Chapter 36: Fragrance

INTRODUCTION

Innovative products and procedures inundate medicine and the specialty of dermatology at a dizzying pace. At the same time, the billion-dollar beauty industry continues to expand, with few if any signs of a decline. The global fragrance and flavor market represents a significant and lucrative subdivision of the beauty market and is constantly testing various fragrance ingredients to stay ahead of encroaching regulation and increased rates of sensitization. Indeed, while contact allergy to fragrance is not a presentation seen in the dermatologist’s office as frequently as acne, for example, it is a common problem seen often throughout the world. This is not surprising since fragrances are virtually omnipresent in products that come into contact with the skin, for example, soaps, body lotions and moisturizers, shampoos, deodorants, shaving products, cosmetics, perfumes, sunscreens, and dental products, as well as food products, detergents, and even air fresheners. Furthermore, as stated in Chapter 18, fragrances consistently place among the top 10 contact dermatitis allergens and represent the second most common allergen family associated with allergic contact dermatitis, second only to nickel, as well as the most often cited cause of such reactions to cosmetic products. This looms as an especially important realization given the general rise in the incidence of contact allergy to various fragrances and the fact that epidemiologic and human allergen sensitization studies have shown that individuals who are found to be sensitive to one allergen through patch testing are at significantly greater risk of having a second allergen identified.^1–3 Particularly, given the greater expertise expected of cosmetic dermatologists regarding agents intended to beautify the skin, it is incumbent upon such specialists to have a strong working knowledge of the primary fragrances identified as provoking allergic reactions. This chapter will focus briefly on selected problematic fragrances, primarily on the worst offenders found within the Fragrance Mix (FM) I and FM II.

DEMOGRAPHICS AND SIGNIFICANCE

An epidemiologic survey in the United Kingdom published in 2004 reported that 23% of women and 13.8% of men displayed adverse reactions to a personal care product (e.g., deodorants and perfumes, skin care products, hair care products, and nail cosmetics) over the course of 1 year.⁴ More recently, in a 1999 to 2006 Brazilian study of 176 patients (154 women and 22 men) seen in a private office who complained of dermatoses resulting from cosmetics, 45% exhibited dermatoses linked to cosmetics and 14% had skin lesions that were found to be caused by inappropriate use of cosmetics.⁵ In addition, several studies have demonstrated that approximately 10% of dermatologic patients who are patch tested for 20 to 100 ingredients exhibit allergic sensitivity to at least one ingredient common in cosmetic products.⁴ Fragrances and preservatives are the most common allergens and women aged 20 to 60 years represent the demographic group that experiences the majority of these reactions.⁶ Individuals who are overexposed to skin care products and ...