Sensitization to benzyl salicylate and other allergens in patients with frontal fibrosing alopecia.

BACKGROUND: Contact sensitization is frequent among patients with frontal fibrosing alopecia (FFA) (52%-76%). OBJECTIVE: To evaluate the frequency of sensitization/photosensitization in an FFA population. METHODS: A population of FFA patients were patch tested (Spanish Contact Dermatitis Research Group [GEIDAC] baseline; cosmetic and fragrance series), and photopatch tested (sunscreen series). RESULTS: Thirty-six patients (mean age: 64.6 years; 35/36: women) were studied. A history of dermatitis was recorded in 69.4% (frequently involving the face). Overall, 80.5% patients showed positive patch-test reactions. The most frequently positive allergens were nickel sulfate (25%), benzyl salicylate (22%), gallates (16.6%), propolis (16.6%), and limonene hydroperoxides (13.8%). Benzyl salicylate was likely relevant to the dermatitis (labeled on personal care products and most patients reporting clinical improvement with allergen avoidance). Patch tests with sunscreens showed positive reactions to 11 materials (five patients). Photopatch tests were positive in one case. CONCLUSION: We speculate a possible relationship between sensitization to benzyl salicylate and FFA. Hypothetically, the most likely explanation is that sensitization to benzyl salicylate involving FFA patients is a consequence of increased exposure to it. It is unclear whether allergen avoidance may impact the prognosis of alopecia. However, it seems to significantly improve the patients´ quality of life by lessening dermatitis and pruritus.

Calcium pantothenate is present in cosmetics and may cause allergic contact dermatitis.

Calcium pantothenate (CAS no. 137-08-6) is the calcium salt of pantothenic acid (vitamin B5). It is used in cosmetics due to its anti-static and hair conditioning properties. A 53-year-old female nurse's aide presented with intermittent facial eruptions (Figure S1). Patch tests were positive to calcium pantothenate, an ingredient of two of her products (a cleansing milk and a facial tonic). To our knowledge, no previous cases of sensitization from calcium pantothenate have been reported except for one case of systemic dermatitis from a nutritional supplement in a dexpanthenol-sensitized patient.

Occupational allergic contact dermatitis from methyl aminolevulinate.

Photodynamic therapy (PDT) is used to treat certain types of nonmelanoma skin cancer. Metvix cream applied topically in PDT is composed of the active substance methyl aminolevulinate and 14 excipients composing the vehicle. One case of occupational allergic contact dermatitis from methyl aminolevulinate is reported. A 49-year-old nurse's aide working in a PDT unit in the dermatology department developed a dermatitis involving the eyelids and fingers. The lesions began a few months after she started working in that unit. Patch tests were performed with the standard series (Spanish Group for Research into Dermatitis and Skin Allergies [GEIDAC]), cosmetics series, Metvix cream "as is," the Metvix vehicle supplied by the manufacturer, and some of the excipients separately (methyl para-hydroxybenzoate [Nipagin M], propyl para-hydroxybenzoate [Nipasol M], isopropyl myristate, cetostearyl alcohol [Lanette N], and disodium edetate). After day-2, day-4, and day-7 readings, positive results were achieved only with Metvix cream "as is." Tests performed on a control group of 15 individuals were negative. Literature on cases of allergic contact dermatitis from methyl aminolevulinate is reviewed. It should be emphasized that the present case is the first occupational case reported so far.