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The authors of this study investigated the presence of contact allergens in 1651 natural personal care products (NPCPs) sold in the US. The ingredients from these NPCPs were compared with 191 potential contact allergens in the Contact Allergen Management Program database. At least one contact allergen was noted in 94.2% of the NPCPs. Additionally, 73 unique allergens were identified in the NPCPs.
It is prudent for physicians to counsel patients on the risk of contact dermatitis to "natural" products, especially given the lack of FDA regulation and the increasing prevalence of contact allergens in NPCPs.
Contact dermatitis is the fifth most prevalent skin disease in the US, exceeding $1.5 billion in direct annual medical costs. Personal care products (PCPs) such as soaps, lotions, and fragrances contain ingredients that may cause allergic contact dermatitis (ACD). The prevalence of PCP-related dermatitis increased 2.7-fold between 1996 and 2016. Increasing numbers of natural PCPs (NPCPs) have been marketed to consumers concerned about the effects of chemicals on the skin, such as irritation and allergic reactions. Retail chains such as supermarkets are the most prolific distributors of NPCPs, accounting for 41.7% of worldwide NPCP revenue in 2019. The US Food and Drug Administration (FDA) has not defined clean or natural, allowing sellers to freely advertise with these terms that imply safety and health benefits.
Allergic contact dermatitis is a very common condition that dermatologists see in their office. Patch testing is the gold standard for identifying causative allergens, which can then lead to education, avoidance, and potential clearing of the dermatitis. Patients put numerous products on their skin each day, and each of these contains numerous ingredients; therefore, patients are exposed to many potential allergens routinely. The proliferation of natural and clean products has increased recently and has resulted in many products that patients may think are safer; however, these too contain allergens.
This study looked at natural personal care products and found that, of those studied, 94.2% had at least 1 contact allergen, and 89.5% contained 1 or more of the 100 most prevalent allergens in the American Contact Dermatitis Society Contact Allergen Management Program database. Fragrances were the most common. This study demonstrates that patients need to understand that natural and clean, terms not regulated by the FDA, frequently contain potentially allergenic products. Patients with dermatitis need to be actively queried regarding all products, as those considered natural and therefore presumed to be safe by the patient are often omitted from patient history. Patch testing and review of allergens are needed. Furthermore, consumer education regarding the terms “clean,” "natural,” as well as other marketing terms should be done, so that consumers realize that these do not mean they are free of problems or allergen-containing ingredients.