Allergic Contact Dermatitis from Carmine

Daniel W. Shaw


Dermatitis. 2009;20(5):292-295. 

In This Article

Abstract and Introduction


A 28-year-old woman developed allergic contact dermatitis within 6 to 24 hours exclusively after using carmine-containing eyeshadows and lipsticks. She had both a positive patch test result and a positive antecubital repeated open application test result with carmine 2.5% in petrolatum. Thirty other patients had negative patch test results.
Carmine is a widely used pigment derived from gravid cochineal insects. Carminic acid is the source of its color. Only two previous publications describing allergic contact dermatitis from carmine could be found. The ingredient in carmine causing these delayed hypersensitivity reactions has not been studied.
In contrast, there are numerous reports of immediate hypersensitivity reactions from carmine, mostly from its use in foods and beverages but also from cosmetics and pharmaceuticals. These are immunoglobulin E–mediated reactions directed against cochineal proteins.


Cochineal extract is the concentrated solution produced by the removal of alcohol from an aqueous alcohol extract of dried and pulverized gravid cochineal insects.[1–4] These insects, mostly Dactylopius coccus, parasitize many species of prickly pear cactus (Opuntia spp).[2,4,5] Carmine (Natural Red 4 [CI 75470]) is an insoluble aluminum or calcium-aluminum lake (precipitant) derived from cochineal extract.[4] It may be processed further to yield a water-soluble powder.[4]

Carmine and cochineal extract may be different shades of red, violet, magenta, or orange, depending on its concentration and its hydrogen ion concentration (pH).[3,4] The color is due chiefly to carminic acid, a hydroxyanthraquinone linked to a glucose unit.[4] FD & C grade carmine must contain at least 50% carminic acid.[1,3] Both carmine and cochineal extract contain residual cochineal insect proteins.[3,6,7]

Cochineal extract or carmine is used as a colorant in foods, drugs, cosmetics, textiles, inks, paints, and biologic stains.[1–4] These should not be confused with the chemically unrelated Indigo Carmine (FD & C Blue 2 [CI 73015]) or with Cochineal Red (CI 16255), a synthetic azo dye not approved in the United States for use in foods, drugs, or cosmetics.[3]

There are at least 18 published reports describing 33 cases of immediate hypersensitivity reactions to carmine, many of which resulted in systemic anaphylaxis.[6,8–24] Many other cases have been reported to the United States Food and Drug Administration (FDA).[3] In contrast, in a search of the PubMed/MEDLINE, EMBASE, and Scopus databases, the author could find only two previous publications describing delayed hypersensitivity (allergic contact dermatitis) from carmine.[25,26]