115 Technology Drive, Trumbull, Connecticut 06611

36 Sanford Street, Fairfield CT 06824

Telephone: 203.459.8712

Michael S. King, MD, FAAAAI, Diplomate of the American Board of Allergy and Immunology

Allergic Contact Dermatitis- Common Allergens
Return to Home Page Home Page Metal Allergy. Nickel metal and its salts are probably responsible for the majority of cases of allergic contact dermatitis. Some studies have found that about thirty per cent of women are allergic to nickel. Most contact occurs with exposure to jewelry containing nickel, which can be found in gold that is less than fourteen carat purity. Nickel is also found in watches, belt buckles and the new coin, the Euro.  Surprisingly, nickel salts may be found in some cosmetics, especially eye shadow and mascara. In cosmetics, nickel  is occasionally used in green pigments, but is slowly being removed from most products. As with all ingredients, the FDA does not require  listing on the ingredients label if it is less than one per cent  Other metals that are related to nickel and to which you may also react to  are cobalt and chromium. Cobalt is used in the manufacture of stainless steel, and is also found in belt buckles and bra strap clasps, paints, varnishes and cement. Chromium is commonly found in cement and tanned leather, and is responsible for hand and foot eczema. Chromium salts can also be found in some shoe polishes. Chromium salt allergy can be persistent long past the primary exposure and is a major source of disability in the cement industry. There is some evidence of cross reactivity with nickel allergy.

Other metal salts causing contact dermatitis that we have available for testing include copper, gold, vanadium, silver and palladium.

Fragrances have widespread distribution in cosmetics, shampoos, hairsprays, detergents, soap, air fresheners and many other places. There are hundreds of fragrance chemicals, but about twenty are the most common allergens. These include cinnamic aldehyde, cinnamic alcohol, eugenol, isoeugenol, oakmoss, geraniol, and hydroxycitronella. Because individual products may have unique fragrances, they should be patch tested individually. We also include a mixture of musk ambrette, moskene  and lichen acids to increase the sensitivity of patch testing. When fragrance is identified as an allergen, we can guide you to fragrance free products.

Ethylene Diamine is a preservative and stabilizer found in creams and ointments. It can be a component of industrial products such as epoxy resins, dyes, waxes and insecticides. Most non-occupational exposure is through cosmetics and prescription creams and ointments.

Balsam of Peru is a natural fragrance  obtained from trees and is a complex mixture of several substances. It usually occurs with other fragrance allergies. It is found in flavorings, cough syrups, sun screens, insect repellants, hair conditioners and shampoos. When identified as an allergen, alternative sources of products will be offered.

Colophony or rosin is a product of pine trees that is in widespread use, with millions of tons produced throughout the world. It can be found in adhesives, caulking compounds, cements, gum, grease removers, eye shadow, mascara, rouge, nail products, paints, paper, sawdust, shoes, and soaps.

Rubber is made elastic by a process called vulcanization, and many of the chemicals used in the process are strong sensitizers or allergens. These include isopropyl n-phenylenediamine, mercaptobenzothiazole and carba compounds. Affected individuals usually have a hand dermatitis from rubber gloves, or a foot dermatitis from shoes. Other sources of exposure include condoms, diaphragms and elastic in under garments including bra straps and underwear.

p-Phenylenediamine is a chemical used in the manufacturing of clothing dyes and hair coloring agents. Depending on the source of exposure, sensitive persons may have a scalp, eyelid or hand dermatitis. If the rash occurs from clothing dyes, then light colored cotton or wool fabrics are recommended. Reactions also can occur with related dyes such as para-toluene diamine (toluene diamine sulfate). Alternative dyes include products made from Henna, vegetables and metals.

n-isopropylphenylene diamine is a chemical used in the production of rubber to prevent oxidation, a process that tends to make rubber brittle and crack. It is also used to give rubber a black color and as pigment in some cosmetics.It may also cause reactions in people allergic to phenylenediamine containing hair dyes where it remains as a contaminant. Allergic individuals usually present with dermatitis on the eyelids, face, scalp hands or feet.

Disperse Dyes are not color fast and tend to bleed with washing. They are available in many colors and tent to leach from clothing with sweat and perspiration. Many people with allergy to disperse dyes will also react to hair dyes such as phenylene diamine.

tert-Butylphenol Formaldehyde Resin is used as a glue or adhesive and is mostly found in wood products, shoes and leather products. Carpenters and home builders may develop a hand dermatitis from repeated exposure, but it most commonly causes a foot dermatitis from leather shoes and boots.

Epoxy Resins are also strong sensitizers, and are familiar as very strong two- part glues. They are also a component of certain paints,but can be found in many manufactured products and some shoes.

Wool Alcohols or Lanolin Alcohols are products of sheep and are a mixture of alcohols, esters and fatty acids. Lanolin is a only a week sensitizer on normal skin but is likely to cause allergy in broken, eczematous skin. They are found in many ointments, moisturizers, creams, lotions, soaps, sunscreens and topical medications. Wool clothing does not usually cause problems.  Other substances containing Lanolin are Eucerin and Aquaphor. Lanolin in your moisturizer can make you eczema worse if you are unaware you are allergic to this substance

Parabens are preservatives used in cosmetics, medications  and skin care products. Preservatives prevent the growth of mold and bacteria in personal care products.  Paraben allergy may only affect already inflamed skin, and not harm normal skin. This is termed the "paraben paradox". Parabens are also found in many foods, but it is not clear that ingesting them has an adverse effect. Substances related to parabens that may cause allergy include para-aminobenzoic acid esters and p-phenylenediamine. Free and Clear has a line of personal care products products free of parabens.

Formaldehyde is used as a preservative and antiseptic in skin care products. It can also be found in clothing, deodorants, dishwashing liquid, paper products, paints and foam rubber. An antiseptic is a substance that  kills  bacteria. This type of  allergy is prevalent in health care workers and agricultural industry. Many related substances in personal care products release formaldehyde. These include Quaternium 15, imidazolidinyl urea, DMDM hydantoin, Bronopol, and Tris-Nitro. Scalp dermatitis may be caused by sensitivity to any of these substances as well as a more generalized dermatitis.

DMDM Hydantoin is a preservative found in many shampoos and conditioners. People who react to DMDM Hydantoin are also likely to be sensitive to formaldehyde and products that release formaldehyde. Formaldehyde kills germs on contact. Many personal care products are available without these compounds.

Thimerosal is also an antiseptic and preservative found in cosmetics and topical medications. These include mascaras, eye creams, make-up removers and merthiolate. Although it is also found in many vaccines, it appears to be safe when given into muscle meaning it does not cause allergic reactions injected. It is gradually being removed from most non-prescription products.

Cl-Me isothiazolinone is a preservative found in many shampoos, cosmetics, skin care products, soaps, baby wipes, makeup removers, shampoos and sunscreens. It is also found in several industries where it is known as Kathon. Several lines of cosmetics are available that are free of this substance. Scalp dermatitis is common is persons allergic to this substance.

Quaternium 15 is a formaldehyde releasing chemical that acts as a preservative and disinfectant. It is found in many cosmetics but also used in sanitizing soaps and baby wipes. Allergic individuals usually present with a facial or hand dermatitis.

Corticosteroids are a surprising and unexpected cause of eczema or dermatitis. Although they are used to treat theses conditions, some individuals are truly allergic to them. The typical scenario situation when steroid allergy should be suspected is a rash that fails to improve with topical application of a steroid cream. It is more likely to occur with moderate and low potency steroid preparations than high potency preparations. Test of the  vehicle, meaning  the cream or ointment that carries the medication,  are usually not the source of the allergy when patch testing is performed. Testing involves a moderate potency steroid called budesonide and a low potency steroid known as tixocortol. The  relatively new calcineurin inhibitors, Protopic and  Elidel,  can sometimes be substituted if steroid allergy is found.

Benzophenone 3 is a allergen found in many sunscreens and cosmetics. It absorbs a broad spectrum of ultraviolet light that can protect the skin against harmful rays of the sun. It is also used as a photo-protector to prevent the decay or degradation of personal care products that are sensitive to light. It may cause allergic contact dermatitis or become a skin sensitizer when exposed to the sun.

Eyelid Dermatitis can be a result of multiple factors. Contact allergy, airborne allergens and irritants are major causes of dermatitis in this area. The skin of the eyelids is very thin and can respond to substances that otherwise do not affect other areas of the body. Most substances affecting the eyelids are transferred by the hands. These include preservatives such as parabens, methyl methacrylate, colophony  and toluene sulphonamide formaldehyde resin in nail polish, fragrances and neomycin in topically applied ointments. Contact lens solutions containing thimerosal were a cause of eyelid dermatitis until several years ago, but have been removed from all commercially available preparations. Eyelash curlers made of nickel can also be a cause of eyelid eczema. Likewise, if the curlers contain a rubber tip, this can also be a sensitizer. Other causes of eyelid dermatitis  include atopic dermatitis, which is worsened by airborne or food allergens and seborrheic dermatitis, from  hypersensitivity reaction to the skin's own oils and bacteria and possibly mites. Rosacea can also be confused with eyelid eczema when it does not have the common involvement of the butterfly area  of the face. Some people attempt folk remedies such as Preparation H to relieve eyelid swelling. This  should be avoided because it contains many substances that are contact allergens. Ice packs should also be avoided to prevent frostbite or thermal injury.

Foot or Shoe Dermatitis is common in people who have excessive sweating of their feet. Liquid sweat will dissolve many substances in the shoe or sock and cause direct contact and absorption by the skin. Common substances in shoes that can cause dermatitis include chromium salts used in the tanning of leather, formaldehyde, thiurams, carba compounds, colophony based adhesives, thioureas, glutaraldehyde,  dyes, rubber compounds, methacrylates and epoxy based adhesives. When shoe dermatitis is suspected, plastic or wooden shoes are available as alternatives. Increased sweating of the feet should also be treated with antiperspirants.

Methacrylates are most familiar as the ingredients of "crazy glue", finger nail polish and artificial nails, but are also found in home products.  They are a common cause of eyelid dermatitis, especially in women, because  they are inadvertently transferred from the hands to the face. Ethylacrylate and tetrahydrofurfuryl methacrylate are also important mediators of acrylic allergy and part of our standard panel.

Sunscreens  are occasionally found to be contact allergens. The major classes responsible for sensitization include para-amino benzoic acids, benzophenone, homosalate and cinnamates. All classes are available for patch testing at Allergy and Asthma Associates of Connecticut. Cinnamate sunscreens are related to certain fragrances such as cinnamic alcohol an can cross react.

Euxyl K 400 is cause of allergic contact dermatitis (ACD) of the hands that was recently recognized by physicians in Europe. This substance is used as a preservative in personal care products and is a mixture of two compounds, methyl-dibromo-glutaronitrile and phenoxyethanol. Both substance kill yeast, mold and bacteria with prolonged exposure. The former chemical is responsible for ACD whereas the latter compound is thought to be non-allergenic.    Euxyl K 400 is found in shampoos, cosmetics, bath preparations, toiletries, hand cleaners, water based paints and glues. Euxyl K400 tends to be more widely used in Europe than in the US. It is available for patch testing and part of our standard series. Other names for the same substance include 1, 2 dibromocyanobutane, Merquat 2200 and tektamer 38.