Allergy to Preservatives and

Vehicles
Maria Victoria Rosabelle M. Rovira, MD
1. Formaldehyde and formaldehyde-releasing
preservatives
2. Other common preservatives
3. Less common preservative allergens
4. Other additives in topical products
5. Vehicles
 FORMALDEHYDE
• Common allergen
• Used in a variety of applications:
1. Clothing
a. Apparel that may contain formaldehyde resins and some free formaldehyde:
Waterproof finishes, sweat-proof, permanent press, suede and chamois
2. Glues, papers, wet-strength tissues with gelatin and starch; rubber cement, cements, cements for
paper cups and plywood
3. Embalming fluid, fixtures
4. Cosmetics and personal care products containing formaldehyde releasing preservatives
5. Some household cleaners—rug, tire, toilet bowl, and window
6. Some polishes—automobile, cement floor, shoe, and suede shoe
7. Certain medications:
a. Wart remedies
b. Formitol mouthwash
c. Antidote for mercury poisoning (sodium formaldehyde sulfoxylte)
d. Denatured alcohol
e. Renal dialysis unit disinfectant
f. Root canal preparation disinfectant (Forno-Cresol)
 FORMALDEHYDE

8. Products used in the manufacturing of explosives

9. Mildew preventative in some fruits and vegetables
10. Disinfectants used in dairy equipment
11. Some paints—primers, anti-corrosion, paint-stripping agents
12. Printing-etching materials, inks, sealers for cylinder die rolls,
autoprime in offset printing machines
13. Dry cleaning spotting agents
14. Coatings and adhesives—phenol, melamine, urea,
sulfonamide and cashew nutsell-type resin
15. Smoke contact and inhalation: burning wood, coal, charcoal,
cigarettes and cigarsavoid smoked ham and fish
 Formaldehyde-releasing Preservatives
• Quaternium-15
– Widely used topical preservatives
– Found in shampoos and conditioners, eye
makeup, foundation, lotions, creams, shaving
products, hair gels, liquid soaps
– Skin moisturizersmajor source of
sensitization to Q-15
– Older names: Dowicil 75 100 and 200, N-(3-
chlorallyl)-hexaminium chloride, and chlorallyl
methenamine chloride
– Highly soluble in water, odorless and colorless
– Antimicrobial activity
 Formaldehyde-releasing Preservatives
• Diazolidinyl Urea
– Newest FRP
– Superior biocide to ImU but usually combined with another
agent for antifungal efficacy
• Imidazolidinyl Urea
– AKA Germall 115
– One of the most commonly used cosmetic preservatives after
parabens
– Reported to be nontoxic and nonirritating
– Colorless, odorless, tasteless, not pH-dependent
– Active against bacteria>molds, yeasts
– Less frequent sensitizer than Formaldehyde or Q-15
 Formaldehyde-releasing Preservatives

• Bronopol
– Active against gram (+) and gram (-) bacteria, fungi
and yeasts
– Effective against P. aeruginosa
– Used in Eucerin; patients developed acute allergic
contact dermatitis after use on dermatitic skin
from 5 weeks to 2 years
Occupational Formaldehyde Allergy
• Sterilizing agents and fumigants caused ACD in
brewing workers, mushroom and poultry
farmers, workers making binders for paints
and glues, newsprint workers, woodworkers,
and lithoprinters
Tests for the Presence of Formaldehyde
• Acetylacetone method:

Reagent: ammonium acetate 15 g ; acetylacetone 0.2 ml;

acetic acid (Glacial) 0.3 ml; distilled water to 100 ml
Procedure: Add 2.5 ml reagent to sample in a clean glass
container. Sample size: 0.5 g. Solids and liquids tested as is.
Ointments, oils, greasy products mixed with few drops of
Triton X-100, an emulsifying agent. Heat mixture for 10 mins
at 140F. A yellow color develops if formaldehyde is present.
ALLERGY TO OTHER COMMON PRESERVATIVES:

PARABENS, MCI/MI

PARABENS
Propyl- and methylparaben esters used as popular preservatives in cosmetics and topical agents to
prevent bacterial < fungal and yeast contamination
Other parabens: Ethyl-, butyl-, and benzylparabens
Parenterals: antibiotics, corticosteroids, anesthetics, vitamins, antihypertensives, insulins,
diuretics, heparin, chemo agents
Rated second to water as ingredient most commonly used in cosmetic formulations
Incidence of allergy low compared to other common preservatives
“Paraben Paradox”
- Safe in cosmetics but sensitize patients using topical therapeutic agents
- Applied to inflamed, eczematous, excoriated, damaged skin
METHYLCHLOROISOTHIAZOLINONE/
METHYLISOTHIAZILONONE (MCI/MI)

Trade names Kathon CG and Euxyl K100)

Broad spectrum activity against fungi, gram (+) and gram (-) bacteria
Used as biocides in industrial products and systems, ie, metalworking
fliuds, watercooling towers and latex emulsions
Occupational exposure can cause caustic burn upon direct exposure
to undiluted products
sodium bisulfite and glutathione can inactivate MCI/MI rapidly;
useful against an industrial spill
In the US: prevalence of allergy: parabens<MCI/MI<formaldehyde
 ALLERGY TO OTHER PRESERVATIVES AND
ANTIOXIDANTS
VITAMIN E
Used as an antioxidant in foods, skincare products (face
cream, cream for striae distensae, product for cellulitis)

THIMEROSAL
Used as an antiseptic and preservative in eye
medications, cosmetics, contact lens solutions and
injectables such as vaccines
Eye medications: conjunctivitis, conjunctivitis+eyelid
dermatitis, dermatitis of hand without conjunctivitis
Source of sensitization: injected vaccinations (ie, DPT)
and allergy immunotherapy
BENZALKONIUM CHLORIDE (BAC)

Mixture of alkyl dimethyl benzyl

ammonium chlorides
Preoperative skin disinfectant of surgical
instruments; treatment used in burns,
ulcers, wounds; and infected dermatoses
(Zephiran chloride)
Present in some cosmetics, deodorants,
mouthwashes, lozenges, and ophthalmic
preparations
Used in fabrication of textiles and dyes and
in metallurgy and agriculture
Inhibits bacteria but not Pseudomonas;
less active against fungi
ZINC PYRITHIONE

Has bactericidal and fungicidal properties

Used in seborrheic dermatitis
(+) 7 cases of reported allergy that
triggered pustular psoriasis
May cross-react with piperazine, a
diethylamine which may in turn cross-
react with ethylenediamine dermatitis
CHLORHEXIDINE
Used as a disinfectant and
bacteriocide in cleansing
products, esp in healthcare
facilities
Reported ACD, anaphylactic
reactions
COCAMIDOPROPYL BETAINE
A surfactant used in shampoos and cosmetics
Sites of dermatitis usually scalp and face
Hand dermatitis in hair dressers
 ALLERGIES TO VEHICLES IN
TOPICAL PRODUCTS
PROPYLENE GLYCOL
A dihydric alcohol
Odorless, viscous liquid, readily miscible with water, acetone, chloroform,
and essential oils
Widely used as a vehicle for topical therapeutics, cosmetics, hand and body
lotions
Antimicrobial activity against E. coli, Pseudomonas, as well as Candida
albicans
Reports:
More frequent in winter due to degree of hydration
(+) patch test to lipstick [cheilitis]
(+) patch test to Lanolin Cocoa cream used for striae
[abdominal dermatitis]
Difficult with hyperirritable skin
>Patch testing with 10% PPG may give occasional transient irritant responses
POLYETHYLENE GLYCOL
Mixture of glycols
Vehicle in topical medicaments, suppositories, shampoos,
detergents, hair dressings, insect repellents, cosmetics,
toothpastes, and contraceptives
Lower molecular PEGs from 200-400allergic contact urticaria
and eczema
Higher molecular weight PEGs are rare sensitizers
GLYCERIN
Much less active than PEG in producing
primary irritant and allergic reactions
Exhibits antimicrobial properties as a
concentrated solution
Less desirable solvent; poorer permeation
through the stratum corneum
A rare sensitizer, may be used as substitute
for PEG
Thank you