| Abstract [eng] |
Background. Daily use of cosmetic products may lead to sensitization, particularly in individuals with a compromised skin barrier and chronic inflammation, such as those with chronic inflammatory facial skin diseases. Fragrances and preservatives are the most common allergens in cosmetic formulations. However, data on the sensitization patterns in this patient population in Lithuania is lacking. Aim. To determine the frequency and clinical relevance of sensitization to cosmetic compounds in patients with chronic inflammatory facial skin diseases. Methods. A retrospective analysis of the medical records of 158 patients, referred to Vilnius University Santaros Clinics Dermatovenerology Centre was performed. All patients underwent patch testing with allergens from the European baseline (S-1000) and cosmetic (C-1000) series. Subjects were grouped according to age (≤35 vs. >35 years), history of atopic diseases, occupational exposure to chemical agents. A p-value <0.05 was considered statistically significant. Results. Sensitization to at least one allergen from either series was found in 83.5% patients, of them 94.7% were women, 5.3% men, with a median age of 39 years (IQR: 28–47). Sensitization to at least one allergen from the European baseline series was observed in 75.8% of cases, most commonly to methylisothiazolinone (MI) (33.3%), potassium dichromate (25.8%), and nickel sulfate (24.2%). All sensitized patients also reacted to at least one cosmetic series allergen, most frequently to methylisothiazolinone/methylchloroisothiazolinone mix (MI/MCI) (28.0%), MI (27.3%) and thimerosal (18.9%). The majority of patients were sensitized to preservatives (92.4%). Cosmetic products were the most frequently reported symptom-triggering factor (34.8%). Sensitization to hexahydro-1,3,5-tris(2-hydroxyethyl)triazine was more common in younger patients (p=0.024). Atopic individuals were significantly more often sensitized to mercapto mix (p=0.019), rubber allergens (p=0.043), and emulsifier/emollient groups (p=0.010). Occupational exposure was associated with sensitization to parabens (p=0.031), p-phenylenediamine (PPD) (p=0.021), triethanolamine (p=0.030), triclosan (p=0.009), phenylmercuric acetate (p=0.044), and dye-related allergens (p=0.020). Fragrance sensitization was observed in 40.9% of patients, most commonly to balsam of Peru (16.7%), with the most frequent combination being reactions to both Fragrance Mix I and II. Fragrance sensitization was significantly associated with sensitization to plant-based allergens (ρ=0.343; p=0.011), metals (ρ=0.307; p=0.024), rubber (ρ=0.384; p=0.004), and drug-related allergens (ρ=0.305; p=0.025). Conclusions. The majority of patients were diagnosed with allergic contact dermatitis, were young or middle-aged, and usage of cosmetics were most often reported as symptom-triggering factors. Sensitization was most commonly observed to preservatives, particularly methylisothiazolinone (MI) and its combination with methylchloroisothiazolinone (MCI/MI). Age, history of atopic diseases, and occupational exposure to chemicals were significantly associated with specific sensitization patterns: younger patients were more frequently sensitized to hexahydro-1,3,5-tris(2-hydroxyethyl)triazine; atopic patients showed higher sensitization rates to mercapto mix, rubber allergens, and emulsifiers/emollients; while those exposed to chemicals at work were more often sensitized to parabens, p-phenylenediamine, triethanolamine, triclosan, phenylmercuric acetate, and dye-related allergens. Sensitization to fragrances was identified in nearly half of the patients, most frequently to balsam of Peru. Moreover, fragrance sensitization was statistically significantly associated with sensitization to other allergen groups, including plant-derived substances, metals, rubber, and pharmaceutical compounds. |
