Cosmetics as Causes of Contact Urticaria Syndrome

at Workplace : review of Some Cases

Made Wardhana, Made Bratiartha

Dept of Dermato-venereology, Udayana Medical School/Sanglah Hospital, Denpasar

Abstract

Background: Contact urticaria is a transient, wheat and flare response at the site of skin contact to topically applied substances. Lesion occur within minutes to an hour and leave normal skin. Contact urticaria syndrome is the range contact urticaria reactions comprises a spectrum from localized urticaria to involvement of extracutaneous organ. It's divided into 4 stages. A great number of agents produce contact urticaria, including foods, fragrances, flavoring, metal, animal and plant products.

Aim: Aim of this study to determine characterized of contact urticaria due to cosmetic products.

Subjects and methods: This is a retrospective, descriptive study. We revised all medical records of patients with contact urticaria since January 2003 to December 2004 in the Out Patients Unit of Sanglah Genral Hospital. The diagnoses was based on anamnesis and clinical finding. The variables studied were: gender, age, work related, diagnosis associates to contact urticaria, and open patch test by using standard allergens, after 20 minutes was evaluate the result of test.

Results: In two years periods, enrolled 6 patients, female 4 and 2 males. The median age was 28,6 years (range 21-36 years). Two cases ;s new, and for cases is residive. Only two cases with positive result against fragrance and Peru balsam.
Conclusion: Fragrance and Peru balsam is the common as etiology of contact urticaria in beauticians. Usually patients have historic of residive urticaria.

Key words: Cosmetics, Cotnact Urticaria Syndrome. Workplace.

Background

Contact urticaria is a transient, wheat and flare response at the site of skin contact to topically applied substances. Lesion occur within minutes to an hour and leave normal skin. Contact urticaria syndrome is the range contact urticaria reactions comprises a spectrum from localized urticaria to involvement of extracutaneous organ. It's divided into 4 stages. A great number of agents produce contact urticaria, including foods, fragrances, flavoring, metal, animal and plant products.^1,2 
As according to mechanism of reaction contact, hence CUS differentiated by for two type that is react the imunologis (Ige-Mediated) and react the non-imunologic. Both able to stimulate mast cell or basofil to release the mediator histamine to lead skin inflammation as urtica.^2,3 
Non-Imunologik factor, representing most often become the cause of contact urticaria (60-70 %) its arising out without preceded by sensitization phase. Some chemicals like amine derivates, amidin derivates, drugs, morphine, kodein, polimiksin, and some antibiotic have play role in triggering of CUS. Therefore phisycal environmental in the  workplace, like hot weather, chilled, blunt trauma, X-ray, and massaging, earn directly improve the sensitivity of mast cell to granulation.^3,4
Imunologik factors more important factors in acute contact urtikaria than chronic, usually IgE bearing at surface of  mast cell and or basofil, if any contactant will bind with IgE in surface of mast cell, will be occured mast cell degranulation, then will release some mediator especially histamine.
Complement (especially C3A, C5A) also has important role in complement activation by classical and alternative pathway to release anafilatoksin that capable to stimulate  of mast cell and basofil, this case usually as the effect exotoxin of some microbes.
Binding with complement will lead contact urticaria by cytotoxic reaction and immune-complex.Some research state that almost 80% unknown the exact cause.
Some contactant mostly as causes of CUS : textile, drug, food, bite/ sting the insect, fotosensitizer, bacterium toxin, component of cosmetics.^3,4,5
Recently, cosmetics product have wide that way merebaknya so that case of side effects visible usage kosmetika progressively mount, this matter require to get the good protection  worker of salon and also cosmetic user in in society.
We report some cases of contact urticaria due to cosmetics either beauticians from beauty salon and cosmetics product user. Aim of this study to determine characterized of contact urticaria due to cosmetic products.

Subjects and Methods

This is a case series as retrospective, descriptive study. We revised all medical records of patients with contact urticaria since January 2003 to December 2004 in the Out Patients Unit of Sanglah Genral Hospital. The diagnoses was based on anamnesis and clinical finding. The variables studied were: gender, age, work related, diagnosis associates to contact urticaria, and open patch test by using standard allergens, after 20 minutes was evaluate the result of test.
Questionare was alloted at random to beauty salon, if later there is among natural beautician suffer a skin disorder asked to contact the us or come meeting the us, then, an interview will conducted and  physical examination. From 100 questionare sheet was distribute to beautician, 9  beautician state that thye was has skin problem, but only 2 person with contac urticaria.
Diagnose was based on anamnesis, clinical feature, and site of urticara. Some patient with contact dermatitis, patch tes was done by European Standard. We report same cases with contact urticaria triggered by cosmetic products. Open patch tes was done for each contact urticaria cases by using suspected cosmetic products.

Review of Some Cases

Cases 1

Ms. DW, a housewife, 42 year, complaining often itch  neck area, shoulder, upper chest. At the time of fisrt coming there is no sign of urticaria, she said that complain have since more than 1 month and residive. She told about history of cosmetic user such as : perfumes, hair dye, and others cosmetic cream. We advice to keep continue using cosmeticnas usually. If appearance a wheal, immediately contact me ata any time. In same days later, patients come to hospital with urticaria in the neck area after sprayed a perfume. This patients we carry out open patch test by  Pasien ini dilakukan tes tempel terbuka (open test) with the most common substance weared namely ; perfume, cream, bleaching cream, shampoo, others. Test was done by6 using directly patched of sugested cosmetic, then, the result observed after 15-30 minutes.Test was positive result againt perfume.

   

Cases 2

Wawan, a 29-years oled male, work as hair dresser in beauty salon. This case get from survey on some beauty salon.

Quesionaire was distribute to 100 sheet for beauty salon in down town of Denpasar,

There is 9 the people return kwesioner the through post, and come direct meet the researcher report happened the husk trouble after working the salon and 2 [among/between] its are urtikaria contact and have several times do happened. From result inspection of this case see the existence of lesion urtika [at] back of hand and [about/around] arm bangle. [At] this case is truely found that patient also suffer rhinitis alergika, often sneeze if/when breathing in dirt. Of result tes open which done to the materials suspected [by] be like; hair paint ( 2 type), dilution penyubur hair, cream to cream bath, shampoo, materials to pelurus hair. But [there] no satupun which reaktif. Patient suggested to always to wear the gauntlet each;every working.

   

Cases 3

Ms. WT, 28-years, hairdresser for 4 year ago. This case got from survey. Physical examination revealed some urtica at the neck, hand and arm with slight itch. In this cases, open patch tes was done with there is no positive result.

  

Cases 4

Mrs. AN, a hair dresser, 35 year, have worked as hair dresser since 3 year ago, she conduct hair polish, rebounding, blow, and the face decoration. About since 3 week ago often complain itching and arise wheal at forearm and dorsum manus. We conduct the open patch test for substance that most common use cosmetic substance such as ; hair dye, cream for bath, and some kind of perfume. Test was after its the disease improvement; then asked to  come again for the test. Test result interprate after 15-30 minute, result of tes [of] [at] this case [is] negative for all substance. Patient advice to use han protection (glove)

 

Cases 5

A hairdresser, woman 34-year, have worked as hair dresser since 5 year, his occupation dominant conduct hair dressin  and always contact with cream bath, hair coloring, rebounding, etc. Since a month ago often appearence wheal at dorsum manus, forearm, in several hours disappearence. She also many time feel itching whole the body, and has allergic history againt food. Open test was conduct againt suspected cosmetic product particullarly some kind of hair dye (3 brand). Test result indicate positive reaction againt one  kind of hair dye. We advice to use glove in his work.

   

Cases 6

Mrs. Win, a hair dresser, 34-year old, have worked as hair dresser since 3 year, she dominant conduct the hair-styling which deal with cream bath, rebounding, substance for the curling of hair, and hair dye.

Patient come to out-patient unit of Sanglah Hospital, with complain since last 2 month appearence wheals at forearm and dorsum manus. No history of atopi, both  him self  and his family. Patient was treated for 3 days to improve the wheal, then advice to came again for open patch test againts common substances in work place. All substance with negative  result.

 

Discussion
We report 5 case UK and 1 case with SUK effect of kosmetika, 5 is worker salon/penata hair and a is the housewife wear the product kosmetika. Sindroma urtikaria contact is the case very rare, his diagnosis easy to, can recover the perfection without secondhand, but if/when happened recuring will become the problem. Two from 6 case dicurigani because of hair paint, 2 case suspected by theX the perfume effect. Result of tes open only 2 case give the result reaktif to hair paint and perfume. Shall each;every product kosmetika provided with the active materials composition or carrier materials clearlyly, this matter to facilitate the to watcher if/when happened the undesirable reaction.
          In two years periods, enrolled 6 patients, female 4 and 2 males. The median age was 28,6 years (range 21-36 years). Two cases ;s new, and for cases is residive. Only two cases with positive result against fragrance and Peru balsam.
Urtikaria contact (UK) is is reacting urtika tentative local generally happened the few minutes do shall some [hour/clock]s after happened the contact [at] husk with kontaktan selected and can disappear without leaving the secondhand. Syndrome urtikaria contact (SUK) is urtikaria the contact accompanied with symptom anafilaktik systematical.
According to Maibach and Johnson ( what is cited by Marks, 2002) SUK are urtikaria which also entangle the organ ektra kutan, thereby SUK divided become : 1. urtikaria which only limited to just contact area, 2. urtikaria generalisata including angioudem, 3. urtikaria related to symptom asthma, rhinitis, conjungtivitis, orolaringink, gastro-intestinal tact.
And 4. urtikaria related to reaction anafilaktoid. According to research only 15 % patient UK have the symptoms history ekrta-kutan, more than anything else UK which non-imunologi very rare happened the symptom ektra-kutan.^2,3,4 Case UK truely is very rare reported because of UK frequently swiftly lose [by] xself without leaving the secondhand, so that patient feel not necessarily medicinize. After having happened many times then come kedokter. Be like [at] our case, from 6 case, 5 people of worker of beauty salon and a from the housewife often wear the materials kosmetika including perfume.
Diagnosis UK not difficult, urtika that happened a few moments after using the materials kontaktan, with especial sigh itch, some cases is also can with sigh feel burnt be like [at] case of 4 and case of 6 [at] hair dresser.       
Most of all cases in his work utilize multifariously [of] manner kosmetika ( multiple kosmetic), so that difficulty in looking for cause of him. In our case which done tes open only some estimated materials types is kosmetika most is often used. To know cause of him categorically, some researchers suggest to do tes open by wearing the materials yanag is very suspected, is not recommendation to be done tes patch biasa(tertutup), because worryed of happened pretend anafilaksis.
Tes the recommended is tes patch open meagrely the materials dicurugai directly or thinned with the materials sesuai.2,7,8 Pada our case, all patients done tes open, but only 2 the case give the positive reaction that is case of 1 reaktif to the perfume is often used and case of 5 reaktif to hair polish. [At] case 5, have several times do come with dermatitis atopik and contact dermatitis, three months before all patient have been done tes jab and tes patch with result reaktif to some alergen inhalan and materials kontaktan, this patient also have the sneezes history be like [at] case 2. According to this case definition can be told as simdroma urtikaria contact caused by involvement of organ besides husk.

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