CONTACT DERMATITIS DUE TO FRAGRANCE

CONFIRMED BY ALLERGIC TEST

Azizah Chairiani1, Suswardana2

1
Medicine Student at Trisakti University
SMF Dermatology and Venerology RSAL dr. Mintohardjo
2
SMF Dermatology and Venerology RSAL dr. Mintohardjo

Abstract

Introduction
There are two types of contact dermatitis. The causes and symptoms of the two are nearly the
same. Irritant contact dermatitis (ICD) is an inflammatory response of the skin to various
external stimuli. It arises as a result of activated innate immunity to direct injury of the skin
without prior sensitization1. ICD is a complex reaction modulated by both intrinsic and
extrinsic factors2. Intrinsic factors which influence the susceptibility to ICD include genetic
predisposition, for example, atopic diathesis, age, sex, and body region. Extrinsic factors
include the inherent nature of the irritants, exposure volume, concentration, duration,
repetition, and the presence of further environmental and mechanical factors.

Differentiation of ACD and ICD is important because of different therapeutic and

management options. In most cases contact dermatitis is suspected from anamnestic and
clinical findings. Diagnosis is confirmed by patch testing.

Case

A 24 years old woman presenting with an itching, rash, and burning sensation on her back,
armpits, and crease of bra straps for 2 weeks. Further inquiry revealed history of itching
treatment with cloramfecort cream from a doctor for this last a week. She had previous
history of seborroic dermatitis 2 years ago.

Physical examination showed all vital sign were normal. On presentation, she had
erythematous macular lesions with pustules on crease of bra straps and neck,
hyperpigmentation macular lesions and erythematous pustules around on bilateral axilla. Two
days after first visit the allergy test have been done with the patient, from suspected items
which are deodorant, fabric softener, detergent, perfume, body spray, and cloramfecort
cream, showed that the most likely caused is all variant contains of perfume and fragrance.

Discussion

The patient showed allergic sensitivity to is all variant contains of perfume or fragrance she
had used. We believe that sensitization occurred while using deodorant, softener, detergent,
perfume, and body spray.

Fragrance Components are frequent culprits in cosmetic allergies. Sensitization is

most often induced by highly perfumed products, such as toilet waters, after-shave lotions,
and deodorants, but fragrance-containing skin-care products may also cause reactions3. The
main skin sites affected are the face, neck, axillae, and hands.

The affected skin area is usually confined to the area in contact with the allergen. The
affected skin will develop itch red rash that can be papules, vesicles or blisters. In long
standing condition, the skin rash may become lichenified (thickened) plaques, may lead to
areas of hypo-pigmented (light colored) or hyper-pigmented (darker colored). In this case,
crease of the bra strap, neck, and axilla are the contact areas with fragrance.4

However, testing with additional markers such as, for example, other individual
components, as well as with complex natural mixtures increases the sensitivity of the testing.
Multiple positive patch test reactions are frequently associated with fragrance allergy and
often indicate the presence of cross-reacting ingredients between simple fragrance chemicals
and natural product. Fragrance components may be allergenic by themselves, but may also
contain sensitizing oxidation products5.
Steps should be performed in patients is to avoid all variant contains of perfume that
maybe used by the patient daily, test cloramfecort for 2 weeks by apply it on follar of the
hand and see if it become red and or itchy bumps presents do not use it at the skin that is
irritant contact dermatitis. Metilprednisolone 4mg 2 tablets in the morning, 2 tablets in the
noon, and 1 tablet after dinner. Cetirizine 10 mg once a day before sleep, CTM tablet twice a
day, and inerson ointment twice a day.

Conclusions

Fragrance components and preservatives are the most frequent cosmetic contact allergens;
however, all ingredients must be considered as potential culprits and patch tested. Besides
allergic contact dermatitis, also immediate type reactions may occur, for which prick tests are
the golden standard for diagnosis. Once the specific allergens are identified, the patient
should be informed on which products can be safely used in the future. Indeed, the so-called
hypoallergenic products are not necessarily less sensitizing6.

References

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Raton, Fla, USA, 2006.
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Elsevier; 206. p.18-127.
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E. Andersen, Comparison of elicitation potential of chloroatranol and atranol2
allergens in oak moss absolute, Contact Dermatitis, vol. 54, no. 4, pp. 192195,
2006.
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Science and Technology, A. O. Barel, M. Paye, and H. I. Maibach, Eds., chapter 53,
pp. 553562, Informa Healthcare USA, 3rd edition, 2009.