Background: The diagnostic effectiveness of a baseline series depends directly on the selection of haptens to be tested. In the present study, we have used a baseline series supplemented with additional cosmetic ingredients, three of which occurred more frequent and are more relevant than any of those listed in the European Baseline Series (EBS).
The aim of the present study was to assess the sensitization rates and relevance of emerging cosmetic ingredients that are not included in the European Baseline Series.
"KRAK2" is a multicentre collaboration of 10 dermatology and allergy clinics in Poland. From 2013 to 2014, for routine patch testing the centres used the Extended Polish Baseline Series (Chemotechnique), which included all haptens present in the EBS plus 20 additional substances. Out of the total 50 haptens or hapten mixes, the Polish series included 22 cosmetic ingredients. In total 1608 patients with chronic or recurrent eczema participated in the testing: 1154 female and 454 male, aged 0.5-90 years (median 42). Patch tests were applied on the patient's back in IQ Ultra Chambers (Chemotechnique) with an occlusion time of 48 h and at least two readings during the observation time of at least 5 days (7 days preferably). Positive patch-test reactions were assessed by the treating doctors as to their relevance to current eczema.
Results: The most frequent sensitizers among all cosmetic ingredients tested were substances not present in the EBS: gallate mix 5% in petrolatum (sensitization rate 16.0%; clinically relevant 6.2%), followed by hydroperoxides of linalool 1% in petrolatum (9.8% and 4.7%, respectively) and hydroperoxides of limonene 0.3% in petrolatum (7.7%; 3.2%). A first "representative" of the EBS - Fragrance Mix I 8% in petrolatum -occupied only rank 4 (7.0%; 5.3%), equal with methylisothiazolinone (MI) 0.02% aqueous (7.0%; 5.3%), followed by para-phenylenediamine base 1% in petrolatum (3.1%; 1.7%), MI/methylchloroisothiazolinone (2.8%; 2.1%), Fragrance Mix II 14% in petrolatum (2.6%; 2.2%) and hydroxyisohexyl 3-cyclohexenecarboxaldehyde (2.4%; 1.7%). Other haptens not in the EBS that came out relatively high were propolis cera 10% in petrolatum (3.3%; 1.8%) and carvone 5% in petrolatum (1.6%; 0.8%). Formaldehyde 1% in petrolatum/sorbitan sesquioleate yielded significantly higher positivity and relevance (5.2%; 2.6%) than formaldehyde 1.0% aqueous (1.3%; 0.5%).
In conclusion, cosmetic ingredients are relevant causes of eczema; however, the most frequent ones are not included in the EBS. In order to improve the diagnosis of eczema in children, routine patch-test series should reflect the current data on exposures and frequency of sensitizations.
Patch testing in Krakow (Cracow), Poland
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Document created: 29 May 2017, last updated: 30 May 2017.