ArticleLiterature Review

Sunscreen Allergy: A Review of Epidemiology, Clinical Characteristics, and Responsible Allergens

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Abstract

Although allergy to sunscreen represents a small proportion (< 1%) of allergic contact dermatitis reactions in North America, it is one of the most common causes of photoallergy. The epidemiology and clinical characteristics of sunscreen allergy are summarized in this review. In addition, a detailed discussion of specific chemical sunscreen allergens is provided.

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... 4-Methoxycinnamic acid studied in this paper is used in cosmetic industry and medicine as antibacterial agent [19,20]. Its esters are also used in the perfume industry as essential components of aromatic substance, perfumes and pharmaceuticals [21]. ...
... The solvent-solute interaction for E-4mCinA has been analyzed by derived Kamlet-Taft and Catalan models. In the derived models, statistical parameters are kept in reasonable values (see Eqs. (18), (19), (20), (21)). Kamlet-Taft and Catalan solvatochromic models derived for both absorption and fluorescence spectra are given in Eqs. ...
... Kamlet-Taft and Catalan solvatochromic models derived for both absorption and fluorescence spectra are given in Eqs. (18), (19), (20), (21), respectively. The solvent parameters being derived Kamlet-Taft and Catalan solvatochromic models are given in Table 4. Kamlet-Taft model for absorption spectra: and 23,632 cm −1 values are wavenumbers for fluorescence spectra in gas phase, respectively. ...
Article
The UV–vis absorption and steady state fluorescence spectra of E-4-methoxycinnamic acid (abbreviated as E-4mCinA) have been recorded in serial solvents with different properties. Specific and non-specific solute-solvent interactions are evaluated by the way of spectral changes. The ground state and excited state dipole moments are determined by using Lippert–Mataga, Bakhshiev, Bilot–Kawski and Reichardt solvatochromic shift methods as a function of solvents parameters and spectral shifts in the absorption and fluorescence spectra. The relatively large excited state dipole moment value indicates that E-4mCinA is more polar in the excited state. Solvatochromism of E-4mCinA is investigated by using Kamlet–Taft and Catalan models. Kamlet–Taft solvatochromic model indicates that specific interactions are dominant in controlling the absorption and fluorescence spectral shifts. Solvent dipolarity/polarizability is found to play significant role in solvatochromic behavior of fluorescence spectral shifts. Catalan solvatochromic model designates that solute-solvent interactions are predominantly governed by solvent dipolarity. Molarity, water and pH effects on the spectral and solvatochromic behaviors are investigated. It is confirmed that E-4mCinA acid displays aggregation depended spectral changes. Nonetheless, adding water to methanolic solution of E-4mCinA leads to forming new charge transfer channels by the way of interaction between one molecule water and two molecule methanol. Acidic and basic media give rise to protonation and deprotonation process for E-4mCinA. Theoretical UV spectra and HOMO, LUMO plots and energy values have been calculated both in gas phase and methanol by B3LYP/6-31G(d) and TD- B3LYP/6-31G(d) level of theory. Ground state molecular electrostatic potential (MEP) and solvent accessible surface (SAS) are computed in gas phase by using B3LYP/6-31G(d) method.
... During recent decades, the search for new molecules showing photoprotection has increased as these can counteract the adverse effects provoked by ultraviolet radiation (UVR) [1][2][3][4][5]. UVR from sunlight is considered a carcinogenic agent and mainly promotes skin cancer [6][7][8]. ...
... However, certain compounds used in sunscreens can cause adverse effects, such as allergies or neurotoxicity [1,2]. The secondary factors are related to molecules possessing biological activities able to counteract the effects of UVR at the cellular and molecular level (e.g., anti-inflammatory, free radical scavenging, DNA repair, and anti-apoptotic activities). ...
Article
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The research on compounds exhibiting photoprotection against ultraviolet radiation (UVR) is a matter of increasing interest. The methanolic extract of a cell culture of Buddleja cordata has potential photoprotective effects as these cells produce phenolic secondary metabolites (SMs). These metabolites are attributed with biological activities capable of counteracting the harmful effects caused by UVR on skin. In the present work, the methanolic extract (310–2500 µg/mL) of B. cordata cell culture showed a photoprotective effect on UVB-irradiated 3T3-Swiss albino fibroblasts with a significant increase in cell viability. The greatest photoprotective effect (75%) of the extract was observed at 2500 µg/mL, which was statistically comparable with that of 250 µg/mL verbascoside, used as positive control. In addition, concentrations of the extract higher than 2500 µg/mL resulted in decreased cell viability (≤83%) after 24 h of exposure. Phytochemical analysis of the extract allowed us to determine that it was characterized by high concentrations of total phenol and total phenolic acid contents (138 ± 4.7 mg gallic acid equivalents and 44.01 ± 1.33 mg verbascoside equivalents per gram of extract, respectively) as well as absorption of UV light (first and second bands peaking at 294 and 330 nm, respectively). Some phenylethanoid glycosides were identified from the extract.
... 8 There are four kinds of adverse skin reactions from sunscreens: irritant, allergic, phototoxic or photo-irritant, and photoallergic. 9 The prevalence of true allergy to chemical sunscreen filters is low among those patients referred for patch testing and in various studies is thought to be less than 1%. 9 The occurrence of photoallergic contact dermatitis (PACD) is felt to be rare but may be underestimated due to the low use of photo patch testing. 10 Irritation-both simple and phototoxic-is thought to occur at least as often as allergic reactions, but again, the true incidence is likely higher due to underreporting. ...
... 9 The prevalence of true allergy to chemical sunscreen filters is low among those patients referred for patch testing and in various studies is thought to be less than 1%. 9 The occurrence of photoallergic contact dermatitis (PACD) is felt to be rare but may be underestimated due to the low use of photo patch testing. 10 Irritation-both simple and phototoxic-is thought to occur at least as often as allergic reactions, but again, the true incidence is likely higher due to underreporting. ...
... Certain antioxidants, such as retinol palmitate, tocopherol (vitamin E) acetate and ascorbic acid (vitamin C), are utilized more specifically in sunscreen and moisturizing products to avoid aging [118,122]. However, in such preparations, they are uncommon causes of allergic contact dermatitis (Table 3) [118,123,124]. However, the low incidence of confirmed cases of allergic reactions may be due to a lack of recognition of a contact allergy or photoallergy to sunscreen products, as a differential diagnosis of a primary sun intolerance is not always evident [118]. ...
Article
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Moisturizers are one of the most widely used preparations in cosmetics and have been extensively used to soften the skin for consumers. Moisturizers work effectively in combating dry skin which may cause pain, tightness, itch, stinging, and/or tingling. The aim of this review is to evaluate published studies on the history, ingredients, preparation processes, characteristics, uses, and applications of moisturizers. Moisturizers bridge the gap between medicine and consumer goods by being used to make the skin more beautiful and healthy. In the future, in moisturizer therapy, the capacity to adapt specific agents to specific dermatological demands will be crucial. Cosmetically, moisturizers make the skin smooth by the mechanism of increasing the water content in the stratum corneum, hence exerting its most vital action, which is moisturizing action and maintaining a normal skin pH.
... In this context, photoallergy is associated with a cell-mediated immune response which is initiated by covalent binding of a light-activated hapten (for instance, a drug or a species derived therefrom) to a protein (Tokura, 2009;Ariza et al., 2011;Onoue et al., 2017). It is considered an emerging health concern due to the widespread use of topical drugs (including antibiotics, antifungals, antihistaminics, cardiovascular and nonsteroidal antiinflammatory drugs), cosmetics, and nutraceutical in humans, which has attracted considerable attention from both industry and regulatory agencies (Schothorst et al., 1972;Girotti, 2001;Deleo, 2004;Dubakiene and Kupriene, 2006;Scheuer and Warshaw, 2006;Lugovic et al., 2007;Bylaite et al., 2009;Santoro and Lim, 2011;Elkeeb et al., 2012;Onoue et al., 2013;Honari, 2014;Kerstein et al., 2014;Scheinfeld et al., 2014;Onoue et al., 2016). ...
Article
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Triflusal is a platelet antiaggregant employed for the treatment and prevention of thromboembolic diseases. After administration, it is biotransformed into its active metabolite, the 2-hydroxy-4-trifluoromethylbenzoic acid (HTB). We present here an investigation on HTB photobinding to human serum albumin (HSA), the most abundant protein in plasma, using an approach that combines fluorescence, MS/MS, and peptide fingerprint analysis as well as theoretical calculations (docking and molecular dynamics simulation studies). The proteomic analysis of HTB/HSA photolysates shows that HTB addition takes place at the ε-amino groups of the Lys137, Lys199, Lys205, Lys351, Lys432, Lys525, Lys541 and Lys545 residues and involves replacement of the trifluoromethyl moiety of HTB with a new amide function. Only Lys199 is located in an internal pocket of the protein, and the remaining modified residues are placed in the external part. Docking and molecular dynamic simulation studies reveal that HTB supramolecular binding to HSA occurs in the “V-cleft” region and that the process is assisted by the presence of Glu/Asp residues in the neighborhood of the external Lys, in agreement with the experimentally observed modifications. In principle, photobinding can occur with other trifluoroaromatic compounds and may be responsible for the appearance of undesired photoallergic side effects.
... This was confirmed in a study that demonstrated poor photostability of avobenzone in a majority of sunscreens in the market [32]. Additionally, chemical sunscreen is one of the most common causes of photoallergy [33,34]. ...
Article
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Sunscreen use is recommended for the prevention of sunburn and skin cancer. Little is known regarding sunscreen availability in high versus low income communities. We analyzed sunscreen availability in three large metropolitan counties to determine the relationship between availability and community demographics. We included sun care products in all pharmacies and supermarkets open as of July 2013 in representative high and low income zip codes in Cook County, Illinois, Miami-Dade County, Florida, and San Diego County, California. We recorded the percentage of tanning oil, sunscreens with a sun protection factor (SPF) < 15, SPF > 15, physical sunscreens, spray sunscreens, mean price per ounce (PPO), and mean SPF. Of the total products assessed, 11.0% were tanning oils, with physical sunscreens accounting for only 3.4% of the available sunscreens and 46.2% of sunscreens being spray-on. A comparison between higher and lower income zip codes demonstrated a significantly increased percentage of sunscreens with SPF < 15 in high income zip codes. Lower income zip codes had higher percentages of sunscreens with SPF > 15 and higher PPO, even when taking into account SPF. Further studies of sunscreen usage patterns in different populations must take into account sunscreen availability and price, as these significantly differ based on the community demographic.
... Products containing physical or mineral sunscreens agents, like zinc oxide or titanium dioxide, are less likely to irritate baby's skin than chemical filters and should be preferred. Also, paraaminobenzoic acid (PABA), octocrylene and oxybenzone must be avoided because they are associated with skin reactions (28)(29). ...
Article
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This article aimed a review about a new market category that is children’s products. Nowadays the United States and Brazil lead this market. These products are for particular age groups such as baby (0-2 years), children (3-7 years), pre-teens (8-12 years) and teenagers (above 12 years). The child's skin is more hydrated, sensitive, has a pH around neutrality, the epidermis is thinner than an adult skin. To ensure the safety, they should be formulated with regard to children's skin that is more permeable and present increased susceptibility to skin infections. Restrictions of these products are regulated in each country so that the effectiveness and safety of these products are guaranteed.
... Although many suspected sunscreen allergies arise from non-active ingredients in the formulation, the most common sunscreen photoallergens are para-aminobenzoic acid (now rarely used), benzophenones and butyl methoxy dibenzoylmethane. 5 Concerns have been raised about the oestrogenic effects of some sunscreen ingredients, especially benzophenones, which have a high topical bioavailability, and 4-methylbenzylidene camphor (4-MBC) and octyl methoxycinnamate (OMC), which have shown weak oestrogenic effects in vitro. ...
Article
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Sunburn is caused by ultraviolet B radiation, but ultraviolet A may be more damaging to the skin. Sunscreens should ideally block both wavebands. The sun protection factor of a sunscreen is mainly based on blocking ultraviolet B. It does not measure the effectiveness against blocking ultraviolet A. Sunscreens may be organic or inorganic chemicals. The cosmetic acceptability of metal oxide sunscreens may be improved if they are formulated as nanoparticles. The absorption of organic sunscreens and nanoparticles does not appear to cause significant systemic effects. Regular use of sunscreen significantly reduces the development of actinic keratosis, squamous cell carcinoma and melanoma.
... Chemically synthesized UV screens are relevant environmental contaminants (Balmer al. 2005), and for some active compounds androgenic and estrogenic effects have been detected (Krause et al. 2012). Besides, common active ingredients like 3-benzophenone of zinc oxide have shown to produce reactive oxygen species and photoallergenic effect in humans (Brezová et al. 2005, Hanson et al. 2006, Scheuer and Warshaw 2006. As a result, the industry is seeking for more innocuous and natural compounds to replace current chemically synthesized and controversial ingredients. ...
Chapter
The Patagonia region constitutes a vast geographic area with multiple extreme environments having one or more of these stress factors: cold, high UV incidence, desiccation, ultra-oligotrophy, acidity, and the presence of heavy metals, among others. Yeasts that constantly live under stress conditions evolve adaptive mechanisms to minimize or resist their negative effects and thus permit survival and reproduction. These specific mechanisms are promising sources of biotechnologically relevant molecules or genes. Here we summarize numerous yeast bioprospection studies performed in the conventional and extreme environments of the Argentinean Patagonia. More than 1000 yeasts and dimorphic fungi were collected and molecularly identified; when possible, relevant secondary metabolites were screened, as well as their ability to tolerate several types of stress in laboratory conditions. Screened metabolites include carotenoid pigments, mycosporines (UV sunscreens), and cold-active enzymes. In some cases, these traits could be correlated to habitat characteristics and for those (e.g., mycosporines, carotenoid pigments, heavy metal tolerance) their potential role in the adaptive mechanisms to specific stress factors was evaluated. Genome sequencing and analyses were performed for biotechnologically relevant isolates such as Saccharomyces eubayanus, Saccharomyces uvarum, and Phaffia rhodozyma (synonym of Xanthophyllomyces dendrorhous). The biotechnological potential of selected species is addressed as specific study cases. The present work represents an overview of our findings related to biotechnologically relevant yeasts from Patagonian natural environments.
... BP-3 and BP-8 have a common 2-hydroxy-4-methoxyphenyl methanone moiety in their chemical structures. Although it did not reach statistical significance, avobenzone, reported as a photoallergen in various sunscreen agents (Scheuer and Warshaw, 2006), tended to increase PDE4B gene transcription in NHKs. Avobenzone, like BP-3 and BP-8, contains a methoxyphenyl group. ...
... The "blocking" of UVR penetration can be achieved through the application of either physical or chemical sunscreen. Physical sunscreens are sunscreens that contain titanium dioxide or zinc oxide nanoparticles that reflect and scatter UVR, whereas chemical sunscreens are made of organic molecules that absorb UVR energy and emit them as less dangerous wavelengths [41][42][43][44]. Nevertheless, regardless of their classification, the validation of the "blocking" ability of these sunscreens was set by ISO and FDA to have at least a critical wavelength of 370 nm when claiming the title of being a broad-spectrum sunscreen [45][46][47]. ...
Article
Full-text available
The importance of cosmetics in our lives is immeasurable. Covering items from daily personal hygienic products to skincare, it has become essential to consumers that the items that they use are safe and effective. Since natural products are from natural sources, and therefore considered “natural” and “green” in the public’s eyes, the rise in demand for such products is not surprising. Even so, factoring in the need to remain on trend and innovative, cosmetic companies are on a constant search for new ingredients and inventive new formulations. Based on numerous literature, the seed of Swietenia macrophylla has been shown to possess several potential “cosmetic-worthy” bioproperties, such as skin whitening, photoprotective, antioxidant, antimicrobial, etc. These properties are vital in the cosmetic business, as they ultimately contribute to the “ageless” beauty that many consumers yearn for. Therefore, with further refinement and research, these active phytocompounds may be a great contribution to the cosmetic field in the near future.
... 2-phenylbenzimidazole-5-sulfonic acid [12]. Physical blocker contains titanium dioxide and zinc oxide in bulk form or in their nanoparticles forms [13]. ...
Chapter
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Herbs are being used in skin care and therapeutics from centuries. Their ingredients including bioactive phytochemicals have been widely used in sunscreens, moisturizers, and anti-aging lotions. Sunscreens have enhanced photo-protection activity when they contain bioactive components including vitamins such as A, C and E, flavonoids, carotenoids, polyphenols, hydroxy and phenolic acids. Herbal formulations in sunscreens or skin care products are used to repair or hide skin imperfections such as wrinkles and dark circles, and also for soothing and cooling of the skin. Their anti-bacterial and anti-fungal activities help to treat acne. Some herbal constituents with strong antioxidant properties inhibit the formation of free radicals and counterbalance reactive oxygen species (ROS). Regular exposure to ultraviolet (UV) radiation can cause sunburns, rashes, premature aging of the skin, oxidative stress, DNA damage and cancer. In order to avoid these undesired effects, the protection from UV ray exposure and prevention from its harmful effects are desired. The chemical-based products may cause allergy and contact dermatitis, while natural or herbal products are generally non-toxic and biodegradable. Also, nanoformulation of herbal components may effectively be absorbed to layers of skin cells to sustained and prolonged effects. Herein, different types of herbs with active components that could serve as a photoprotectant against harmful UV rays are discussed.
... The aforementioned cinnamic acid derivatives absorb UV radiation mostly in the UVB region, covering wavelengths in the 280-320 nm range (peak absorption at 310 nm) for octinoxate, 290-360 nm (peak absorption at 303 nm) for octocrylene, 270-328 (peak absorption at 311) for cinoxate, and peak absorption at 310 nm for amiloxate [29,32,33]. UV filters from that group are characterized by poor water solubility and are preferred in waterproof applications [34]. ...
Article
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Cinnamic acid derivatives are widely used in cosmetics and possess various functions. This group of compounds includes both naturally occurring as well as synthetic substances. On the basis of the Cosmetic Ingredient Database (CosIng) and available literature, this review summarizes their functions in cosmetics, including their physicochemical and biological properties as well as reported adverse effects. A perfuming function is typical of many derivatives of cinnamaldehyde, cinnamyl alcohol, dihydrocinnamyl alcohol, and cinnamic acid itself; these substances are commonly used in cosmetics all over the world. Some of them show allergic and photoallergic potential, resulting in restrictions in maximum concentrations and/or a requirement to indicate the presence of some substances in the list of ingredients when their concentrations exceed certain fixed values in a cosmetic product. Another important function of cinnamic acid derivatives in cosmetics is UV protection. Ester derivatives such as ethylhexyl methoxycinnamate (octinoxate), isoamyl p‐methoxycinnamte (amiloxiate), octocrylene, and cinoxate are used in cosmetics all over the world as UV filters. However, their maximum concentrations in cosmetic products are restricted due to their adverse effects, which include contact and a photocontact allergies, phototoxic contact dermatitis, contact dermatitis, estrogenic modulation, and generation of reactive oxygen species. Other rarely utilized functions of cinnamic acid derivatives are as an antioxidant, in skin conditioning, hair conditioning, as a tonic, and in antimicrobial activities. Moreover, some currently investigated natural and synthetic derivatives of cinnamic acid have shown skin lightening and anti‐aging properties. Some of them may become new cosmetic ingredients in the future. In particular, 4‐hydroxycinnamic acid, which is currently indexed as a skin‐conditioning cosmetics ingredient, has been widely tested in vitro and in vivo as a new drug candidate for the treatment of hyperpigmentation. This article is protected by copyright. All rights reserved.
... Das bedeutet, dass beim Verdacht einer Kontaktsensibilisierung auf Lichtschutzmittel immer eine Photopatchtestung erfolgen sollte. Genaue Daten zur Prävalenz von Sensibilisierungen gegen UV-Filter sind nicht bekannt; innerhalb eines zur Photopatchtestung einbestellten Patientenkollektivs wurde eine Häufigkeit von <1 % berichtet [5,6]. Die höchsten Induktionsraten eines allergischen Kontaktekzems durch eine UV-Filtersubstanz wurden für Methylene bis-benzotriazolyl tetramethylbutylphenol (Tinosorb M, BASF, Ludwigshafen, Deutschland) beschrieben, wohingegen 4-tert-Butyl-4'-methoxydibenzoylmethan als der führende Auslöser eines photoallergischen Kontaktekzems identifiziert wurde [4,7]. ...
Article
UV-Filtersubstanzen können sowohl allergische als auch häufiger photoallergische Kontaktekzeme auslösen. Deshalb sollte bei Verdacht auf eine Kontaktsensibilisierung gegenüber Lichtschutzmittel immer eine Photopatchtestung durchgeführt werden. Wir berichten über eine 65-jährige Frau mit seit 11 Jahren verstärkt nach Sonnenexposition auftretender Rötung der Haut im Gesichts- und Dekolletébereich trotz Anwendung eines Lichtschutzpräparates. Anhand der (Photo‑)Patchtestung konnte die Diagnose eines allergischen Kontaktekzems auf den UV-Filter 4-tert-Butyl-4’-methoxybenzoylmethan etabliert werden. Unter der Therapie mit einem topischen Glukokortikosteroid und Meidung der kausalen UV-Filtersubstanz kam es zur raschen Abheilung.
... 5 Synthetic sunscreens may, however, cause adverse effects such as skin irritation, allergy, and endocrine disruption. 6,7 Natural products including flavonoids, anthraquinones, and tannins, which have a structure similar to that of synthetic sunscreens, have been shown to be capable of absorbing UVR. [8][9][10] The Cs-HK1 mycelial biomass was prepared by mycelial liquid fermentation in our laboratory, as reported previously. ...
Article
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Mushrooms are potential sources of novel natural cosmeceutical ingredients. This study was conducted to evaluate the cosmetic (skincare) benefits of the valuable medicinal species Ophiocordyceps sinensis (=Cordyceps sinensis). The mycelial extracts of 2 O. sinensis strains, Cs-HK1 and Cs-4, prepared sequentially with ethyl acetate, ethanol, and hot water were tested with in vitro assays for tyrosinase-, collagenase-, and elastase-inhibitory activity. The ethyl acetate extracts of both fungal strains showed potent antityrosinase and antielastase activity, with low half-maximal inhibitory concentrations (0.14-0.47 mg/mL) comparable to those of the respective reference compounds (arbutin and epigallocatechin gallate). All mycelial extracts exhibited moderate or significant anticollagenase activity; most extracts showed a significant photoprotective effect with a sun protection factor up to 25. The results from this study show the potential use of O. sinensis as a source of cosmetic ingredients for skincare applications.
... The rest had reactions only to the excipients. These findings are consistent with the current literature understanding in that true ACD to the active ingredient in sunscreens is uncommon and below 1% [129]. ...
Article
Full-text available
Consumer products and topical medications today contain many allergens that can cause a reaction on the skin known as allergic contact dermatitis. This review looks at various allergens in these products and reports current allergic contact dermatitis incidence and trends in North America, Europe, and Asia. First, medication contact allergy to corticosteroids will be discussed along with its five structural classes (A, B, C, D1, D2) and their steroid test compounds (tixocortol-21-pivalate, triamcinolone acetonide, budesonide, clobetasol-17-propionate, hydrocortisone-17-butyrate). Cross-reactivities between the steroid classes will also be examined. Next, estrogen and testosterone transdermal therapeutic systems, local anesthetic (benzocaine, lidocaine, pramoxine, dyclonine) antihistamines (piperazine, ethanolamine, propylamine, phenothiazine, piperidine, and pyrrolidine), topical antibiotics (neomycin, spectinomycin, bacitracin, mupirocin), and sunscreen are evaluated for their potential to cause contact dermatitis and cross-reactivities. Finally, we examine the ingredients in the excipients of these products, such as the formaldehyde releasers (quaternium-15, 2-bromo-2-nitropropane-1,3 diol, diazolidinyl urea, imidazolidinyl urea, DMDM hydantoin), the non-formaldehyde releasers (isothiazolinones, parabens, methyldibromo glutaronitrile, iodopropynyl butylcarbamate, and thimerosal), fragrance mixes, and Myroxylon pereirae (Balsam of Peru) for contact allergy incidence and prevalence. Furthermore, strategies, recommendations, and two online tools (SkinSAFE and the Contact Allergen Management Program) on how to avoid these allergens in commercial skin care products will be discussed at the end.
... The high intensity of UV radiation could be absorbed by chemical absorbers, while physical blockers contain ingredients which reflect or scatter them [11]. Chemical absorber contains chemical compounds such as avobenzone, para-aminobenzoic acid, benzophenones, cinnamates, salicylates, dibenzoylmethanes, anthranilates, octyl triazone, 2-phenylbenzimidazole-5-sulfonic acid [12]. Physical blocker contains titanium dioxide and zinc oxide in bulk form or in their nanoparticles forms [13]. ...
Chapter
Ultraviolet (UV) radiation is responsible for different skin diseases and allergic reactions. Synthetic sunscreens are widely used to protect the skin in the intense UV environments. Different synthetic molecules are being used as active ingredients in the commercial sunscreens, however, few of them are reported to cause toxicity to humans and ecosystems. Regulatory bodies like USFDA and European Commission have issued a guideline for the safe use of active chemical ingredients in the commercial sunscreens. Therefore, there is an increasing interest in the screening of safe and efficacious natural molecules having potential photoprotective properties. This chapter presents a scientific summary to emphasize the possible use of certain microbial metabolites as active ingredients in the commercial sunscreens.
... Water-resistant sunscreen with high lipophilic/hydrophilic ratios increases comedogenicity. 28,29 Ultraviolet protective (UPF) 50+ fabrics used for mask wear should be the principal intervention for broad-spectrum sun protection for the lower half of the face during the COVID-19 pandemic, 1 to improve patient compliance to photoprotection and incentivize maskwearing, also eliminating periodic reapplication of sunscreens. ...
Article
"Maskne" is a new term coined during the 2020 COVID-19 pandemic. It refers to a subset of acne mechanica, deserving consideration in view of widespread reusable fabric mask-wearing to control the pandemic worldwide. Understanding of underlying pathophysiology directly relates to the novel skin microenvironment and textile-skin friction created by mask-wearing, distinct from nontextile-related acne mechanica previously linked to wearing of headgear. Specifically, the occlusive microenvironment leads to microbiome dysbiosis, which is linked to various dermatological conditions. Additional textile-skin interactions include factors such as breathability, stickiness sensations, moisture saturation, and hygiene maintenance. Increased skin temperatures can trigger sweat/heat-related dermatoses, and ear loops potentially trigger pressure-induced dermatoses. Important therapeutic considerations include increased skin irritation potential of conventional acne treatments under occlusion, exacerbation of chronic dermatoses, that is, perioral dermatitis, rosacea, and eczema, and susceptibility of these same patient groups to heightened discomfort with mask-wearing. Cotton, as the traditional fabric of choice for dermatology patients, has limited benefits in the context of face masks - increased subjective discomfort relates to increased moisture saturation and stickiness, inevitable because of high biofluid load of the nasal and oral orifices. Prolonged textile-skin contact time, directly proportional to the risk of maskne, can be an opportunity for the application of biofunctional textiles.
... Although inorganic sunscreens are popular for their lesser penetration into the living epidermis (Langerhans cells, keratinocytes, and melanocytes), and thus a lower risk of inducing allergic contact reactions, their property of scattering light results in formulations with a propensity to leave a whitish hue on the patient's skin, making them less cosmetically pleasing [59]. Tinting these formulations with universal skin tone tints helps to counter the whitish hue and improve cosmesis. ...
Article
Ultraviolet radiation (UVR) exposure is well established as the major environmental risk factor for the development of melanoma, cutaneous squamous cell carcinoma (cSCC), and basal cell carcinoma (BCC). Additional risk factors including genetic mutations, other environmental agents, and immune status are important in modulating the effects of UVR. Dermatologists advocate a multi-pronged approach to minimizing UVR exposure including lifestyle modifications, UVR protective clothing, and topically applied sun-protective products, i.e. sunscreen. New Federal Drug Administration (FDA) regulations on sunscreen have brought certain long-standing ingredients in sunscreen products under scrutiny. The FDA's proposed rule for over the counter (OTC) monograph states that the inorganic sunscreens, zinc oxide and titanium dioxide, were found to be "generally recognized as safe and effective," but cite insufficient evidence to grant organic sunscreens the same designation. This proposed rule by the FDA and our increasing understanding of multifactorial mechanisms of UVR damage are an impetus for innovation and advances in sun protective technology. A complete set of strategies designed to limit the risk of UV-induced skin cell malignant transformation and tumor development must address the fuller consideration of genetic, environmental, and immune factors that cooperatively drive cutaneous carcinogenesis. Recent advances in our understanding of the biochemical processes underpinning UVR associated cutaneous cellular damage, genotoxicity, and clonal expansion provide investigators with a spectrum of opportunities for technologic innovation in the prevention of skin cancer. Strategies to improve upon current topical sunscreen formulations have strived for broader UVR spectral coverage, more favorable aesthetics, increased adherence, and minimal penetration into the living epidermis. In addition to improved sunscreens, future topical therapies may target processes within the epidermis that contribute to carcinogenesis. These include reactive species quenching, delivery of DNA repair enzymes, and targeting of cytokines essential to the proliferation of mutant keratinocytes.
... 6-methylcoumarin, musk ambrette, and hexachlorophene have been associated with numerous cutaneous eruptions and their use has been stopped [116]. To date, most photoallergic reactions are caused by products, often sunscreens, containing p-aminobenzoic acid (PABA) derivatives, benzophenones, salicylates, dibenzoylmethane derivatives, and anthranilates [14,117]. In addition, some derivatives of benzophenones show structural similarities with ketoprofen, leading often to cross-reactivity [118]. ...
Article
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Photosensitivity induced by drugs is a widely experienced problem, concerning both molecule design and clinical practice. Indeed, photo-induced cutaneous eruptions represent one of the most common drug adverse events and are frequently an important issue to consider in the therapeutic management of patients. Phototoxicity and photoallergy are the two different pathogenic mechanisms involved in photosensitization. Related cutaneous manifestations are heterogeneous, depending on the culprit drug and subject susceptibility. Here we report an updated review of the literature with respect to pathogenic mechanisms of photosensitivity, clinical manifestations, patient management, and prediction and evaluation of drug-induced photosensitivity. We present and discuss principal groups of photosensitizing drugs (antimicrobials, nonsteroidal anti-inflammatory drugs, anti-hypertensives, anti-arrhythmics, cholesterol, and glycemia-lowering agents, psychotropic drugs, chemotherapeutics, etc.) and their main damage mechanisms according to recent evidence. The link between the drug and the cutaneous manifestation is not always clear; more investigations would be helpful to better predict drug photosensitizing potential, prevent and manage cutaneous adverse events and find the most appropriate alternative therapeutic strategy.
... 90 Sunscreens can also be a cause of ACD on the face and neck, and both sensitization and photosensitization should be investigated when suspected. 91,92 HND can be induced by TCS withdrawal. In particular, overuse of potent TCS on the face can lead to many adverse events upon withdrawal, including burning, itching, and facial redness. ...
Article
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Atopic dermatitis is a heterogeneous disease and resists classification. In this review, we discuss atopic dermatitis nomenclature and identify morphologic phenotypes, which will facilitate correct diagnoses and development of treatment strategies. We support using the term ‘atopic dermatitis’ rather than eczema, because it describes the allergic background and inflammation (‘itis’) as drivers of the disease. Atopic dermatitis has many morphologic manifestations that vary by topographic area affected, age, or race and require consideration in differential diagnosis. Different phenotypes based on morphology and topographic location, ethnicity, and age are discussed. A better-defined phenotype identification for atopic dermatitis will facilitate earlier and correct diagnosis of this complex condition and inform selection of the most appropriate treatment choice in an era in which targeted therapies may generate more individualized patient care.
Thesis
Although UV filters are important, widespread used cosmetic ingredients, their reaction potential towards skin proteins has hardly been studied so far. Therefore, the aim of the present thesis was to investigate the reactivity of widespread UV filter substances towards skin proteins using increasingly complex protein and skin model systems and different analytical techniques. At first, the development of a rapid high-performance thin-layer chromatographic (HPTLC) screening method on an amino phase as protein model provided an easy and rapid way to estimate the reactivity of the common UV filters benzophenone-3 (BP-3), hydroxymethoxybenzoyl sulfonic acid (HMBS), butyl methoxydibenzoylmethane (BM-DBM), 3-benzylidene camphor (3 BC), 4 methylbenzylidene camphor (4 BMC), octocrylene (OCR), ethylhexyl methoxycinnamate (EHMC), ethylhexyl salicylate (EHS), diethylhexyl butamido triazone (DEBT), ethylhexyl triazone (EHT), and octyldimethyl p-aminobenzoic acid (OD-PABA) towards amino groups under thermal and irradiation conditions. A direct comparison of the results of the screening with (photo) patch test data of the dermatological practice showed that especially those UV filters, which are known to be common triggers for (photo) allergic reactions, showed the highest tendency to bind to the amino phase. This indicates that the screening may be well suited to identify possible skin sensitizers as part of a multistage testing strategy. The observation that the reactivity of the different UV filters was influenced by both heat and UV irradiation was verified during the subsequent studies with butylamine and ethanolamine. The UV filters showed individual, time- and temperature-dependent reactivities towards the amines. Benzophenone imines, enamines, and amides were identified as typical reaction products by means of electrospray ionization mass spectrometry (ESI-MS), Fourier transform infrared (FTIR), and nuclear magnetic resonance (NMR) spectroscopy. BP-3, HMBS, the dibenzoylmethanes, OCR, and EHS showed by far the highest reactivity what was in good correlation with the previous screening, indicating a different contact-allergic potential of the UV filters. In contrast, the esters EHMC and EHT showed a significantly lower reactivity, and for the UV filters 3 BC, 4-MBC, and OD-PABA no conversion was observable at all. The formation of the reaction products had partly big influence on the respective UV filter spectra. In the case of BP-3, HMBS, and EHS, the conversions led to a strong bathochromic shift and hence to approved UVA protection. In contrary, in the case of DBM and BM-DBM and especially OCR, a breakage of the original molecule structures was observed, resulting in a significant decrease of the respective absorption strength. The same reaction tendencies could also be observed, when using Boc-protected lysine, the tetrapeptide Boc-Gly-Phe-Gly-Lys-OH (Boc-GFGK), and bovine serum albumin (BSA) as increasingly complex protein or skin models. OCR and BM-DBM confirmed to be most reactive towards the lysine side chains of the mentioned model systems, followed by DBM > BP 3 > EHS > EHMC > EHT in decreasing order. To determine the covalent binding of the UV filters to the protein BSA, beside the extraction of the unbound UV filters, the increase of the molar mass of the formed BSA-adducts was additionally exemplarily determined for EHMC and DBM by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOFMS). Both methods gave comparable results. Binding to BSA did not affect the UV absorption properties of BM-DBM, EHMC, and EHT, but led to a bathochromic shift in the cases of BP-3 and EHS. For OCR, a strong hypsochromic shift and a nearly complete loss of UVA+B protection was observable. To better reflect the usual application conditions, a thin gelatine layer was chosen as further skin model. The UV filter amounts applied were adapted according to the existing ISO norm for the determination of the SPF. Afterwards, UV irradiation was performed. The binding amounts were determined both by extraction of the unbound UV filters and by isotope-ratio mass spectrometry (IRMS), where two synthetized, stable-isotope labelled UV filter analogues (EHC-d5 and DBM-d5) were used. In contrast to the esters EHMC and EHT, which showed comparatively small binding amounts, for the UV filters OCR, BP-3, EHS, and BM-DBM significant reaction tendencies towards gelatin were observed. Finally, various commercial sunscreens and personal care products with UV protection were applied on either prepared porcine skin or glass plates, followed by UV irradiation. Significant differences were observed for the amounts of UV filters extracted from glass and skin. The lower recoveries in the case of the skin indicated an additional reaction of the UV filters towards the skin samples. BP-3 showed the highest discrepancy between the recoveries from glass and skin after irradiation, followed by EHS > BM DBM > OCR > EHMC > EHT in decreasing order. The present dissertation showed that cosmetic UV filters were able to react with amino structures of different proteins under thermal and irradiation conditions. As the formation of protein adducts is seen as key event in the development of (photo) allergic reactions, the results indicate a specific skin sensitization potential of the UV filters. This is confirmed by the experience of dermatological practice. Since such reactions have partly strong influence on the respective UV filter spectra, the existing in vitro methods using PMMA or quartz glass as substrates have to be questioned, since those methods cannot capture such skin-typical reactions.
Article
Photopatch tests are used to diagnose photoallergic contact dermatitis and identify the causal agents. The frequencies of positive results and associated allergens vary by country; therefore, it is necessary to know the information specific to each country. To establish the frequency of positive photopatch test results, and their relevance, in patients with suspected photoallergic contact dermatitis in a national dermatology centre located in Bogota, Colombia. One hundred patients investigated for possible photoallergic contact dermatitis were enrolled in the study. They were photopatch tested with a selected group of allergens, and occluded for 48 hours; the duplicate right-hand panel was irradiated with 5 J/cm(2) ultraviolet (UV)A. The readings were performed on D2, D4, and D6, in accordance with the guidelines of the ICDRG, and the relevance was evaluated with the COADEX system. There were a total of 20 photopatch reactions in 15 patients, 95% of which were caused by UV filters, most frequently benzophenone-3 (55%). Eight of the positive reactions (53.3%) appeared on D6. UV filters continue to be the most common causes of photoallergic contact dermatitis in our patients. Readings up to D6 (96 hr after irradiation) are important to identify delayed positive reactions. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Chapter
Photosensitive skin reactions occur when human skin abnormally reacts to ultraviolet radiation or visible light. The forms of photosensitivity are phototoxity and photoallergy. Phototoxic disorders have a high incidence, whereas photoallergic reactions are much less frequent in the human population. Several hundred substances, chemicals or drugs may invoke phototoxic or photoallergic reactions. In order to avoid photosensitive reactions it is essential to determine the photosensitizing properties of such substances before drugs are introduced in therapy or products made available on the market. This chapter reviews the mechanisms of photosensitization, explains the most important differences between phototoxic and photoallergic reactions, summarizes the most common photosensitzers and presents the clinical features and diagnostic procedures of phototoxic and photoallergic reactions.
Article
This parameter was developed by the Joint Task Force on Practice Parameters, which represents the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Contact Dermatitis: A Practice Parameter-Update 2015." This is a complete and comprehensive document at the current time. The medical environment is changing and not all recommendations will be appropriate or applicable to all patients. Because this document incorporated the efforts of many participants, no single individual, including members serving on the Joint Task Force, are authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information or interpretation of this practice parameter by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. These parameters are not designed for use by the pharmaceutical industry in drug development or promotion. Previously published practice parameters of the Joint Task Force on Practice Parameters for Allergy & Immunology are available at http://www.JCAAI.org or http://www.allergyparameters.org. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Article
Five types of industrial lignin are blended with a pure cream and a commercial sunscreen lotion. Lignin is found to significantly boost their sunscreen performance. Photostability of the lignin-modified lotions is analyzed. The results show that hydrophobic lignin has better sunscreen performance than hydrophilic counterpart. Sun protection factor (SPF) of the pure cream containing 10% organosolv lignin (OL) reaches 8.66. Small amount of hydrophobic lignin dramatically increases SPF value of the sunscreen lotions. Adding 1% lignin almost doubles the sun lotion’s SPF. Addition of 10% OL to the lotion boosts its SPF from 15 to 91.61. However, it is also found that hydrophilic lignin tends to demulsify the lotions due to an electrostatic disequilibrium. After 2 hours of UV radiation, UV absorbance of all the five lignin-modified sunscreen lotions increases up to the limit of measuring instrument. All the lignin types studied in this work are found to have a general synergistic effect with sunscreen actives in the commercial lotion. An effort is also made to elucidate radical mechanisms of the synergy.
Article
Full-text available
Brazil is a country of continental dimensions with a large heterogeneity of climates and massive mixing of the population. Almost the entire national territory is located between the Equator and the Tropic of Capricorn, and the Earth axial tilt to the south certainly makes Brazil one of the countries of the world with greater extent of land in proximity to the sun. The Brazilian coastline, where most of its population lives, is more than 8,500 km long. Due to geographic characteristics and cultural trends, Brazilians are among the peoples with the highest annual exposure to the sun. Epidemiological data show a continuing increase in the incidence of non-melanoma and melanoma skin cancers. Photoprotection can be understood as a set of measures aimed at reducing sun exposure and at preventing the development of acute and chronic actinic damage. Due to the peculiarities of Brazilian territory and culture, it would not be advisable to replicate the concepts of photoprotection from other developed countries, places with completely different climates and populations. Thus the Brazilian Society of Dermatology has developed the Brazilian Consensus on Photoprotection, the first official document on photoprotection developed in Brazil for Brazilians, with recommendations on matters involving photoprotection.
Article
Sunscreen is a key component in the preventive measures recommended by dermatologists and public health campaigns aimed at reducing sunburn, early skin aging, and skin cancer. To maximize compliance, adverse reactions to sunscreens should be minimized. Although inactive ingredients cause many of these reactions, it is important for dermatologists to be aware of reactions to active ultraviolet filters. There are approximately 120 chemicals that can function as ultraviolet (UV) filters. This review focuses on the 36 most common filters in commercial and historical use. Of these, 16 are approved for use by the US Food and Drug Administration. The benzophenones and dibenzoylmethanes are the most commonly implicated UV filters causing allergic and photoallergic contact dermatitis (PACD) reactions; benzophenone-3 is the leading allergen and photoallergen within this class. When clinically indicated, patch and photopatch testing should be performed to common UV filters.
Article
Full-text available
Photosensitization is a process in which the skin reacts to exposure to ultraviolet radiations. There are various associated dermatological consequences like photoxicity and photoallergic reactions which make the disease more complicated. There are various drugs which together with solar radiations worsen the situation of photosensitivity and hence termed as photosensitizers. The developments on the use of phytoconstituents from the herbal extract is the ardent need for fighting against the deleterious photosensitization reactions. This review attempts to highlight the problems of photosensitivity its pathological manifestation with the approach to treat them naturally with the help of skin rejuvenating herbs.
Article
Contact dermatitis due to cosmetic products is a common dermatologic complaint that considerably affects the patient's quality of life. Diagnosis, treatment, and preventive strategies represent a substantial cost. This condition accounts for 2% to 4% of all visits to the dermatologist, and approximately 60% of cases are allergic in origin. Most cases are caused by skin hygiene and moisturizing products, followed by cosmetic hair and nail products. Fragrances are the most common cause of allergy to cosmetics, followed by preservatives and hair dyes; however, all components, including natural ingredients, should be considered potential sensitizers. We provide relevant information on the most frequent allergens in cosmetic products, namely, fragrances, preservatives, antioxidants, excipients, surfactants, humectants, emulsifiers, natural ingredients, hair dyes, sunscreens, and nail cosmetics.
Chapter
Primary prevention measures are used with the intent to decrease or ameliorate the effects of pro-tumorgenic damage to normal tissue. Secondary prevention consists of interventions that decrease morbidity and mortality from melanoma for patients whose skin harbors initiating mutations and/or early-stage melanomas. The most important secondary prevention modality is early detection and removal of melanoma before it attains metastatic or lethal potential. Secondary prevention can also involve halting the progression of transformed cells to lethal cancers by other means such as therapeutic prevention. Tailoring prevention strategies to different populations and specific patients starts with assessments of phenotypic, environmental, and genetic risk factors for melanoma. Our discussions of primary prevention focus on the effects of ultraviolet radiation (UV) and methods for decreasing risk by the use of sunscreen, and avoiding exposure to UV from the sun and tanning beds. We then discuss secondary prevention modalities and identify those that are most appropriate for patients and populations at each level of risk for melanoma. Secondary prevention strategies include education, skin self-examination, use of mobile applications, provider screenings, total body skin examinations by dermatologists, and genetic testing. We also discuss population-level interventions and additional public health issues surrounding melanoma prevention.
Article
Background/Objectives Allergic contact dermatitis, photoallergic contact dermatitis and irritant reactions to sunscreens are common reasons for dermatology consultation. Patch testing for contact allergy relies on up-to-date knowledge of allergen exposures. The aim of this study was to investigate contact allergens and photoallergens in sunscreens commercially sold on the shelves of supermarkets and pharmacies in New Zealand. Methods A comprehensive market data review of suppliers’ websites was performed from March to August 2019 to obtain a list of the commonly sold sunscreens in our region. Ingredients were collated and analysed according to International Nomenclature of Cosmetic Ingredients (INCI) names. Ultraviolet (UV) filters, preservatives and fragrances were included for analysis. Place of sale and cost of sunscreens were also recorded. Results Ninety-five sunscreens were analysed: 36% sold in supermarkets, 43% in pharmacies and the remainder available in both. The most frequent UV filters were butyl methoxydibenzoylmethane (contained in 70% of products) followed by octocrylene (63%) and homosalate (50%). The common photoallergen benzophenone 3 was found in 19% of products. Phenoxyethanol was the most common preservative (68%) followed by disodium EDTA (30%) and propylparaben (26%). Two sunscreens contained methylisothiazolinone. Sixty-one per cent contained at least one fragrance, the most frequent being limonene (17%) and linalool (13%). There was an average of 1.1 New Zealand baseline series allergens per product (range 0 to 6, standard deviation 1.27). Conclusion Common allergens including those with high sensitising potential were frequently found in New Zealand sunscreen. Knowledge of ingredients used by manufacturers is useful in dermatological assessment of skin contact reactions.
Article
Chemical photosensitivity can be elicited by exposure of the skin to various pharmaceutical substances, foods, cosmetics and other environmental chemicals, followed by exposure to sunlight. There are at least three types of chemical photosensitivity, i.e., photoirritancy (narrowly defined as phototoxicity), photogenotoxicity and photoallergenicity, and their clinical characteristics and mechanisms are quite different. Concerns about chemical photoallergy is increasing, and various studies have been made to clarify the photobiochemical characteristics of photoallergens and the mechanisms involved. Various methodologies, including in silico prediction models, photochemical assay systems, and in vitro phototoxicity prediction tools, have been developed to predict the photoallergenic potential of chemicals over the past few years. The aim of this manuscript is to review the clinical characteristics, pathogenetic mechanisms and photobiochemical features of photoallergens, with special emphasis on the current status about development of screening systems for predicting photoallergenic potential of chemicals.
Article
New 19 complexes of carboxylates with transition and rare elements as central ions and their ligands were characterized by chromatographic analyses. The parameter of relative lipophilicity (RM0) of the tested compounds was determined experimentally by the reversed-phase high-performance thin layer chromatography method with the mixtures of various organic modifiers (ACN, acetone, dioxane) and water as a mobile phase. The extrapolated RM0 values were compared with the logP values calculated from the molecular structures of tested solutes. Similarities between the lipophilicity indices were analysed by PCA and linear regression. Thin layer chromatography combined with the magnetic field has been proposed as a complementary method for determination of lipophilicity of the investigated compounds. The chromatograms in the field and outside it were developed simultaneously in two identical chromatographic chambers. One of them was placed in the external magnetic field of 0.4 T inductivity. We proved that chelation causes drastic change of compound lipophilicity, but all complexes did not exhibit enhanced activity as compared to the parent ligand. Also in the magnetic field retention of some complexes changed, which means that the presence of the mentioned field influences physicochemical properties of the compounds and their interactions with the stationary phase. This article is protected by copyright. All rights reserved.
Article
Topical sunscreen products are universally applied by numerous individuals to protect their skin from the detrimental effects of UV radiation. However, lately, studies have revealed the risks associated with percutaneous absorption of UV filters leading to undesirable systemic side effects such as hormonal disturbances and allergies. In this study, an innovative sunscreen formulation was developed based on starch microsponges as a key carrier encapsulating an organic sunscreen benzophenone‑3. The developed starch microsponges were characterized by scanning electron microscopy and nitrogen adsorption/desorption analysis. The results showed that starch microsponges possessed a high BET surface area (85.45 m2/g) with spherical porous morphology with pore size <200 nm. Benzophenone‑3 was loaded into the starch microsponges by immersion/solvent evaporation and benzophenone‑3 loaded starch microsponges were characterized by scanning electron microscopy, differential scanning calorimetry, powder X-ray diffraction, Fourier transform infrared spectroscopy, and nitrogen adsorption-desorption measurements. Results corroborated that benzophenone‑3 was successfully entrapped within the nanopores of starch microsponges. A starch microsponge based sunscreen cream was formulated, characterized and clinically tested. Rheological, texture and sensorial assessment showed that starch microsponges based sunscreen product showed good spreadability, non-sticky, rich texture favorable for consumer usage. In vitro and ex-vivo studies demonstrated benzophenone‑3 loaded starch microsponges gave improved photoprotection, higher SPF and reduced cutaneous penetration compared to raw benzophenone‑3 cream. Clinically, patch study confirmed that the developed starch microsponges based sunscreen cream was skin safe and biocompatible. Thus, the amalgamation of sunscreen molecule benzophenone‑3 into starch microsponges produced a safe, effective innovative sunscreen product.
Chapter
Phototoxic dermatitis from exogenous chemicals can be polymorphic. It is not always easy to distinguish phototoxicity from photoallergy. Phytophotodermatitis from plants containing furocoumarins is one of the main causes of phototoxic contact dermatitis. Topical and systemic drugs are a frequent cause of photosensitivity, often with phototoxic aspects. The main clinical pattern of acute phototoxicity is an exaggerated sunburn. Subacute phototoxicity from systemic drugs can present as pseudoporphyria, photoonycholysis, and dyschromia. Exposure to phototoxic drugs can enhance skin carcinogenesis.
Chapter
Irritant and allergic occupational dermatitis in bath attendants can be induced by water, disinfectants, sunscreens, swimming clothes, or equipment. Especially repeated and prolonged wet work causes skin irritation and impairs the skin barrier function. Contact dermatitis to disinfectants is rarely observed and mainly caused by chlorinated or brominated by-products in the swimming pool water, such as trihalomethanes (e.g., trichloromethane, chloroform), haloamines, haloacetic acids, and haloketones or disinfectants used to disinfect pool edges, showers, bathrooms, or pediluvia, such as sodium hypochloride, aldehydes, and quaternary ammonium compounds. Contact dermatitis associated with disinfectants used in swimming pools are rather due to irritancy, but may also be caused by true sensitization. Urticaria induced by swimming in pools can be cold-induced urticaria, aquagenic urticaria, or contact urticaria to chlorinated water. Rare causes of occupational dermatoses in bath attendants are skin infections due to pathogens in the pool water, aquagenic pruritus, or skin cancer induced by exposure to UV-light during outdoor activities.
Article
Full-text available
This number of the Revista da Sociedade Portuguesa de Dermatologia e Venereologia contains two articles dedicated to idiopathic photodermatoses, for which autoimmune reactions to an unknown endogenous chromophore are suspected to be involved – polymorphous light eruption, actinic prurigo, hydroa vacciniforme, chronic actinic dermatitis, and solar urticarial.1,2 Many of these and other photodermatoses have a very clear clinical presentation, while others may mimic allergic contact dermatitis (ACD) or photo-allergic contact dermatitis (PhACD), a classical T cell-mediated or delayed type IV hypersensitivity reaction to an exogenous chromophore applied on the skin in the presence of, or followed by exposure to ultraviolet (UV) or visible light.3,4 Allergic contact reactions can be followed by persistent photosensitivity and chronic actinic dermatitis, such as in cases of chronic ACD from certain plants, e.g., Compositae that are rich in sesquiterpene lactones,5 fragrances, lichens, and colophony,4 or in PhACD or photo-aggravated ACD from drugs like ketoprofen, etofenamate, and chlorproethazine, or even other contact allergens, such as tosylamide/formaldehyde resin, fragrances, and thiourea derivatives.4The long persistence of these chemicals in the epidermis (for up to at least 17 days in the case of ketoprofen),6 or the formation of endogenous photosensitizers might perhaps explain the progression to chronic actinic dermatitis.4 In patients with idiopathic photodermatoses the use of sunscreens is mandatory, however, the sensitization risk from these chemicals may be enhanced by the previous skin inflammation and the need for repeated application for long periods.7 UV filters, which are chromophores that capture UV light, are among the most frequent causes of PhACD,8-11 namely benzophenones, dibenzoylmethane derivatives, octocrylene, and cinammates.9,10,12-14 Although more recent UV filters seem to be more photostable and less prone to induce PhACD,3 a few cases have been described,9 for example, from polysilicone-15 (Parsol®SLX).15 With regard to methylene bis-benzotriazolyl tetramethylbutylphenol (syn. bisoctrizole or Tinosorb® M), ACD from it is due to the surfactant decyl glucoside, in particular, which is added in order to stabilize the sunscreen molecule.16,17 Topical drugs, such as the non-steroidal anti-inflammatory ketoprofen, piketoprofen, suprofen, etofenamate, piroxicam, and benzydamine,18 as well as phenothiazine derivatives, i.e., promethazine or chlorproethazine, and isothipendyl chlorhydrate19 are frequent causes of ACD/PhACD, either by direct application or by transfer from other individuals in close contact (consort or connubial dermatitis). Moreover, some of these chemicals, particularly ketoprofen, exhibit cross-reactions with UV filters, i.e., benzophenone(s) and octocrylene, the latter containing benzophenone residues. Also fenofibrate, a systemic drug, shares the benzophenone ring and can cross react with ketoprofen and related molecules.3,20 Furthermore, patients with PhACD from ketoprofen present with concomitant reactions to the perfume ingredient cinnamic alcohol, reactions that at present are difficult to explain by cross-reactivity.21 Therefore, patch and photo-patch testing are highly recommended in patients with idiopathic and autoimmune photodermatoses, as well as in all other diseases aggravated by sunlight, in order to detect and avoid exposure to possible aggravating factors, and particularly to UV filters. Recently, recommendations for diagnostic patch testing have been issued by the European Society of Contact Dermatitis (ESCD),22 and in a cooperative effort of the ESCD and European Society of Photodermatology (ESPD), an agreement was not only reached regarding standardized protocols for photo-patch testing,23 but also on the list of 20 allergens to be included in the European baseline photo-patch tests series and an additional extended series including certain classical photo-allergens.24 Last but not least, photo-patch tests with all the patient’s own topical products and systemic photosensitizers to which the patients is exposed are strongly recommended as well, since the outcome may further contribute to the relevance of positive reactions observed, or avoid “false”- negative reactions obtained by testing standardized allergens only.24
Chapter
Photosensitivity is a skin reaction to light, mostly to UV light, due to the presence of endogenous or exogenous chromophores in the dermis or epidermis. Photoactive molecules in products applied to the skin or systemic drugs are frequent causes of photosensitivity. Most reactions involve non-specific cutaneous inflammation – phototoxicity – but hypersensitivity to the chemicals or their photoproducts, namely, a T-cell-mediated reaction, can also develop – photoallergy. Often both mechanisms coexist, and a non-specific phototoxic inflammation favors sensitization to the photoactive product, with possible further consequences (recognition of chemically related compounds, life-long immunologic memory, and possible progression to persistent light reactivity). Clinical presentation of phototoxic and photoallergic reactions is highly variable both on their time course and lesional morphology: urticaria or eczema on sun-exposed areas, exaggerated sunburn, linear phytophotodermatitis, pseudoporphyria, photoonycholysis, hypo- or hyperpigmentation, and less frequently erythema multiforme, lupus erythematosus, and lichenoid reactions. Precancerous lesions and skin cancers are also increasingly associated with chronic exposure to photoactive chemicals. Chemicals responsible for photosensitivity change with time due to recognition and elimination of important hazards and depend on regional exposure habits. Around the world, most frequent causes of exogenous photosensitivity are furocoumarins from plants, UV absorbers in sunscreens and cosmetics, and topical and systemic drugs (NSAIDs, antimicrobials, phenothiazines, anticancer drugs).
Chapter
Phototoxicity is more frequent than photoallergy, but it is not always easy to distinguish between these two patterns of photosensitivity. Phytophotodermatitis from plants containing furocoumarins is one of the main causes of phototoxic contact dermatitis. Topical and systemic drugs are a frequent cause of photosensitivity, often with phototoxic aspects. The main clinical pattern of acute phototoxicity is an exaggerated sunburn, but bullae, purpura, pseudoporphyria, photoonycholysis, and dyschromia can also occur. Exposure to phototoxic drugs is increasingly associated with enhanced skin carcinogenesis.
Article
Contact dermatitis due to cosmetic products is a common dermatologic complaint that considerably affects the patient's quality of life. Diagnosis, treatment, and preventive strategies represent a substantial cost. This condition accounts for 2% to 4% of all visits to the dermatologist, and approximately 60% of cases are allergic in origin. Most cases are caused by skin hygiene and moisturizing products, followed by cosmetic hair and nail products. Fragrances are the most common cause of allergy to cosmetics, followed by preservatives and hair dyes; however, all components, including natural ingredients, should be considered potential sensitizers. We provide relevant information on the most frequent allergens in cosmetic products, namely, fragrances, preservatives, antioxidants, excipients, surfactants, humectants, emulsifiers, natural ingredients, hair dyes, sunscreens, and nail cosmetics.
Article
• Two patients with follicular dermatitis were found to have a contact sensitivity to homomenthyl salicylate, a sunscreening chemical present in a commercially available suntan lotion. One patient did not use the product, but her boyfriend did, and contact between the two individuals resulted in a follicular dermatitis developing in her. A second patient with contact dermatitis to homomenthyl salicylate also had a follicular eruption. Both patients appear to represent true allergic sensitivities. (Arch Dermatol 114:442-443, 1978)
Article
• Lip swelling developed following the use of a cinnamic aldehyde-containing mouthwash in a woman with allergic rhinitis and asthma. Open application of the mouthwash on the antecubital fossae of the patient and control subjects produced immediate erythematous or urticarial responses in all tested individuals. Subsequent investigation established cinnamic aldehyde as the responsible ingredient. The incidence of positive reactions was shown to depend on site of application, vehicle, concentration, and time of reading. Of several related cinnamates, only cinnamic acid produced easily detectable responses at similar concentrations.(Arch Dermatol 116:74-76, 1980)
Article
Patients (1,943, consecutive) with dermatitis have been examined with regard to sensitivity to perfumes from toilet soaps and detergents. Out of 78 patients, exactly 4% of each sex, showed postive reactions to perfumes and in three fourths of these cases, the reaction was found to be associated with sensitivity to benzyl salicylate.Of the perfume-positive patients, 46% showed simultaneous reaction to wood tars and 23% to balsam of Peru. Of the patients positive to wood tars, 34% showed a simultaneous reaction to perfumes. Since only few had been treated with wood tars or balsam of Peru, primary sensitization to perfumes may contribute to the continued high incidence of sensitivity to wood tars and balsams.Of the perfume-positive patients, 64% had dermatitis of the extremities which are habitually most exposed to soap and water.
Article
From 1989-1991. 214 patients (45 PD/AR, 54 PLE, 115 controls) were patch tested to a sunscreen series containing 9 constituents. 16/214 (7.5%) patients reacted in one or more sunscreens, with allergy being significantly more common in PD/AR patients (10–45 versus 2/54 PLE and 4/115 contact dermatitis clinic controls). The benzophenone group of sunscreens (mexenone, oxybenzone) were the most frequent sensitizers, accounting for 8 of the 27 positive patch tests observed. Clinicians should consider contact allergy to sunscreens in PD/AR patients as an explanation for exposed-site dermatitis episodes.
Article
Since 1990 7 sunscreen allergens have been included in the standard photopatch protocol at 2 Swedish dermatology clinics. 355 consecutive patients with suspected photosensitivity were tested, and in 28 of these (7.9%), a total of 42 allergic reactions were found. 80% of the reactions were of photocontact origin. The most common allergen was benzophenone-3 (Eusolex 4360), with 15 photocontact and 1 contact allergic reactions, followed by isopropyl dibenzoylmethane (Eusolex 8020) (8 photocontact, 4 contact) and butyl methoxydibenzoylmethane (Parsol 1789), with 6 photocontact reactions. There were 2 cases of photocontact allergy to phenylbenzimidazole sulfonic acid (Eusolex 232), which has not been reported previously. 1 case of contact urticaria from benzophenone-3 was accidentally found. In addition, 21 + reactions of doubtful relevance were noted in 14 patients: 16 on irradiated and 5 on non-irradiated test sites. Among these, irritant and phototoxic reactions may be included. These results indicate that the inclusion of UV filters in the standard photopatch protocol is important. Immediate-type testing for urticaria could also be of value.
Article
Many contact allergens can cause an erythema-multifor-me (EM)-like or urticarial papular and plaque eruption (UPPE) (1–6). Although numerous topical medicaments have been reported as causing UPPE, oxybenzone (2-hydroxy-4-methoxy benzophenone, benzophenone 3, Eusolex 4360) has not.
Article
A patient suffering from an eczema of the right hand showed after routine patch testing an immediate urticarial reaction to cinnamaldehyde. The same reaction could be noted in three out of eight control persons. Laboratory investigations revealed cinnamaldehyde to have a histamine liberating effect, a fact not previously mentioned in reports on untoward reactions to this compound.
Article
Two patients with follicular dermatitis were found to have a contact sensitivity to homomenthyl salicylate, a sunscreening chemical present in a commercially available suntan lotion. One patient did not use the product, but her boyfriend did, and contact between the two individuals resulted in a follicular dermatitis developing in her. A second patient with contact dermatitis to homomenthyl salicylate also had a follicular eruption. Both patients appear to represent true allergic sensitivities.
Article
In those photodermatoses in which the action spectrum involves wavelengths outside the short ultraviolet (i.e. is greater than 320 nm) little protection can be obtained against long UV (is greater than 320 nm) by the application of chemical light screening agents. An action spectrum involving wavelengths is greater than 320 nm is a common occurrence and may necessitate the additional provision of protection from a physical light screening agent. Such a physical agent is titanium dioxide and in a study of its use in a variety of formulations using in vitro techniques it was shown to be effective throughout the wavelengths 400-700 nm. It was also shown to have a satisfactory protective capacity in those photodermatoses in which the action spectrum involves wavelength peaks 365 nm (335-395 nm) and 400 nm (370-430 nm). It also has a reasonable cosmetic acceptability provided care is taken to incorporate in the formulations colouring agents which can be varied to suit the individual patient.
Article
A case of chronic actinic dermatitis (CAD) is described to illustrate the natural history of the condition over 30 years and sunscreen allergy as a complicating factor.
Article
Reports in the literature of sensitization associated with many commonly used sunscreening agents including p-aminobenzoic acid (PABA), PABA derivatives, anthranilates, salicylates, cinnamates, benzophenones, and dibenzoylmethane derivatives are reviewed. Several of these case reports involved subjects with various photodermatoses, implicating enhanced sensitivity of the patient's skin to both light and chemicals. Despite the widespread use of sunscreens, the small number of published reports of contact and photocontact sensitization to these agents suggests that either such sensitization is less than commonly perceived or is underreported. Establishment of a registry for reporting adverse effects associated with sunscreening agents would help to characterize the incidence of sensitization.
Article
Dibenzoylmethanes are widely used in Europe in UVA-absorbing sunscreens. We found that 2 of these, 4-isopropyl-dibenzoylmethane and 4-tert.butyl-4'-methoxy-dibenzoylmethane caused allergic or photoallergic contact dermatitis. This is the first report on allergic and photoallergic reactions caused by dibenzoylmethanes.
Article
A black man with a broad-spectrum light sensitivity simultaneously showed an urticarial and contact sensitivity to a preparation containing 2-hydroxy-4-methoxybenzophenone-5-sulfonic acid (sulisobenzone). Both the benzophenone and sulfonic acid parts of the molecule were required for elicitation of the contact reaction, while benzophenone alone elicited the urticarial reaction.
Article
Lip swelling developed following the use of a cinnamic aldehyde-containing mouthwash in a woman with allergic rhinitis and asthma. Open application of the mouthwash on the antecubital fossae of the patient and control subjects produced immediate erythematous or urticarial responses in all tested individuals. Subsequent investigation established cinnamic aldehyde as the responsible ingredient. The incidence of positive reactions was shown to depend on site of application, vehicle, concentration, and time of reading. Of several related cinnamates, only cinnamic acid produced easily detectable responses at similar concentrations.
Article
Reports of contact sensitization and photocontact sensitization induced by various sunscreening agents are reviewed. Current knowledge about the most often used sunscreening agents is summarized. The problems of cross-sensitization and sensitization in photodermatoses are discussed. Strategies for patch and photopatch testing, as well as immediate-type testing, are critically evaluated.
Article
In the last decade UV filters have been incorporated in a large number of cosmetic products. The purpose of our study was to evaluate the prevalence of sunscreen allergy in patients with a suspected photodermatitis. 108 patients were patch-tested with the Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali (GIRDCA) standard series and photopatch-tested with the photopatch series. Allergy and/or photoallergy to sunscreening agents was diagnosed in 8 subjects (7.4%). Oxybenzone was positive in 4 patients, isoproyl dibenzoylmethane in 3 patients, p-aminobenzoic acid and 2-ethylhexyl-p-methoxycinnamate in 1 patient, respectively. Our results obtained during a 3-year period (January 1990 to June 1993) confirm that sunscreens are presently the commonest photoallergens.
Article
From 1989-1991, 214 patients (45 PD/AR, 54 PLE, 115 controls) were patch tested to a sunscreen series containing 9 constituents. 16/214 (7.5%) patients reacted to one or more sunscreens, with allergy being significantly more common in PD/AR patients (10/45 versus 2/54 PLE and 4/115 contact dermatitis clinic controls). The benzophenone group of sunscreens (mexenone, oxybenzone) were the most frequent sensitizers, accounting for 8 of the 27 positive patch tests observed. Clinicians should consider contact allergy to sunscreens in PD/AR patients as an explanation for exposed-site dermatitis episodes.
Article
We have studied the influence of variations in allergen concentration and UVA dosaging on the results of photopatch testing with the Scandinavian standard photopatch series in 29 patients with photocontact and/or contact allergy to 1 or several of the allergens in that series. Photocontact test reactions were more sensitive to allergen dilution than plain contact test reactions. Even dilution from the standard 5% to 2.5% significantly reduced para-aminobenzoic acid photocontact test reactions. Reducing the UVA dose from the standard 5 J/cm2 to 2.5 or 1 J/cm2 in 2 out of 5 cases turned a significant (++) reaction into a doubtful one (+). Increasing the standard UVA dose of 5 J/ cm2 to 20-40 J/cm2 turned a single + photocontact reaction to trichlorcarbanilide and a single 1 + plain contact reaction to chlorhexidine into ++ reactions. In the majority of cases, however, neither photocontact nor plain contact test reactions were augemented by UVA doses up to 80 J/cm2. We conclude that a UVA dose of 5 J/cm2 is sufficient for eliciting photocontact allergic test reactions, and that a reduction of either the UVA dose level or the standard allergen concentrations of the Scandinavian photopatch test guidelines may cause loss of significant photocontact test reactions in a proportion of the cases.
Article
Photosensitization may be defined as a process in which a reaction to normally innocuous radiation is induced by the introduction of a specific radiation-absorbing substance (the photosensitizer) that causes another component (the substrate) to be changed by the radiation. This review focuses on photosensitization produced by exogenous chemicals. Idiopathic photodermatoses, including polymorphous light eruption and its variants, solar urticaria and chronic actinic dermatitis, are also discussed. Clinical recognition patterns of the photodermatoses are stressed as well as several diagnostic procedures available for confirmation of the condition. Finally, descriptions, therapeutic uses, and adverse reactions of sunscreens are provided.
Article
This review summarizes published and unpublished data of our 15-year experience with sunscreen allergy and photoallergy. From 1981-1996, 402 patients with suspected clinical photosensitivity were patch and photopatch tested with the commercial sunscreens and facial cosmetics that they had used and with chemical UV absorbers, fragrance materials, preservatives, and emollients. 80 patients (20%) (28 men, 52 women) demonstrated allergic and/or photoallergic contact dermatitis to 1 or more UV absorber(s). In 47 patients with photodermatoses or photo-aggravated dermatoses and in 33 subjects with normal photosensitivity, 91 allergic and 84 photoallergic reactions to UV filters were observed. Over the years sunscreens were added to the test series, which since 1989 comprised the following 10 UV absorbers and which induced allergic (a) and photoallergic (pa) reactions (number, type of reaction): 4 UVA absorbers--isopropyldibenzoylmethane (30a/32pa); butyl methoxydibenzoyl-methane (15a/13pa); benzophenone-3 (3a/9pa); benzophenone-4 (0a/0pa); and 6 UVB absorbers--PABA (2a/2pa); octyl dimethyl PABA (1a/2pa); methylbenzylidene camphor (32a/5pa); octyl methoxycinnamate (3a/4pa); isoamyl p-methoxycinnamate (4a/10pa); and phenylbenzimidazole sulfonic acid (1a/7pa). The frequent (photo)sensitization to isopropyldibenzoylmethane was the reason that its production was discontinued in 1993. 47 patients reacted to fragrance materials, 11 to preservatives and 2 to lanolin alcohol. These constituents were contained in the commercial sunscreens and cosmetics that they had used. Continuous revision of the UV absorber photopatch test series was necessary to be closer to the real frequency of exposure and of reported (photo)allergy to newer sunscreens. Clinicians should consider contact and photocontact allergy, especially in patients with photodermatoses and photo-aggravated dermatoses, and they should perform photopatch testing. Once the culprit has been identified, its INCI (International Nomenclature Cosmetic Ingredients) designation should be given to the patient, who must be warned to avoid products containing the (photo)allergen.
We report the epidemiology of sunscreen allergy over a period of 5 years at the National Skin Centre. A total of 61 patients with suspected allergy to sunscreen underwent patch or photopatch testing to our sunscreen series from 1992 to 1996. The results were retrospectively analysed and evaluated. Out of these 61 patients, 5 were found to have positive patch test reactions to sunscreens. 2 were photoallergic, and 3 were allergic to active ingredients in sunscreens. The main causative allergens were 2-ethylhexyl-4-methoxycinnamate (Parsol MCX) and 2-hydroxy-4-methoxybenzophenone (oxybenzone). We conclude that sunscreen contact allergy is uncommon in our practice.
Article
The qualities of para-aminobenzoic acid (PABA) are discussed and an account is given of how it came to be the favourite sunscreen of the post World War II era. Slowly, however, dermatologists became aware that it was a fairly common sensitizer and that it tended to cross-sensitize with compounds of similar chemical structure both in contact with the skin and given as systemic drugs. Furthermore, continued exposure to chemicals of this type could lead to autoimmune responses especially systemic lupus erythematosus and dermatomyositis. Discussion of these complications from the use of PABA took place at two meetings of the Dermatological Association of Australia in 1964 and 1965, and played a part in the slow withdrawal of PABA from sunscreens.
Article
The purpose of this study was to evaluate the prevalence of sunscreen contact allergy and/or contact photoallergy in 370 patients with suspected photodermatitis. Patch and photopatch tests were performed using the French Society of Photodermatology (SFPD) standard series. A total of 57 cases of contact allergy and/or photocontact allergy to sunscreens were diagnosed (15.4%). Amongst these, 27 reactions were related to oxybenzone and 14 to isopropyl dibenzoylmethane. These results, obtained from January 1990 to December 1994, confirm that, given the high frequency of photosensitization cases, a large part of the battery of photopatch tests should be dedicated to sunblocks.
Article
Numerous cosmetics are used on a daily basis by men, women, and children. Despite a few adverse reactions, cosmetics are a remarkably safe group of products.
Article
Despite the enormous increase in sunscreen use, allergic contact (AC) and photoallergic (PA) reactions to ultraviolet (UV) filters are considered rare. To analyse the data from 2715 patients who underwent photopatch testing at St John's Institute of Dermatology during the period 1983-98. A retrospective analysis of all positive photopatch test episodes was undertaken with the results retrieved from the environmental dermatology database and further verified with the original archived patch test documentation for each individual patient. In 111 patients with positive reactions (4.1%), there were 155 AC or PA reactions to allergens in the photopatch test series. Eighty PA reactions were observed in 62 (2.3%) patients (32 men and 30 women, age range 28-75 years), with UV filters accounting for 52 positive reactions (65%), drugs 16 (20%), musk ambrette 11 (14%) and the antiseptic trichlorocarbanilide one (1%). The most common UV filter photoallergen was benzophenone-3 with 14 positive results, followed by benzophenone-10 (n = 9), isopropyl dibenzoylmethane (n = 6), p-aminobenzoic acid (PABA) (n = 5), octyl dimethyl PABA (n = 5), butyl methoxydibenzoylmethane (n = 4), isoamyl methoxycinnamate (n = 2), ethyl methoxycinnamate (n = 2), octyl methoxycinnamate (n = 2), amyl dimethyl PABA (n = 2) and phenylbenzimidazole sulphonic acid (n = 1). A similar number of AC reactions to UV filters was detected in this study. Thus 49 patients (1.8%) had a total of 75 reactions: 51 due to UV filters and 24 as a result of exposure to fragrances and therapeutic agents. Benzophenone-10 accounted for 13 AC reactions and benzophenone-3 for eight reactions. Twenty-two patients had a PA reaction alone, whereas 19 patients had chronic actinic dermatitis and 15 patients polymorphic light eruption (PLE) in addition. Thus, 34 of the 62 patients (55%) had a preceding underlying photodermatosis. These results show a low yield of positive photopatch tests. Thus, despite the large increase in the use of UV filters over the last decade, the development of PA reactions remains rare. Furthermore, most of the common UV filter photoallergens identified in this study, including PABA, amyl dimethyl PABA and benzophenone-10, are now rarely used in sunscreen manufacture, while isopropyl dibenzoylmethane was voluntarily removed from the market in 1993. Currently, benzophenone-3 is the commonest contact photoallergen still in widespread use. In contrast, the UVB filter octyl methoxycinnamate, used in a number of sunscreens, produced only two positive PA reactions in 12 years of testing. Nevertheless, although these reactions are extremely rare, patients with photodermatoses such as PLE and chronic actinic dermatitis do represent a group of patients at increased risk of developing photoallergy. Further photopatch test series should be regularly reviewed and updated, as the relevance of individual photoallergens changes over time. Currently, there is no evidence that PA reactions represent a common clinical problem.
Article
We report on our experience with sunscreen allergy between 1992 and 1999 and also review the international literature on sunscreen allergy. There were a total of 21 allergic reactions to sunscreen chemicals observed in 19 patients over the 8 years. There were nine positive photopatch reactions to oxybenzone, eight to butyl methoxy dibenzoylmethane, three to methoxycinnamate and one to benzophenone. No positive reactions were observed to para aminobenzoic acid. Six patients also had positive patch tests to components of the sunscreen base. In our experience, sunscreen chemicals are the most common cause of photoallergic contact dermatitis.
Article
Allergic contact sensitization to 'para amino' compounds is frequent and the spectrum of cross-reactivity between members of this chemical group is variable. A retrospective analysis of clinical patch test data obtained with a special test series in the centres of the Information Network of Departments of Dermatology (IVDK) between 1995 and 1999. In the 638 patients tested with the above test panel positive reactions were observed most often to p-aminoazobenzene (16.2%), p-phenylenediamine (14.1%), p-toluylenediamine (10.0%), followed by 4,4'-diaminodiphenylmethane (8.5%), Disperse Orange 3 (8.4%) and p-aminophenol (3.1%). Among the 544 patients tested with p-phenylenediamine and all seven additional 'para amino' compounds, concordance between reactions varied greatly. The stronger the positive test reaction to p-phenylenediamine, p-toluylenediamine or p-aminoazobenzene, the more frequently additional positive reactions to the other compounds were observed. A screening employing several 'para amino' compounds is necessary to describe the individual spectrum of allergic contact sensitization, as there is no reliable marker substance. Further research should aim at (i) establishing the mechanism of cross-reactivity to 'para amino' compounds and (ii) identifying exposures in the environment.
Article
Unlabelled: Interleukin 10 (IL-10) is a key cytokine produced by a multitude of immune effector cells and possesses distinct regulatory effects on immune functioning in the skin. In this article we report the current understanding of the immunobiology of IL-10 and identify the role of IL-10 in cutaneous infection as well as in autoimmune and neoplastic processes. We reviewed the literature to examine the function of IL-10 in different cutaneous disorders. IL-10 can influence and potentially treat T1/T2 differentiation, antigen-presenting cell functioning, antigen-presenting cell-mediated T-cell activation, and T-cell, B-cell, and mast cell growth and differentiation that is aberrant in various disease processes. The literature consensus is that the multitude of effects of IL-10 contribute to the pathogenesis of different skin disorders. In certain circumstances IL-10 could represent novel therapeutic approaches to treating cutaneous diseases. Learning objective: At the conclusion of this learning activity, participants should be acquainted with the role of IL-10 in many infectious diseases, autoimmune skin disease, inflammatory processes, and malignancy. Its possible role in the resolution of various skin diseases should be better understood.
Article
To determine whether photoallergic contact dermatitis is as uncommon as it is usually considered to be and to review the associated clinical features. We reviewed the literature on photoallergic reactions induced by the topical contact of the skin with a chemical in the presence of, or followed by, exposure to UV or visible light. Some of the more recently observed photo-allergens and those presenting special clinical features are discussed. The literature cites several topical substances that give rise to photoallergic contact dermatitis, some of them only exceptionally but others quite frequently. The clinical features are not always those of a eczematous eruption, and several parts of the body may be affected. Many topical photoallergic culprits have been reported in the literature, the most important of which are sunscreen agents and, recently, non-steroidal anti-inflammatory agents (NSAIDs). Not at all exceptional is the occurrence of photoaggravation and recurrent transient or even persistent light reactions on previously exposed as well as non-exposed areas (often sparing the original application site), particularly with the NSAID ketoprofen. Moreover, cross-reactions with chemically-related as well as non-chemically related molecules are common. The potentially misleading clinical features observed in some cases, the diversity of the casual substances identified, and the low frequency with which photopatch testing is carried out in general indicate that the occurrence of photoallergic contact dermatitis might well be underestimated.
Article
Photocontact dermatitis is not a common condition, but neither is it rare. Both photo-irritant contact dermatitis (PICD) and photoallergic contact dermatitis (PACD) are seen by most dermatologists in general practice. PICD is diagnosed on clinical grounds and is usually caused by furocoumarins in plants like limes and celery. PACD is caused primarily by sunscreens but can also be the result of fragrances and antibacterial agents. PACD can only be diagnosed by photo-patch testing that most dermatologists, even those who patch test and give phototherapy in their office, do not perform. The procedure as outlined in this manuscript is relatively simple and can easily be accomplished in the dermatologist's office.
Article
Allergic contact dermatitis is a significant cause of cutaneous disease affecting many individuals in the home and at the workplace. Patch testing is the most worthwhile diagnostic tool for the evaluation of patients with suspected allergic contact dermatitis. This study reports the results of patch testing from January 1, 2001, to December 31, 2002, by the North American Contact Dermatitis Group (NACDG). Patients were tested with an extended screening series of 65 allergens. A standardized patch-testing technique was used. Data from these patients were recorded on a standardized computer entry form and analyzed. Sixty-five allergens were tested on 4,913 patients. The top 10 allergens remain the same in this study period as in the 1999-2000 study period: nickel sulfate (16.7%), neomycin (11.6%), Myroxilon pereirae (balsam of Peru) (11.6%), fragrance mix (10.4%), thimerosal (10.2%), sodium gold thiosulfate (10.2%), quaternium-15 (9.3%), formaldehyde (8.4%), bacitracin (7.9%), and cobalt chloride (7.4%). Of the 4,913 patients tested, 69% had at least one positive allergic patch-test reaction. Of all patients, 15.8% had occupation-related dermatitis; 15.4% were determined to have irritant contact dermatitis, and 11.1% of the 15.4% had a relevant reaction to an occupational irritant. Of all patients tested, 16.7% had a relevant reaction to an allergen not in the NACDG standard series, and 5.5% had a relevant reaction to an occupational allergen not in the standard series. Our findings once again reinforce the need for a more comprehensive group of diagnostic allergens than those found in the standard screening kits. The usefulness of patch testing is enhanced when a greater number of allergens are tested, especially nonstandard allergens occupationally encountered.
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