The Validated Hypoallergenic Cosmetics Rating System: Its 30-year Evolution and Effect on the Prevalence of Cosmetic Reactions

Its 30-Year Evolution and Effect on the Prevalence of Cosmetic Reactions

Vermén M. Verallo-Rowell


Dermatitis. 2011;22(2):80-97. 

In This Article

Differential Diagnosis of Cosmetic Reactions

Cosmetic contact dermatitis (CCD) is the most common reaction to cosmetics.[4] It is an acquired hypersensitivity from direct contact of the epidermis with allergens in the cosmetic or an accessory. Table 1 [45–9] summarizes the definition, presentation, and pathogenesis of each of the three primary CCD types (contact urticaria, irritant contact dermatitis, and allergic contact dermatitis).

Cosmetic reactions that may be mistaken for CCD are hypopigmentation and hair or nail yellowing and breakage. Reports of acneiform eruptions and acne cosmetica from ingredients tested in rabbit ears were common just a few decades ago.[10,11] A review of modern manufacturing practices concluded that products containing ingredients found to be comedogenic in rabbit ears are not necessarily comedogenic in human skin. Reputable manufacturers now generally test for ingredient and product comedogenicity and acnegenicity on human skin to the point that a nongreasy non-occlusive cosmetic made by such manufacturers is unlikely to be acnegenic.[12]

Stingers (also described as hyperactive, intolerant, and irritable) were first described by Grove and colleagues.[13] Stingers sting, burn, prickle, tingle, or cause slight pain sensations primarily on the nasolabial folds and cheeks. These symptoms are severe, but visible skin changes are minimal. Studies of stingers versus nonstingers show stingers to be associated with transepidermal water loss, a more permeable horny layer,[14] a higher density of sweat glands and hair follicles, and an elaborate network of sensory nerves.[15] Causes are often found to be specific to the stinger and include toners, astringents with alcohols, and low-pH acids (ascorbic, azelaic, glycolic, kojic, and salicylic).[16] In the Grove and colleagues test for stingers, lactic acid or a suspect chemical is applied with a cotton swab to a patient's cheek; after a few minutes, the substance elicits a moderate-to-severe sensation that can be measured on a point intensity scale.[17]