dermatitis (ACD). A PubMed search identified 99 studies, with 3185 patients and 31 categories of scalp products. Hair products reportedly associated with scalp ACD were hair dyes (41%), shampoos (28%), and conditioners (22%). The most commonly reported patch test-positive allergens were p-phenylenediamine (23%), nickel (15%), fragrance mix (13%), balsam of Peru (10%), cocamidopropyl betaine/3-dimethylaminopropylamine (7%), and methylchloroisothiazolinone/methylisothiazolinone (6%). Common symptoms and signs include eczematous lesions, pruritus, and a burning sensation. Medical practitioners should be aware of causative agents to provide appropriate patient education, counseling, and/or treatment.

Impact of trends in new and emerging contact allergens

Allergic contact dermatitis represents a T cell-mediated, delayed-type hypersensitivity response to exogenous agents. While allergic contact dermatitis is one of the most common causes of skin disease encountered by dermatologists, emerging trends within the field are in constant flux, as influenced by ever-changing industry practices and evolving consumer behaviors. Although certain allergens continue to predominate, new chemicals are frequently being introduced, thus shifting the pattern of allergen exposure and sensitization. This review examines the impact of trends in new and emerging contact allergens, with particular attention to clinical contexts in which these agents may be encountered. In addition, we offer a working knowledge of these allergens’ characteristics, sources, and relevance, while outlining recommendations to accurately evaluate, diagnose, and provide appropriate counseling for these diseases.

Prevalence and trend of allergen sensitization in patients referred for patch testing with a final diagnosis of psoriasis: North American Contact Dermatitis Group data, 2001-2016

BACKGROUND

Little is known about the relationship between psoriasis and allergic contact dermatitis (ACD).

OBJECTIVE

To examine the associations with ACD, related clinical characteristics, and common positive and clinically relevant allergens of patients with a final diagnosis of psoriasis who were referred for patch testing.

METHODS

Retrospective analysis of 38 723 patients from the North American Contact Dermatitis Group.

RESULTS

Patients with a final diagnosis of psoriasis had lower proportions of ACD than those without psoriasis (32.7% vs 57.8%). In multivariable logistic regression models, psoriasis was inversely associated with female sex, Black or Asian race, and history of atopic dermatitis and hay fever. Patients with a final diagnosis of psoriasis were less likely to have one or more positive allergic patch-test reactions or to have a current clinically relevant patch-test reaction to the majority of the most commonly positive and/or relevant allergens. The most clinically relevant allergens included nickel sulfate, methylisothiazolinone, and fragrance mix I.

CONCLUSION

Approximately one-third of patients who were referred for patch testing with a final diagnosis of psoriasis were also diagnosed with ACD. In select patients with suspected psoriasis who also have a clinical presentation suggestive of ACD, patch testing may be helpful.

Prevalence and Trend of Allergen Sensitization in Adults and Children with Atopic Dermatitis Referred for Patch Testing, North American Contact Dermatitis Group Data, 2001-2016

BACKGROUND

The association between atopic dermatitis (AD) and allergic contact dermatitis (ACD) is controversial.

OBJECTIVE

To analyze the prevalence, reaction strength, and trends of the most commonly positive and relevant allergens in patients with AD referred for patch testing.

METHODS

This was a retrospective analysis of 38,482 patients from the North American Contact Dermatitis Group, 2001 to 2016.

RESULTS

Most adults (56.0%) and children (52.8%) with a history of AD had a final diagnosis of ACD. Adults (66.5% vs 65.6%; χ², P = .1459) and children (61.4% vs 62.3%, P = .7074) with or without a history of AD had similar proportions of one or more allergic patch test reactions. Adults with a history of AD had a greater number of allergic patch test positive reactions than those without it (2.0 ± 2.4 vs 1.9 ± 2.3; t test, P < .0001), whereas children did not (1.5 ± 1.8 vs 1.4 ± 1.6; P = .3839). Nickel sulfate, methylisothiazolinone, formaldehyde, fragrance mix I, sodium gold thiosulfate, and thimerosal were the most common allergens in adults and children with a history of AD. In multivariable logistic regression models, adults with versus without a history of AD had increased odds of reacting to 10 of the top 25 North American Contact Dermatitis Group screening allergens. Most allergens had similar strengths of reaction in adults or children with and without a history of AD or a current AD diagnosis; cobalt, fragrance mix I, and propylene glycol had weaker reactions. In multivariable logistic regression, adults with versus without an AD history had increased odds of relevance for 10 of the 25 most currently relevant allergens, whereas children with an AD history did not have increased relevance for any specific allergens.

CONCLUSIONS

Most patients referred for patch testing with AD history had a final diagnosis of ACD. Patients with AD history had a similar likelihood of having a positive patch test reaction as those without an AD history. Adults with an AD history had a higher number of positive patch test reactions.

Hand eczema in children referred for patch testing: North American Contact Dermatitis Group Data, 2000-2016

BACKGROUND

Little is known about the aetiologies and relevant allergens in paediatric patients with hand eczema (HE).

OBJECTIVES

To characterize the aetiologies and determine the proportion of positive and currently relevant allergens in children/adolescents (age < 18 years) with HE referred for patch testing.

METHODS

A retrospective analysis (2000-2016) of North American Contact Dermatitis Group data was performed.

RESULTS

Of 1634 paediatric patients, 237 (14·5%) had involvement of the hands. Final physician diagnoses included allergic contact dermatitis (49·4%), atopic dermatitis (37·1%) and irritant contact dermatitis (16·9%). In multivariable logistic regression models, employment was the only association with increased odds of any HE or primary HE. Children with HE vs. those without HE had similar proportions of positive patch tests (56·1% vs. 61·7%; χ² -test, P = 0·11). The five most common currently relevant allergens were nickel, methylisothiazolinone, propylene glycol, decyl glucoside and lanolin. In multivariable logistic regression models of the top 20 relevant allergens, HE was associated with significantly higher odds of currently relevant reactions to lanolin, quaternium-15, Compositae mix, thiuram mix, 2-mercaptobenzathiazole and colophony. The allergens with the highest mean significance-prevalence index number were methylisothiazolinone, carba mix, thiuram mix, nickel and methylchloroisothiazolinone/methylisothiazolinone.

CONCLUSIONS

Children with HE who were referred for patch testing had a high proportion of positive patch tests, which was similar to the proportion found in children without HE. Children with HE had a distinct and fairly narrow profile of currently relevant allergens.

Sodium Lauryl Sulfate vs. Sodium Coco Sulfate. Study of the Safety of Use Anionic Surfactants with Respect to Their Interaction with the Skin

As a result of growing awareness, consumers are increasingly interested in products that are safe on the skin and environmentally-friendly. This is one of the most important reasons for the very rapid development of the natural cosmetics segment which has been observed for several years now. Among the most commonly used anionic surfactants of natural origin are sodium lauryl sulfate (SLS) and sodium coco sulfate (SCS). As there are no unambiguous reports on the safety of using SCS, in this study an attempt was made to evaluate the effect of SCS on the skin. The results of the determination of the skin irritation potential (zein value) indicate that the analyzed parameter is approximately 15 % lower in SCS than in SLS. SCS has a stronger ability to interact with epidermal lipids and cause their elution from the skin, which in turn may damage the protective epidermal barrier. The results obtained during the evaluation of the effect produced by the analyzed substances on the metabolism of human keratinocytes (HaCaT) show that after 4 h of incubation with the studied groups of compounds there was a significant decrease in cell proliferation. The highest decrease in cell metabolism was demonstrated for SLS.

Patch Testing with Decyl and Lauryl Glucoside: How Well Does One Screen for Contact Allergic Reactions to the Other?

BACKGROUND

Alkyl glucoside surfactants, present in many cosmetic products, can cause allergic contact dermatitis. Decyl glucoside has been part of the North American Contact Dermatitis Group standard allergen panel since 2009.

OBJECTIVES

This study aimed to identify rates and relevance of positive patch test reactions to decyl and lauryl glucosides and to determine how well one of these glucosides screens for contact allergic reactions to the other.

METHODS

A retrospective analysis was performed on 897 patients suspected of having a cosmetic-related dermatitis and patch tested with both decyl and lauryl glucosides between 2009 and 2016.

RESULTS

Forty-eight patients (5%) had positive reactions to decyl glucoside and/or lauryl glucoside. Among the alkyl glucoside-allergic patients, 65% had positive reactions to both decyl and lauryl glucosides. In 41% of cases, reactions were of definite or probable relevance. In approximately 55% of cases, reactions were of possible relevance.

CONCLUSIONS

Sixty-five percent of glucoside-allergic patients exhibited co-reactions to decyl and lauryl glucosides. Thus, neither glucoside is an adequate screen for allergy to the other. Given that these reactions are often relevant, clinicians should patch test with decyl, lauryl, and other alkyl glucosides in cases of suspected cosmetic allergy.

Allergenic Ingredients in Facial Wet Wipes

BACKGROUND

Allergic contact dermatitis commonly occurs on the face. Facial cleansing wipes may be an underrecognized source of allergens.

OBJECTIVE

The aim of this study was to determine the frequency of potentially allergenic ingredients in facial wet wipes.

METHODS

Ingredient lists from name brand and generic facial wipes from 4 large retailers were analyzed.

RESULTS

In the 178 facial wipes examined, a total of 485 ingredients were identified (average, 16.7 ingredients per wipe). Excluding botanicals, the top 15 potentially allergenic ingredients were glycerin (64.0%), fragrance (63.5%), phenoxyethanol (53.9%), citric acid (51.1%), disodium EDTA (44.4%), sorbic acid derivatives (39.3%), tocopherol derivatives (38.8%), polyethylene glycol derivatives (32.6%), glyceryl stearate (31.5%), sodium citrate (29.8%), glucosides (27.5%), cetearyl alcohol (25.8%), propylene glycol (25.3%), sodium benzoate (24.2%), and ceteareth-20 (23.6%)/parabens (23.6%). Of note, methylisothiazolinone (2.2%) and methylchloroisothiazolinone (1.1%) were uncommon. The top potential allergens of botanical origin included Aloe barbadensis (41.0%), chamomile extracts (27.0%), tea extracts (21.3%), Cucumis sativus (20.2%), and Hamamelis virginiana (10.7%).

CONCLUSIONS

Many potential allergens are present in facial wet wipes, including fragrances, preservatives, botanicals, glucosides, and propylene glycol.

Interactions between surfactants and the skin - Theory and practice

One of the primary causes of skin irritation is the use of body wash cosmetics and household chemicals, since they are in direct contact with the skin, and they are widely available and frequently used. The main ingredients of products of this type are surfactants, which may have diverse effects on the skin. The skin irritation potential of surfactants is determined by their chemical and physical properties resulting from their structure, and specific interactions with the skin. Surfactants are capable of interacting both with proteins and lipids in the stratum corneum. By penetrating through this layer, surfactants are also able to affect living cells in deeper regions of the skin. Further skin penetration may result in damage to cell membranes and structural components of keratinocytes, releasing proinflammatory mediators. By causing irreversible changes in cell structure, surfactants can often lead to their death. The paper presents a critical review of literature on the effects of surfactants on the skin. Aspects discussed in the paper include the skin irritation potential of surfactants, mechanisms underlying interactions between compounds of this type and the skin which have been proposed over the years, and verified methods of reducing the skin irritation potential of surfactant compounds. Basic research conducted in this field over many years translate into practical applications of surfactants in the cosmetic and household chemical industries. This aspect is also emphasized in the present study.

Epidemiology and Co-Reactivity of Novel Surfactant Allergens: A Double-Blind Randomized Controlled Study

BACKGROUND

Surfactants are cleansing agents used in products such as shampoos and soaps.

OBJECTIVES

The aims of this study were to identify positivity rates to 3 novel amide-containing surfactants (sodium lauroyl sarcosinate, isostearamidopropyl morpholine lactate, and disodium lauroamphodiacetate) and evaluate co-reactivity with other surfactants in patients with known surfactant sensitivity.

METHODS

Previously patch-tested, surfactant-positive patients were identified via chart review and invited to participate. Participants were patch tested to screening surfactants (cocamidopropyl betaine, amidoamine, dimethylaminopropylamine, cocamide diethanolamine [DEA], oleamidopropyl dimethylamine, and decyl glucoside), as well as 3 novel surfactants: sodium lauroyl sarcosinate 0.5% and 1.0% aq, isostearamidopropyl morpholine lactate 0.5% and 1.0% aq, disodium lauroamphodiacetate 1.0 and 2.0% aq, and a hypoallergenic liquid cleanser (tested semiopen). Participants and clinicians were blinded. The order of tested allergens was randomized.

RESULTS

Forty-seven participants completed the study. Excluding doubtful reactions, positive reactions were most common to oleamidopropyl dimethylamine (34%) and dimethylaminopropylamine (34%), followed by isostearamidopropyl morpholine lactate (23%). Reactivity was not associated with history of childhood eczema. Co-reactivity was high among oleamidopropyl dimethylamine, dimethylaminopropylamine, cocamidopropyl betaine, amidoamine, and isostearamidopropyl morpholine lactate. None of the participants who reacted to cocamide DEA reacted to an additional surfactant.

CONCLUSIONS

Isostearamidopropyl morpholine lactate may be an important emerging allergen with sensitivity rates comparable with those of oleamidopropyl dimethylamine and dimethylaminopropylamine. Co-reactivity among surfactants was frequent except for cocamide DEA.

Alkyl Glucosides

Alkyl glucosides are surfactants synthesized through the condensation of long-chain fatty alcohols and glucose, extracted from vegetal, renewable sources. Although available for more than 4 decades, they have been rediscovered in recent years because of their eco-friendly character. They are used in various leave-on and rinse-off cosmetics and are considered of low irritancy and allergenicity. However, since the early 2000s, cases of allergic contact dermatitis to this family of molecules have been repeatedly reported. Decyl glucoside was found to be a "hidden" allergen in the sunscreen ingredient Tinosorb M and is likely responsible for most allergic contact dermatitis reported to this compound. Members of the North American Contact Dermatitis Group have seen a steady increase of the rate of sensitization to decyl glucoside. Cross-reactions with other glucosides are common but not automatic; thus, patch testing multiple compounds is recommended.

New Contact Allergens: 2008 to 2015

Every year, new contact allergens, chemicals reported to have caused contact allergy/ACD for the first time, are described in literature. In the journals Contact Dermatitis and Dermatitis, 172 such compounds were identified in the period 2008-2015, 119 of which induced ACD. These are presented with the following data: name, synonyms, Chemical Abstracts Service (CAS) number, patch test data, function or class, causative product, number of patients, occupation (in case of occupational ACD), additional clinical data (if applicable), and references. Approximately one third of the new allergens were ingredients of cosmetics, followed by drugs causing occupational ACD (18%), chemicals in rubber, plastics, and paints (9%), drugs causing a drug eruption (9%), as well as chemicals used in laboratories inducing occupational ACD (8%). In 40%, the dermatitis was occupationally acquired. Fifty-three other chemicals causing contact allergy as indicated by positive patch test reactions only are shown without specifics.

Isobornyl acrylate: an impurity in alkyl glucosides

CONTEXT

Alkyl glucosides and alkyl poly-glucosides are widely used as wetting agents, surfactants and emulsifiers in several industrial and cosmetic products. They are known as well-tolerated and are usually added to the primary surfactants in order to reduce the irritating potential of the main foaming agents.

OBJECTIVE

Recently, some authors suggested that allergic contact dermatitis to alkyl glucosides might be more frequent than suspected. On the other hand, the chemical structures of glucosides do not show potentially allergenic chemical groups or strongly polarized structures. The aim of our study is to investigate alkyl glucosides carrying out a detailed chemical analysis on samples of raw materials to identify potentially allergenic impurities or by-products contained in commercial samples of alkyl glucosides.

MATERIALS AND METHODS

We chemically analyzed samples of cocoyl glucoside, decyl glucoside and lauryl glucoside by three different analytical methods, in order to identify any undesired or polluting substances.

RESULT

In each of the three samples, we detected the presence of isobornyl acrylate. Its approximate content in the tested samples is 500 ng/g of the product.

DISCUSSION

Isobornyl acrylate is not used in the synthesis of alkyl glucosides, but as a plasticizer in many plastic materials. It can be easily released to materials flowing over these surfaces when they have high extraction power, as glucosides.

CONCLUSION

Isobornyl acrylate may play a role as hidden allergen, in the form of an impurity collected during the industrial process, explaining some cases of allergic reaction to alkyl glucosides.