acontene copolymer , polyoxyethylene lauryl ether , tetrahydroxypropyl ethylenediamine, 1,3- butylene glycol , shellac , phthalic anhy- dride/trimellitic anhydride/glycols copolymer , colophonium , propolis , colors , and botanicals . The depigmenting agent kojic acid is a common allergen in Japan . A comprehensive literature survey on cosmetic al- lergy has been published [13, 129]. 30.6 Diagnostic Procedures The diagnosis of cosmetic allergy should strongly be suspected in any patient presenting with dermatitis of the face, eyelids, lips, and neck [13, 130]. Cosmetic allergic dermatitis may develop on previously healthy skin of the face or on already damaged skin (irritant contact dermatitis, atopic dermatitis, sebor- rheic dermatitis, allergic contact dermatitis from other sources). Also, dermatitis of the arms and hands may be caused or worsened by skin care prod- ucts used to treat or prevent dry skin, irritant, or atopic dermatitis. Patchy dermatitis on the neck and around the eyes is suggestive of cosmetic allergy from nail varnish or hardeners. More widespread problems may be caused by ingredients in products intended for general application to the body. Hyper- sensitivity to other products, such as deodorants, usually causes a reaction localized to the site of appli- cation. A thorough history of cosmetic usage should always be obtained. When the diagnosis of cosmetic allergy is suspect- ed, patch tests should be performed to confirm the diagnosis and identify the sensitizer. Only in this way can the patient be counseled about their future use of cosmetic (and other) products, and the prevention of recurrences of dermatitis from cosmetic or non-cos- metic sources. Patch tests should be performed with the European (or other national) standard series, a “cosmetics series” containing established cosmetic allergens, and the products used by the patient. The European routine series contains a number of cosmetic allergens and “indicator” allergens: colo- phonium, Myroxylon pereirae (balsam of Peru), fra- grance mix, formaldehyde, quaternium-15, methyl- chloroisothiazolinone (and) methylisothiazolinone, lanolin, and p -phenylenediamine. Although the patient’s products should always be tested (for test concentrations, see Table 3 and Chap.50),patch testing with cosmetics has problems. Both false-negative and false-positive reactions oc- cur frequently.False-negative reactions are due to the low concentration of some allergens and the usually weak sensitivity of the patient. Classic examples of false-negative reactions have occurred with methyl- chloroisothiazolinone (and) methylisothiazolinone [47, 48] and paraben sensitivity. False-positive reac- tions may occur with any cosmetic product,but espe- cially with products containing detergents or surfac- Chapter 30 Cosmetics and Skin Care Products 501
tants, such as shampoos, soaps, and bath and shower products. As a consequence, these products must be diluted (1% in water) before testing. Even then, mild irritant reactions are observed frequently, and, of course, the (necessary) dilution of these products
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