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Dermatitis most commonly occurs from hair dyes, nail polishes, perfumes, lipsticks and sunscreen agents. The chief site of the eruption is the eyelids area, with ears and neck next.
Eye makeup, such as mascara, eye shadow and eye pencil,seldom causes dermatitis (although eyeliner often does)whereas nail polish, while seldom causing trouble around the fingernails, affects the eyelids first. Lower eyelid dermatitis is often form wetting solutions or eye drops.Various formaldehyde resins are used in nail lacquers and nail lacquers and nail hardeners, as are sulfonamide derivatives, both of which sensitize.
Lipsticks contain waxes and fats (occasionally cocoa butter sensitizes), perfumes (occasionally sensitize), and dyes (especially tetrabromofluorescein), which may occasionally dry the lips and produce photosensitivity. Special lipsticks are available that contain neither fluorescein dyes, nor perfumes, like, for example, Almay (Texas Pharmacal) or Ar-Ex.
Sunscreen preparations containing PABA (para-aminobenzoic acid), hydroquinone or digalloy trioleate can sensitize, and in some cases, photosensitize. Bleaching creams are sensitizers too, either mercury, or hydroquinone being the culprit.
Toothpaste and mouthwashes can cause dermatitis from oils,cinnamon or other flavoring, or antiseptics.
Hair dyes are mostly of the permanent or "oxidation" type, containing para-phenylene diamine (PPDA), soap, ammonia and other modifiers which penetrate and color the hair when mixed with 20 volumes of peroxide. This type of dye accepts shampoos and cold waves and sensitizes most commonly. The azo and aniline dyes produce a semipermanent coloring which is tolerated well in most PPDA-sensitive patients, but lasts through only a few washings. Metallic hair dyes (Romans used a lead comb dipped in vinegar to darken gray hair) are also referred to as hair "restorers" and are mostly still based on lead and do not sensitize. Vegetable rinses are ususally made form henna, which is non-sensitizing, although some pyrogallol combinations are sensitizing. Methylene PPDA can cross-react with PABA in sunscreens, local anesthetics and sulfonamides-thiazides (Diruil), tolbutamide (Orinase), chlorpropamide (Diabinase) and saccharin.
Permanent-wave solution, usually thioglycolates, are alkaline reducing agents which make the hair malleable; the hair is "waved" on rollers and then "fixed" with an oxidizer (hydrogen peroxide, perborate, bromates of citric acid). Thioglycolates rarely sensitize, but do occasionally cause primary irritation if not carefully mopped up, and can split and break the hair.
The adhesive used to attach toupees and false eyelashes occasionally causes dermatitis, in which case Duo Surgical Adhesive (Johnson and Johnson) sometimes is tolerated well.Bleaching or freckle creams usually contain mercury or quinones, and all can sensitize; Benzoquin (Elder) is a very potent sensitizer. Face powders and rouge rarely cause dermatitis. Sunscreens, at least those made of PABA (Pre-Sun, Sundown, PABA gel, Sunbrella, etc.) or digalloyltrioleate (Sundare, Sunswept and A-Fil), can sensitize and photosensitize. The benzophenones, e.g., Solbar or Uval,seem promising, although there have been sensitizing cases.Sundare, RVPaque, RVP, Almay Sunburn Preventative, Liquid Sunshine (H. Rubenstein), Sun-Proof Cream (Ardena), Sun-TanGelee (rexall) and Sun Bath (Revlon) are generally acceptable.
Patients should be advised to apply perfume to their clothes if possible rather than to their skin and certainly should avoid using photosensitizing perfumes (e.g. Shalimar) on their skin in bright sun.
Hypoallergenic cosmetics are manufactured by several companies, two of the best being the Almay division of Schieffelin & Company and the Texas Pharmacal Company.
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