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What’s Important?

  1. Contact allergy to fragrance is a common problem often seen throughout the world, with fragrances consistently placed among the top 10 contact dermatitis allergens.

  2. Fragrance is the second most common allergen family associated with allergic contact dermatitis (after nickel), as well as the most often cited cause of such reactions to cosmetic products.

What’s New?

  1. The use of the synthetic fragrance hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC) was banned by the European Union in August 2019.

  2. The most common fragrance screeners in most baseline series include FM I, FM II, and balsam of Peru.

  3. Although banned in the EU, HICC may be deemed by some to be useful for screening, along with hydroperoxides of limonene and linalool, to diagnose fragrance allergy.

What’s Coming?

  1. Continual retrospective studies will help to calibrate evolving patch test standards, helping to identify up-to-date allergens that are most appropriate to include in screening.

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. Players in this subdivision are 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 are placed on the skin, such as 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 19, Contact Dermatitis to Cosmetic Ingredients, fragrances consistently place among the top 10 contact dermatitis allergens. Fragrances are also the second most common allergen family associated with allergic contact dermatitis, following only nickel, as well as the most often cited cause of such reactions to cosmetic products.1 Indeed, most fragrance ingredients can elicit allergic reactions and thereby act as allergens or raise the risk of sensitization, noted Kumar et al.2 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.3–5 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 Fragrance Mix (FM) I and ...

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