Cosmetic allergies are a reaction to the products that people use every day to cleanse, protect and beautify their bodies. Soaps, sunscreens, deodorants, lipsticks and perfumes are just some of the everyday products capable of causing an allergic reaction or asthma attack in millions of Americans.
Many experts are concerned about what they perceive as an increasing threat to public health. Over the past several decades, cosmetics have become a growing part of American life, both for men and women. The average adult uses at least seven different cosmetic products each day, according to the American Academy of Dermatology.
Cosmetic allergies occur when the body reacts to a substance it mistakenly believes is harmful. Cosmetic allergies usually appear as contact dermatitis (a rash where the product was applied). However, in some cases allergies or asthma symptoms can be triggered by inhalation or ingestion.
Avoidance is the primary treatment for most cosmetic allergies. This is particularly troublesome for those who have fragrance allergies, where exposure is often an inevitable part of daily life that is beyond the sufferer’s control. Some have equated the problem to the danger of secondhand smoke.
Though some manufacturers may advertise their products as “allergy free,” there is no such thing as a non–allergenic cosmetic. All cosmetics have the potential to cause allergic reactions.
About cosmetic allergies
The U.S. Food and Drug Administration (FDA) defines a cosmetic as a product intended to cleanse or beautify a person without altering the body’s structure or functions. This includes products ranging from hair shampoo to perfume and underarm deodorant.
An allergic reaction to cosmetics occurs when the body reacts to a substance it mistakenly perceives as a threat. It typically manifests itself as contact dermatitis, causing the skin to become red, itchy, flaky and inflamed.
A reaction to cosmetics does not necessarily mean a person is allergic to the product. Irritation, which also results in contact dermatitis, is more common than an actual allergy. It is the result of a chemical reaction that occurs when a cosmetic is applied to the skin, and not because the body perceives the cosmetic to be an antigen (a substance that causes the immune system to produce antibodies to defend the body).
Contact dermatitis often occurs on or near the site where the product has been applied, such as the face, lips, eyes, ears and neck. The hands can also be affected (usually by moisturizers or nail products).
The most common type of cosmetic allergy involves fragrances. Fragrances can be inhaled or ingested, and they can affect eyes and lungs.
Allergic reactions to fragrances differ slightly from most other kinds of allergies. In most allergic reactions, the body reacts to an allergen that it perceives as a harmful invader by triggering the cells of the body to release certain chemicals. These chemicals, such as histamines, trigger inflammation and other changes that manifest themselves in the symptoms of an allergic reaction.
However, unlike most allergens, fragrance materials are not protein–based, and they generally are too small to be detected by the body. Instead, they act as a hapten, binding with proteins in the skin. As they do so, they modify the proteins, causing the body to perceive the proteins as a foreign substance and to trigger an allergic reaction.
Some fragrance materials are absorbed intact into the body and remain that way. Others are broken down into compounds. The allergic reaction may be to the entire material, or to one or more of its compounds.
Once the process of sensitization to a fragrance material has occurred, it is likely to grow worse with time and repeated exposures. Moreover, fragrance allergies potentially affect not only the person wearing the fragrance, but anyone who comes into contact with that person and is exposed to the substance.
Some individuals are allergic to the scent of a cosmetic, and others react when a chemical ingredient is applied to the skin. Sometimes, it is the preservatives in the cosmetic that trigger an allergic reaction. Some cosmetic preservatives are also used in foods, and ingesting these substances can produce a reaction.
In addition, various fragrances tend to trigger asthma symptoms in some individuals. Researchers have not yet established whether chemicals in fragrances simply exacerbate attacks, or actually sensitize the body and cause asthma itself.
Unlike drugs, most cosmetics do not have to be tested for safety before they go on the market. The exception to this is cosmetics containing medications (e.g., some dandruff shampoos, some fluoride toothpastes), which do have to comply with FDA drug standards. Makers of cosmetics also do not have to register their formulations, test results or consumer complaints with the FDA. Outside of color additives and a few prohibited substances, manufacturers can use whichever ingredients they like and make various claims about them.
Because the industry is self-regulated, consumers should take the safety claims on cosmetic products with a grain of salt. Experts warn that terms used by the industry to promote the safety of cosmetics – including “hypoallergenic,” “natural” and “fragrance-free” – have no objective measure and are largely meaningless. Even products billed as fragrance-free or “unscented” may contain scenting designed to cover up the cosmetic’s chemical smell.
The term “dermatologist-tested” is also not a guarantee that a product will not cause a reaction. This claim only denotes that a physician evaluated the general likelihood of the product to trigger a reaction. It does not mean that the product is safe for everyone.
Though some manufacturers may advertise their products as “allergy free,” there is no such thing as a non-allergenic cosmetic. All cosmetics have the potential to cause allergic reactions.
Manufacturers are required to list the ingredients that make up a cosmetic. They also have to list them in descending order from the ingredient with the highest concentration in the cosmetic (usually water) to the lowest. The makers of cosmetics also must include a warning if a product’s safety has not been proved through testing.
Potential causes of cosmetic allergies
As with any allergy, cosmetic allergies develop after an individual has had one or more exposures to an allergen that the immune system mistakenly perceives as a harmful invader. The immune system then begins to sensitize the body by creating antibodies specifically designed to fight this antigen.
Once sensitization is complete, the body will undergo an allergic reaction the next time it encounters the allergen. It is important to note that a person can use a cosmetic for years without incident before the body suddenly reacts, without any detectable warning.
Fragrances cause more allergic reactions than any other cosmetic ingredient. They are natural or synthetic substances used to give a pleasant odor to cosmetics. Perfumes and colognes are the most obvious source of cosmetic fragrances, but soaps, toothpastes, hair–care products, lipsticks, sunscreens and lotions also contain chemicals used to improve their scent. Even products billed as fragrance–free or “unscented” may contain scenting designed to cover up the cosmetic’s chemical smell.
Fragrances affect not only the person wearing them, but also others who come into contact with the individual. By design, fragrances are intended to travel quickly and easily through the air. Many fragrances are capable of causing damage because they are easily absorbed by the skin, where they trigger irritation.
In addition, inhaled fragrances can irritate hyperactive airways, triggering symptoms of asthma. It is unknown whether or not some fragrance chemicals are the actual source of asthma.
Most fragrances are made of chemicals derived from synthetic compounds, many of which have been synthesized from petroleum products. The smaller the molecule that makes up these materials and the more fat soluble it is, the more likely it is to be absorbed. Children and the elderly are likely to absorb these materials faster and in greater concentrations, because their skin is thinner than most adults.
Factors that determine the degree of irritation include the concentration of the material, length of exposure to it, and condition of the skin and its location on the body. Women also are at greater risk for symptoms of fragrance allergies, because they are more likely to use cosmetics than men, and because their higher ratio of body fat stores the materials longer.
Scent is not the only aspect of cosmetics that can trigger an allergic reaction. For example, alpha-hydroxy acid is a popular ingredient in many skin moisturizers. Most people can use these products – whose active ingredient derives from sour milk (lactic acid), sugarcane (glycolic acid) or apples (malic acid) – without incident. However, those who are allergic to these acids could end up with swollen, tender or itchy skin. The U.S. Food and Drug Administration (FDA) has warned that those with such allergies risk a permanent thinning of the skin’s protective barrier and increased incidences of allergic reactions.
The vast majority of chemicals used in fragrances are petroleum-based synthetic compounds. Some of the most common chemicals and compound ingredients that have been associated with cosmetics allergies include:
- Cinnamic alcohol. Found in perfume, cosmetics, deodorant, laundry detergent, toothpaste and mouthwash.
- Cinnamic aldehyde. Found in toothpaste, bath oil, hair cosmetics, lipstick, mouthwash, soap and laundry detergent.
- Eugenol. Found in cologne, hair cosmetics, aftershave, perfume, hair cream and toothpaste.
- Geraniol. Found in perfume, fragrance, lip salve, facial makeup and skin care products.
- Hydroxycitronellal. Found in perfume, cosmetic products, fragrance, eye cream and aftershave.
- Isoeugenol. Clove scent found in perfume, eye cosmetics and aftershave.
- Limonene. Found in perfume, cologne, disinfectant spray, soap, shaving cream, deodorant, nail color and remover, fabric softener, dishwashing liquid, air fresheners, aftershave and bleach.
- Linalool. Found in perfume, cologne, soap, shampoo, hand lotion, nail enamel remover, hair spray, laundry detergent, dishwashing liquid, air freshener, bleach powder, fabric softener, shaving cream, aftershave and deodorant.
- Oak moss absolute. Found in cologne, aftershave and other scented products made for men.
- Protein hydrolysates. Found in hair conditioners and soaps.
Other sources of cosmetic-related irritation include chemical preservatives designed to prevent spoilage of the cosmetic’s ingredients. Without them, bacteria and fungus would grow on the products. Cosmetics would also be more susceptible to damage related to air and light. Examples of common preservatives include paraben, imidazolidynl urea, Quaternium-15, DMDM hydantoin, phenoxyethanol, methylchloroisothiazolinone and formaldehyde.
It is important to note that patients who react to one type of fragrance or preservative will not necessarily react to another.
Signs and symptoms of cosmetic allergies
The symptoms most commonly associated with allergic reactions to cosmetics are skin rashes. Symptoms are likely to appear within seven to 10 days after exposure, and can appear anywhere on the body, including sites that have had no contact with the cosmetic. In fact, an allergic reaction to a cosmetic usually leaves its mark on the face – including lips, eyes and ears – and the neck. Skin-related symptoms may include:
- Swelling (angioedema)
- Itchiness (pruritus)
- Breakouts that resemble hives
- Red or raw skin
Other symptoms of cosmetic allergies may involve rhinitis (which can be allergic or nonallergic). These include:
- Itchy, watery or burning eyes
- Sore throat
- Chest tightness
- Difficulty breathing
Exposure to cosmetics can also trigger asthma attacks or related symptoms, whether due to an allergic reaction or because the cosmetics irritate an existing asthma condition. Asthma-related symptoms may include:
- Rapid breathing
- Chest pain or tightness
- Chronic coughing
- Shortness of breath
- Stuffy head
- Scratchy or sore throat
- Itchy, watery eyes
- Runny nose
Individuals who suspect that they are experiencing an allergic reaction or irritation as the result of using a cosmetic should stop using the product.
Conditions related to cosmetic allergies
Contact dermatitis is the major condition associated with cosmetic allergies. It is characterized by the appearance of redness, itching and swelling after a substance comes into contact with the skin. There are two kinds of contact dermatitis reactions to cosmetics:
- Allergic contact dermatitis. This occurs in people with allergies to one or more ingredients in a cosmetic. The damage occurs because the immune system is reacting to a substance that it considers harmful.
- Irritant contact dermatitis. This is a reaction unrelated to allergies that can occur in anyone. It is the result of contact with a substance that actually breaks down and damages the skin. Symptoms include patches of itchy, scaly skin or a red rash that develops into oozing blisters. Generally, these symptoms appear within minutes or hours of exposure if the substance is strong, or days to weeks in the case of weaker substances. Skin damage usually is confined to the area where the exposure occurred. Thin areas of skin, such as the eyelids, and cracked and dried skin are likely sites for contact dermatitis.
A number of other conditions may be related to the use of cosmetics, including:
- Hives. Red, swollen patches of skin that occur in groups and may burn, sting or itch. Hives may be caused by irritation due to cosmetic use as well as cosmetic allergies.
- Asthma. A condition in which the airways become blocked or narrowed, causing shortness of breath and difficulty breathing. Cosmetics can trigger asthma symptoms in some people.
- Allergic conjunctivitis. Inflammation of the tissue lining the inside of the eyelid (conjunctiva) that is caused by an allergic reaction. Conjunctivitis may be caused by allergies, irritation or infection – all of which could potentially be linked to cosmetic use.
Diagnosis methods for cosmetic allergies
In diagnosing a cosmetic allergy, a physician is likely to complete a physical examination to check for the appearance of symptoms. A complete medical history, as well as a history of the patient’s exposure to various cosmetics, will also be taken. The patient may be asked to list the type and brands of cosmetic products used.
In addition, a patch test may be performed to try to uncover the allergen responsible for the reaction. A patch test involves soaking an absorbent pad in an allergen and taping it onto the skin of a patient for 24 to 72 hours. If a rash or small bump develops, the patient is most likely allergic to that substance.
Fragrance allergies are the most common form of cosmetic allergy. Today, there are more than 5,000 different fragrances used in products. Very few of these typically cause allergic reactions in people. Fragrance mix is a combination of the eight most common allergy-causing scents. It often is used in patch testing to diagnose fragrance allergies.
The eight components of fragrance mix are:
- Cinnamic alcohol
- Cinnamic aldehyde
- Alpha amyl cinnamic alcohol
- Oak moss absolute
Treatment options for cosmetic allergies
Those who experience symptoms of cosmetic allergies should stop using the cosmetic immediately and thoroughly wash the area to remove any trace of the irritant. They then should consult a doctor about the best way to treat the allergic reaction.
Over-the-counter creams and ointments that contain hydrocortisone or hydrocortisone acetate may be suggested to help control itching, swelling and general redness. Wet dressings and lotions that soothe, reduce itching (antipruritics) or dry the skin may also be of help.
A physician might prescribe a stronger cortisone ointment. A topical corticosteroid may help reduce inflammation. In severe cases, an oral corticosteroid may be necessary. If blistered skin becomes infected, antibiotics may be necessary.
Prevention methods for cosmetic allergies
The best way to prevent cosmetic allergies is to avoid the allergens that cause them. Those who are allergic to a specific ingredient should check the label of every cosmetic before purchase to make sure the ingredient is not present.
Other tips include:
- Choose products with 10 ingredients or fewer. The more basic the ingredient, the lower the likelihood of irritation.
- Use powders when possible. These have fewer preservatives and other ingredients likely to cause irritation. Those who do use a liquid should choose one with a silicone base.
- Complete trial applications. Apply a small amount of the cosmetic to the inner arm three times a day for three consecutive days. Individuals should stop using any product that causes a reaction.
- Avoid waterproof makeup. The solvent needed to remove these products also removes sebum, an oily barrier that protects the skin from irritants that cause breakouts.
- Rotate cosmetics. Using the same brand every day increases the likelihood of becoming sensitized to the product and developing an allergy to it.
- Avoid using old cosmetics. Old cosmetics spoil and become contaminated. Cosmetic buildup on brushes and sponges also harbors germs and dirt that can aggravate skin.
- Use disposable cotton pads or swabs to apply cosmetics.
- Choose colors carefully. Use black eyeliner and mascara. Dermatologists say black is the least allergenic of all colors. Conversely, stick to earth tones – tan, cream, white or beige – for eye shadow. These colors seem to cause less upper–eyelid irritation in women.
- Use unscented or mildly scented soaps, body cleansers, shampoos and conditioners.
- Avoid nail polish. Polishes are easily transferred to the skin, where they can irritate.
- Use sunscreen with zinc oxide or titanium dioxide. Unlike chemical sunscreen agents, these physical sunscreen ingredients cannot cause allergies because they reflect the sun’s rays instead of absorbing them.
- Wash off all makeup – especially around the eyes – before going to sleep.
Question for your doctor on cosmetic allergies
Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to cosmetic allergies:
- Do my symptoms indicate an allergy to cosmetics?
- What tests will you use to determine the cause of my symptoms?
- Will I still be able to use cosmetics if I have a cosmetic allergy?
- Does my cosmetic allergy pose a danger to my overall health?
- What are my treatment options?
- What steps can I take to avoid allergic reactions to cosmetics?
- Are certain brands of cosmetics better for me to use than others?
- What ingredients should I look for and avoid when shopping for cosmetics? What types of products typically contain these ingredients?
- Are products labeled “allergy free”, “non-allergenic” “hypoallergenic”, “natural” or “fragrance-free” safe for me to use?
- Should I test cosmetics before I use them? If so, how should I perform the test?