Allergic Contact Dermatitis: Topical Preservatives, Part I

J. Desiree Douglas


Dermatology Nursing 

In This Article


Synonyms for Quaternium-15

  • 1-(3-Chloroally)-3,5,7-triaza-1-azoniaadamantane chloride

  • Chloroallyl methenamine chloride

  • Azoniaadamantane chloride

  • Methenamine-3-chloroallylochloride

  • cis-1-(3-chloroally) 3,5,7-triaza-1-azoniaadamantane chloride

  • N-(3-Chloroallyl) hexaminium chloride

  • Dowicil 75, 100, 200

  • Preventol D 1

Quaternium-15 is one of the most widely used preservatives (Rietschel & Fowler, 2008). It is not surprising that it is also the most common preservative that causes ACD (Marks et al., 2002; Zug et al., 2009). It affected 10.3% of patients that were patch tested in 2005–2006 (Zug et al., 2009). Quaternium-15 is the top allergen in hand ACD (Warshaw et al., 2007). It is the sixth most common allergen to cause eyelid dermatitis (Rietschel et al., 2007). This is a broad-spectrum preservative that is effective against bacteria, fungi, molds, Pseudomonas aeruginosa, and P. cepacia (Maier et al., 2009; Marks et al., 2002).

Quaternium-15 releases the highest amount of free formaldehyde when compared to other FRPs (Maier et al., 2009). Quaternium-15 0.1% concentration (1,000 ppm) releases 100 ppm of free formaldehyde; this amount is enough to induce dermatitis in a patient with formaldehyde sensitivity (Frosch et al., 2006). Accordingly, when a patient has a positive reaction to quaternium-15 during patch testing, the patient may be sensitive to the formaldehyde that quaternium-15 releases, the actual quaternium-15 molecule, or both the quaternium-15 and formaldehyde (Sasseville, 2004). Approximately 50% of patients with quaternium-15 sensitivity also react to formaldehyde (Frosch et al., 2006).

Certain occupations are affected by ACD caused by quaternium-15 more than others. Hair stylists, machinists, food preparation, health care, housekeepers, and janitors are among the high-risk groups (Maier et al., 2009; Rietschel & Fowler, 2008). However, occupational cases of quaternium-15 are not common (Frosch et al., 2006).

Allergic reactions to quaternium-15 during patch testing are usually relevant (Frosch et al., 2006). Almost 80% of patients were exposed to quaternium-15 through a moisturizer. Hair care products, not including coloring products, were also common sources as they exposed approximately 33% of patients. Makeup accounted for 12% of patients (Rietschel & Fowler, 2008). It is important to mention other quaternium preservatives do not release formaldehyde and, therefore, do not cross-react with quaternium-15 (Maier et al., 2009).

Sources of Quaternium-15 (Maier et al., 2009; Marks et al., 2002).

  • Shampoos, hair conditioners, liquid soaps, and shaving products.

  • Moisturizing creams and lotions, cosmetics, shaving products, and sunscreens.

  • Topical medications.

  • Cleansers, disinfectants, and laundry soaps.

  • Gloves.

  • Metalworking fluids and cutting fluids.

  • Latex paints, glues, and adhesives.

  • Food packaging: paper, paperboard, and polyurethane resins.