Patch-Testing Lip Dermatitis Patients: Data from the North American Contact Dermatitis Group, 2001 to 2004

Kathryn A. Zug; Rachel Kornik; Donald V. Belsito; Vincent A. DeLeo; Joseph F. Fowler, Jr; Howard I. Maibach; James G. Marks, Jr; C.G. Toby Mathias; Melanie D. Pratt; Robert L. Rietschel; Denis Sasseville; Frances J. Storrs; James S. Taylor; Erin M. Warshaw


Dermatitis. 2008;19(4):202-208. 

In This Article

Allergen Sources

Overall, the most common sources of allergic reactions to NACDG allergens as well as to personal products or other supplementary allergens were cosmetics (including makeup and lipstick). This is consistent with most major reviews.[2,4,7] Lipstick was coded as the source of 17 positive reactions in our group of 75 patients with ACC, less than that reported in studies by Lim and Goh[2] and by Strauss and Orton,[7] who found lip products to account for 50% or more of ACC cases. This discrepancy may be explained by the possibility that NACDG investigators included lipstick in a broader cosmetic category instead of coding it more specifically, especially since there is no explicit code for additional lip products such as glosses or balms. After jewelry, the next most common sources of allergy in our series were medicaments (neomycin, bacitracin, budesonide, and tetracaine) and oral hygiene products.

Other studies of cheilitis have noted similar common sources and allergens. Lim and Goh studied 202 patients presenting with cheilitis. The most common source of ACC was cosmetics (58%), followed by toothpastes (29%), medicaments (7%), and nickel (6%).[2] In Francalanci and colleagues' study of ACC, 15 patients were allergic to toothpaste; the majority of sensitizations were due to flavoring substances.[6] The authors suggested that perhaps ACC from toothpaste is underestimated because many toothpaste flavorings (including peppermint, spearmint, carvone, and anethole) are not found in a standard screening series of allergens. In 1999, Freeman and Stephens reported cosmetics and medicaments as the most common sources in their study of 75 patients (24% of patients were allergic), followed by toothpastes and sunscreens (14%).[8] Zoli and colleagues, in 2006, reported the most common relevant allergens as nickel and fragrance mix (4 of 27 [14%] relevant positive patch-test reactions), followed by Myroxilon pereirae and methyldibromoglutaronitrile (Euxyl K400) (3 of 27 [11%]).[4]


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