Eczematous dermatoses

Quaternium-15

Most common cosmetic preservative to cause ACD; personal care products

2-Bromo-2-nitropropane-1,3-diol (Bronopol)

Formaldehyde-releasing preservative in personal care products and variety of industrial applications

Diazolidinyl urea (Germall II)

Formaldehyde-releasing preservative; personal care products (especially bubble baths, baby wipes and household detergents)

Imidazolidinyl urea (Germall 115)

Formaldehyde-releasing antimicrobial preservative used in cosmetics

DMDM hydantoin

Formaldehyde-releasing antimicrobial preservative used in cosmetics like shampoo, hair conditioners and skin care products

Thiuram

Rubber in shoes, rubber gloves, elastic, fungicides, paints, barrier contraceptives

{Thiuram cross reacts w/ disulfiram}

Mercaptobenzothiazole (MBT)

Most common cause of allergic shoe dermatitis

Rubber products, tires, antifreeze, anticorrosive agents, cutting oils, electrical cords, fungicides, rubber shoes (sneakers, tennis shoes, etc.)

Carba mix

Leather shoes, tires, fungicides, cosmetic applicators, gloves, adhesives, elastic, barrier contraceptives; may cross react with thiuram derivatives

{Repeated washing of elastic (ie. undergarments) with hypochlorite (bleach) causes elastic to become more allergenic (due to ↑ availability of carbamates), which may result in ‘elastic dermatitis’ or ‘bleached rubber syndrome’ (but patch test negative for rubber accelerators)}

Mercapto mix

Tires, elastic, rubber gloves, electrical cords, rubber soles of shoes, etc.

Black rubber mix

Heavy-use rubber products such as tires, hoses, cables and belts

Mixed dialkyl thioureas

Neoprene rubber (wetsuit), goggles, elastic, paint remover, shoe insoles

Disperse blue 106

Clothing dye (bed linens, blue dye, clothing, tights, garment lining)

Ethylene urea melamine
formaldehyde mix

Permanent press clothing (wrinkle-resistant)

{Textile dermatitis typically occurs where clothing fits tightly (posterior neck, upper back, lateral thorax, axillae, waistband, flexor surfaces); ± purpuric contact dermatitis}

Epoxy resin (bisphenol A)

Glues, plastics, electrical insulation, paint and primer

Colophony (rosin, abietic acid)

Paper, cosmetics, paint, adhesives, waxes, chewing gum, used in baseball/ ballet/musical instruments to ↑ friction

Cyanoacrylate (methyl or ethyl)

Fast-acting adhesive (Super or Krazy Glue), liquid bandages, Dermabond

Ethyl acrylate

Artificial nail (adhesive)

Methacrylate (methyl or ethyl)

Adhesive, artificial nails, dental fillings/sealants, hearing aids, hard contact lenses, glue (bone cement) for artificial joints, acrylic denture material

{May diffuse through intact surgical glove and cause paresthesias (i.e. most commonly seen in either dentist or orthopedic surgeon)}

p-tert-butylphenol formaldehyde resin

Leather/rubber adhesive

Benzophenone-3

Sunscreens, rubber products, cosmetics

PABA (Padimate O)

Sunscreen (UVB)

{PABA ± cross react w/ sulfonamides, azo dyes, benzocaine, PPD}

Oxybenzone

Sunscreen (UVA)

{Oxybenzone: most common sunscreen agent to cause photoallergic contact dermatitis}

Tixocortol-21-pivalate

Group A (hydrocortisone acetate, prednisone, methylprednisolone)

Budesonide

Group B (triamcinolone acetonide, desonide, fluocinolone acetonide, fluocinonide, halcinonide)

{Budesonide also marker for some Gr. D steroids}

Hydrocortisone-17-butyrate

Group D (hydrocortisone-17-valerate/butyrate, clobetasone-17-butyrate clobetasol proprionate, betamethasone valerate/diproprionate)

Paraphenylenediamine (PPD)

Permanent hair dye, ‘black henna’ (not natural henna from plant), photographic developer, printing inks, black rubber, temporary tattoos

ACD typically on eyelids/ear helices/hairline or hands

{May cross react with: PABA, sulfonamides (including thiazide and furosemide), para-aminosalicylic acid, benzocaine and procaine (ester anesthetics), azo dyes (temporary/semi-permanent hair dye, pen ink, coloring agent)}

Monothioglycolate

Permanent wave preparations; typically in glycerol monothioglycolate

Ammonium persulfate

Hair bleach, bleaching agent in flour

Bacitracin

Topical antibiotic ointment, otic and ophthalmic preparations

Balsam of Peru

Naturally occurring fragrance material, found in topical medications

Benzalkonium chloride

Skin disinfectant (ophthalmic solutions), cosmetics

Benzocaine, tetracaine

Local anesthetic (ester)

{May cross-react with PABA, PPD, and sulfonamides}

Cobalt

Added to other metals to ↑ hardness; found in jewelry, buttons, cosmetics, hair dye, joint replacements, ceramics, enamel, cement, paint, and pottery

Cocamidopropyl betaine

Hair and bath products like shampoo (surfactant)

Ethylenediamine

Medical creams, antifreeze, paint

{Cross-reacts with hydroxyzine and aminophylline}

Euxyl K400

Cosmetic and household products (preservative)

Fragrance mix

Several components (cinnamic aldehyde), detects 70% fragrance allergies

Formaldehyde

Textile resins (wrinkle-free clothing), cosmetics, tissue fixative, embalming solution, paints, disinfectants, and medications

Gold

Jewelry, dentistry, electronics, treatment of certain diseases (RA, SLE, etc.)

Glutaraldehyde

Cold sterilization (medical/dental equipment), disinfectant, tan shoe leather

Lanolin (wool alcohol)

Cosmetics and some topical creams

Methylchloroisothiazolinone
(Kathon CG)

Preservative in cosmetics and shampoos (antibacterial properties)

Neomycin sulfate

Antibiotic ointment, hemorrhoidal cream, otic and ophthalmic preparations

Co-sensitivity often between neomycin and bacitracin

Nickel sulfate

Costume jewelry, buckles, and snaps; dimethylglyoxime test detects nickel (positive if turns pink); ± co-sensitivity seen with nickel and cobalt

Paraben mix

Cosmetics, topical medications, food, textiles, antiperspirants

Potassium dichromate

Cement, leather (footwear), plaster, wood finishes, green felt of card tables

Propylene glycol

Cosmetics, topical medications (vehicle), antifreeze

Thimerosal

Preservative in contact lens solution, vaccines, otic/ophthalmic solution, antiseptic

{↑ photosensitivity with piroxicam if patient with positive reaction to thimerosal}

Tocopherol acetate

Vitamin E

Toluene sulfonamide

{Also known as tosylamide sulfonamide formaldehyde resin}

Nail polish (typically appears as eyelid dermatitis or periungual dermatitis)

Urushiol (includes pentadecacatechol in oleoresin)

Poison ivy, poison sumac, poison oak

{May cross react with Japanese lacquer tree (sap), cashew tree, mango tree, Indian marking nut (black juice), Brazilian Pepper tree (sap), gingko (seed pulp)}

Family: Anacardiaceae

Genus: Toxicodendron; Species: Rhus

Chrysanthemum, ragweed, sunflower, artichoke, arnica, daisy, marigold, arnica

{Dermatitis may be airborne (face, neck) or direct contact (hands)}

Family: Asteraceae or Compositae

{May cross react with permethrin}

Primrose

Family: Primulaceae

Species: Primula obconica

Garlic, onion, chives

Family: Alliaceae

Genus: Allium

Garlic, onion, chives

Family: Alliaceae

Genus: Allium

Peruvian lily

Family: Alstroemeriaceae

Tulip, hyacinth

Family: Liliaceae

d -Usnic acid

Lichens

Several genera including Parmelia

Colophony
(Abietic acid, rosin)

Pine tree (resin)

Family: Pinaceae

Species: Pinus species

Tea tree oil
(Limonene)

Ti or tea tree

Family: Myrtaceae

Species: Melaleuca alternifolia

Turpentine

Family: Pinaceae

Pineapple (Ananas comosus)

Dumb cane (Araceae), daffodils (Narcissus spp.), hyacinth (Liliaceae), pineapple

Phorbol esters
(in milky latex)

Poinsettias, spurges, crotons (Euphorbiaceae)

{May cause temporary blindness if latex contacts eye}

Chili peppers (Solanaceae)

Thiocyanates
(Allyl isothiocyanate)

Garlic (Alliaceae)

Black mustard and radish (Brassicaceae)

Protoanemonin
(Ranunculin)

Buttercups (Ranunculaceae)

{Causes intense linear vesiculation}
{Ranunculin converts to protoanemonin after plant injury}

Black

Carbon, iron oxide

Blue

Cobalt

Brown

Ferric oxide

Green

Chromic oxide

Purple

Manganese

Red

Cinnabar (mercury sulfide), cadmium red

White

Titanium dioxide

Yellow