How to test for fragrance allergy.

Fragrance is the most common cause of cosmetic allergic contact dermatitis. Fragrance allergy detection is best accomplished by testing with the fragrance mixture, balsam of Peru, and either jasmine synthetic or absolute. It would be desirable to have common fragrance allergens listed on cosmetic labels so that patients could avoid the allergens to which they are allergic.

Concomitant positive patch test results with standard screening tray in North America 1985-1989.

Responses to patch test substances may occur contemporaneously. Such simultaneous reactions may reflect concomitant sensitization to 2 dissimilar allergens to which concurrent exposure has taken place (e.g., ethylenediamine dihydrochloride and neomycin). It may occur when the individual has been exposed to only 1 of the substances and exhibits a response to other substances of similar chemical structure (i.e., cross-sensitization such as between para-phenylenediamine and benzocaine). Such simultaneous responses may also be chance occurrences, reflecting multiple sensitization or the result of altered response due to the "angry back syndrome". This investigation established that such concurrence of response is not uncommon and adds further documentation to the literature of these associations in patch test responses.

Sertoli-Leydig cell tumor of the ovary: a rare cause of amenorrhea.

A 15-year-old girl presented to a primary care clinic with secondary amenorrhea, masculinization, and rapidly increasing abdominal girth. Evaluation revealed a large pelvic mass, which was found at laparotomy to be a bilateral Sertoli-Leydig cell tumor producing androgens and high levels of alpha-fetoprotein (AFP). The patient underwent bilateral salpingo-oophorectomy. Other pelvic structures were uninvolved. The postoperative course was unremarkable, with testosterone and AFP levels in the normal range. A thorough literature search revealed no cases in which bilateral Sertoli-Leydig cell tumors were associated with high AFP levels. This case was unusual in its pathology, dramatic in its presentation, and valuable in its implications regarding the work-up of amenorrhea in young women.

Methylchloroisothiazolinone-methylisothiazolinone reactions in patients screened for vehicle and preservative hypersensitivity.

More than 1100 patients were tested with methylchloroisothiazolinone-methylisothiazolinone, 100 ppm, in aqueous and petrolatum-based patch test materials from 1985 to 1987 by members of the North American Contact Dermatitis Group. Thirteen reactions to the aqueous materials and 10 to the petrolatum-based materials were observed. Irritant reactions were infrequent, and about half the reactions were deemed relevant. From 1984 to 1985, patch tests with this substance at a concentration of 250 ppm in petrolatum were conducted. Thirteen persons were identified as allergic, but three others were sensitized by the patch test procedure. Sensitization as not observed in tests with aqueous or petrolatum-based substance at a concentration of 100 ppm, and this concentration appears to be the best compromise between safety and sensitive detection of allergy. Use tests are helpful but not infallible as a guide in establishing relevance with methylchloroisothiazolinone-methylisothiazolinone. Wash-off products are frequently well tolerated by patients with positive reactions to this substance.

How to instruct patients sensitive to fragrances.

Patients who are sensitive to fragrances should either use fragrance-free cosmetics or undergo a repeat open application test to the cosmetic or perfume to determine sensitivity. Unusual reactions include systemic contact dermatitis due to balsam of Peru, benzyl alcohol, and menthol. Some responses involve pigmented eruptions due to phototoxic or photoallergic agents in perfumes and incense. Other reactions include consort dermatitis and reactions to toothpastes, gum and perfumes in paper products, sanitary napkins, ostomy pastes, and detergents.

Prevalence and relevance of allergic reactions in patients patch tested in North America--1984 to 1985.

Between Jan. 1, 1984, and May 1, 1985, 1199 patients with suspected allergic contact dermatitis were patch tested with 32 "standard" allergens, 707 patients with 19 "vehicle and preservative" allergens, and 613 patients with 10 "special study" allergens. Ten dermatologists representing nine geographic centers collected and analyzed data with the use of the American Academy of Dermatology's mainframe computer in Evanston, Illinois. The most common sensitizers identified were nickel, p-phenylenediamine, quaternium-15, neomycin, thimerosal, formaldehyde, cinnamic aldehyde, ethylenediamine, potassium dichromate, and thiuram mix. Each positive reaction was assessed for its clinical relevance.

Perfume dermatitis.

The most common reaction to fragrance materials seen by practicing dermatologists is allergic contact dermatitis. Photodermatitis is occasionally seen, as is contact urticaria, irritation, and depigmentation. Fragrances are the leading cause of allergic contact dermatitis due to cosmetics. The fragrance mixture can cause false-positive reactions; therefore, it is more desirable to test with a separate series of fragrance materials.

Allergic contact dermatitis to the perfume in Mycolog cream.

Mycolog contact allergy is due primarily to its ethylenediamine and fragrance components. In the evaluation of Mycolog-sensitive patients, the major constituents, including the perfume at 5% or 10% in petrolatum, should be tested.

Photoallergic contact dermatitis to men's perfumes.

Three patients with photosensitive eruptions related to the use of different men's perfumes were evaluated. We found that they were photoallergic to musk ambrette, an inexpensive, readily available synthetic perfume ingredient. Studies of cross-reactivity with other perfumed colognes and after-shave lotions suggest that musk ambrette is present in clinically significant concentration in large numbers of other cosmetic products.