Patch Testing with Benzophenone-3 and -4: The North American Contact Dermatitis Group Experience,2013

Abstract

Abstract: Background:

Benzophenone (BZP)-3 and BZP-4 are ultraviolet (UV) absorbers used in sunscreens and personal care products (PCPs) and may cause allergic contact dermatitis.

Objective:

To characterize positive patch test reactions to BZP-3 (10% in petrolatum [pet]) and BZP-4 (2% pet) in a screening allergen series.

Methods:

Retrospective analysis of patients tested to BZP-3 and BZP-4 was conducted by the North American Contact Dermatitis Group from 2013 to 2020.

Results:

Of 19,618 patients patch tested to BZP-3 and BZP-4, 103 (0.5%) and 323 (1.6%) had positive reactions, respectively: 413 (2.1%) reacted to at least 1 BZP (BZP-positive patient). As compared with BZP-negative patients, BZP-positive patients were significantly more likely to have a history of hay fever (39.3% vs 33.4%, P = 0.0134), history of atopic dermatitis (39.8% vs 30.7%, P = 0.0001), and facial involvement (37.4% vs 32.2%, P = 0.0272). Most reactions were currently clinically relevant (BZP-3: 90.4%; BZP-4: 65.8%). Common identified sources included PCPs and sunscreens. Coreactivity between BZP-3 and BZP-4 was low: 13.5% (14/104) of BZP-3–positive patients were allergic to BZP-4 and 4.3% (14/322) of BZP-4–positive patients were allergic to BZP-3.

Conclusions:

Eight-year prevalence of BZP positivity was 2.1%. Reactions were frequently clinically relevant and linked to PCPs and sunscreens.

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References

Knox

, Guin

, Cockerell

EG.

Benzophenones; ultraviolet light absorbing agents. J Invest Dermatol, 1957; 29(6):435–444; doi: 10.1038/jid.1957.119

Landers

, Law

, Storrs

FJ.

Contact urticaria, allergic contact dermatitis, and photoallergic contact dermatitis from oxybenzone. Am J Contact Dermat, 2003; 14(1):33–34; doi: 10.2310/6620.2003.38769

Heurung

, Raju

, Warshaw

EM.

Adverse reactions to sunscreen agents: epidemiology, responsible irritants and allergens, clinical characteristics, and management. Dermatitis, 2014; 25(6):289–326; doi: 10.1097/DER.0000000000000079

Heurung

, Raju

, Warshaw

EM.

Benzophenones. Dermatitis, 2014; 25(1):3–10; doi: 10.1097/DER.0000000000000025

Scheman

, Jacob

, Katta

, et al. Part 4 of a 4-part series miscellaneous products: trends and alternatives in deodorants, antiperspirants, sunblocks, shaving products, powders, and wipes: data from the American Contact Alternatives Group. J Clin Aesthet Dermatol, 2011; 4(10):35–39.

EWG Skin Deep^® | What is OXYBENZONE. EWG. Available at: http://www.ewg.org/skindeep/ingredients/704372-OXYBENZONE-OXYBENZONE/. Accessed May 9, 2022.

Aguirre

, Izu

, Gardeazabal

, et al. Allergic contact cheilitis from a lipstick containing oxybenzone. Contact Dermatitis, 1992; 27(4):267–268; doi: 10.1111/j.1600-0536.1992.tb03268.x

Nedorost

ST.

Facial erythema as a result of benzophenone allergy. J Am Acad Dermatol, 2003; 49(5 Suppl):S259–S261; doi: 10.1016/s0190-9622(03)00440-7

Schram

, Glesne

, Warshaw

EM.

Allergic contact cheilitis from benzophenone-3 in lip balm and fragrance/flavorings. Dermatitis, 2007; 18(4):221–224; doi: 10.2310/6620.2007.06071

10.

ACDS CAMP | American Contact Dermatitis Society (ACDS). American Contact Dermatitis Society. Available at: https://www.contactderm.org/resources/acds-camp. Accessed April 21, 2022.

11.

Shaath

NA.

Ultraviolet filters. Photochem Photobiol Sci, 2010; 9(4):464–469; doi: 10.1039/b9pp00174c

12.

Hughes

, Stone

NM.

Benzophenone 4: an emerging allergen in cosmetics and toiletries?. Contact Dermatitis, 2007; 56(3):153–156; doi: 10.1111/j.1600-0536.2007.01017.x

13.

Gonçalo

, Ruas

, Figueiredo

, et al. Contact and photocontact sensitivity to sunscreens. Contact Dermatitis, 1995; 33(4):278–280; doi: 10.1111/j.1600-0536.1995.tb00492.x

14.

Guin

JD.

Eyelid dermatitis from benzophenone used in nail enhancement. Contact Dermatitis, 2000; 43(5):308–309.

15.

Alanko

, Jolanki

, Estlander

, et al. Occupational allergic contact dermatitis from benzophenone-4 in hair-care products. Contact Dermatitis, 2001; 44(3):188; doi: 10.1034/j.1600-0536.2001.440308-9.x

16.

Travassos

, Claes

, Boey

, et al. Non-fragrance allergens in specific cosmetic products. Contact Dermatitis, 2011; 65(5):276–285; doi: 10.1111/j.1600-0536.2011.01968.x

17.

Caruana

, McPherson

, Cooper

Allergic contact dermatitis caused by benzophenone-4 in a printer. Contact Dermatitis, 2011; 64(3):183–184; doi: 10.1111/j.1600-0536.2010.01864.x

18.

Tsiogka

, Liopyris

, Gregoriou

Allergic contact dermatitis associated with benzophenone sensitization after a recent black ink tattoo. Contact Dermatitis, 2022; 86(6):549–551; doi: 10.1111/cod.14071

19.

European Multicentre Photopatch Test Study (EMCPPTS) Taskforce. A European multicentre photopatch test study. Br J Dermatol, 2012; 166(5):1002–1009; doi: 10.1111/j.1365-2133.2012.10857.x

20.

Kim

, Patel

, Greig

, et al. Photopatch testing in New Zealand: a 12-year retrospective review. Dermatitis, 2021; 32(1):53–56; doi: 10.1097/DER.0000000000000683

21.

Shao

, Hu

, Wang

, et al. Photopatch testing in Chinese patients: a 5-year experience. Contact Dermatitis, 2021; 85(1):78–84; doi: 10.1111/cod.13808

22.

DeLeo

, Adler

, Warshaw

, et al. Photopatch test results of the North American contact dermatitis group, 1999–2009. Photodermatol Photoimmunol Photomed, 2022; 38(3):288–291; doi: 10.1111/phpp.12742

23.

DeKoven

, Silverberg

, Warshaw

, et al. North American Contact Dermatitis Group patch test results: 2017–2018. Dermatitis, 2021; 32(2):111–123; doi: 10.1097/DER.0000000000000729

24.

, Liu

, Wang

Patch test in Chinese patients with cosmetic allergic contact dermatitis to common cosmetic allergens from a European cosmetic series. Contact Dermatitis, 2007; 57(1):50–54; doi: 10.1111/j.1600-0536.2007.01073.x

25.

Scalf

, Davis

MDP

, Rohlinger

, et al. Photopatch testing of 182 patients: a 6-year experience at the Mayo Clinic. Dermatitis, 2009; 20(1):44–52.

26.

Greenspoon

, Ahluwalia

, Juma

, et al. Allergic and photoallergic contact dermatitis: a 10-year experience. Dermatitis, 2013; 24(1):29–32; doi: 10.1097/DER.0b013e31827edc8b

27.

Hung

, Beazer

, Su

, et al. An exploration of the use and impact of preventive measures on skin cancer. Healthcare (Basel), 2022; 10(4):743; doi: 10.3390/healthcare10040743

28.

Biesterbos

JWH

, Dudzina

, Delmaar

CJE

, et al. Usage patterns of personal care products: important factors for exposure assessment. Food Chem Toxicol, 2013; 55:8–17; doi: 10.1016/j.fct.2012.11.014

29.

Hanson

, Warshaw

EM.

Sensitivity to multiple benzophenone sunscreen agents. Dermatitis, 2015; 26(4):192–194; doi: 10.1097/DER.0000000000000131

30.

EWG Skin Deep^® | What is SULISOBENZONE. EWG. Available at: www.ewg.org/skindeep/ingredients/706390-SULISOBENZONE-SULISOBENZONE-SULISOBENZONE-SULISOBENZONE-SULISOBENZONE-SULISOBENZONE-SULISOBENZONE-SULISOBENZONE-SULISOBENZONE-SULISOBENZONE/. Accessed May 9, 2022.

31.

Expert Panel for Cosmetic Ingredient Safety. Amended safety assessment of benzophenones as used in cosmetics. 2021. Available at: https://online.personalcarecouncil.org/ctfa-static/online/lists/cir-pdfs/FR827.pdf. Accessed June 30, 2022.

32.

Xiong

, Warshaw

EM.

Allergenic ingredients in sunscreens marketed for skin of color. Presented at: ACDS 33rd Annual Meeting, March 24, 2022, Boston, MA.

33.

Schneider

, Lim

HW.

Review of environmental effects of oxybenzone and other sunscreen active ingredients. J Am Acad Dermatol, 2019; 80(1):266–271; doi: 10.1016/j.jaad.2018.06.033

34.

Adler

, DeLeo

VA.

Sunscreen safety: a review of recent studies on humans and the environment. Curr Derm Rep, 2020; 9(1):1–9; doi: 10.1007/s13671-020-00284-4

35.

Galamgam

, Linou

, Linos

Sunscreens, cancer, and protecting our planet. Lancet Planet Health, 2018; 2(11):e465–e466; doi: 10.1016/S2542-5196(18)30224-9

36.

Foubert

, Dendooven

, Theunis

, et al. The presence of benzophenone in sunscreens and cosmetics containing the organic UV filter octocrylene: a laboratory study. Contact Dermatitis, 2021; 85(1):69–77; doi: 10.1111/cod.13845

37.

Scheman

, Ruggiero

, Kerchinsky

, et al. Contact allergy cross-reactions and thresholds: a review. Dermatitis, 2022; 33(2):106–109; doi: 10.1097/DER.0000000000000798

38.

Sasseville

, Nantel-Battista

, Molinari

Multiple contact allergies to benzophenones. Contact Dermatitis, 2011; 65(3):179–181; doi: 10.1111/j.1600-0536.2011.01941.x

39.

Gonçalo

, Bruynzeel

DP.

Patch testing in adverse drug reactions. In: Johansen JD, Mahler V, Lepoittevin JP, Frosch PJ, eds. Contact Dermatitis. Cham, Switzerland: Springer International Publishing; 2021:571–591.

40.

Jacobs

MC.

Contact allergy to benzophenone-2 in toilet water. Contact Dermatitis, 1998; 39(1):42–42; doi: 10.1111/j.1600-0536.1998.tb05821.x

41.

Ramsay

, Cohen

, Baer

RL.

Allergic reaction to benzophenone. Simultaneous occurrence of urticarial and contact sensitivities. Arch Dermatol, 1972; 105(6):906–908; doi: 10.1001/archderm.105.6.906

42.

Uter

, Gefeller

, Geier

, Schnuch

Changes of the patch test population (MOAHLFA index) in long-term participants of the Information Network of Departments of Dermatology, 1999–2006. Contact Dermatitis, 2008; 59(1):56–57; doi: 10.1111/j.1600-0536.2007.01313.x

Patch Testing with Benzophenone-3 and -4: The North American Contact Dermatitis Group Experience,2013–2020

Abstract

Abstract: Background:

Objective:

Methods:

Results:

Conclusions:

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References