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Patch Test Reactions Associated With Sunscreen Products and the Importance of Testing to an Expanded Series: Retrospective Analysis of North American Contact Dermatitis Group Data, 2001 to 2010

Warshaw, Erin M. MD, MS,*; Wang, Michael Z. BS,; Maibach, Howard I. MD,; Belsito, Donald V. MD,§; Zug, Kathryn A. MD,; Taylor, James S. MD,; Mathias, C.G. Toby MD,**; Sasseville, Denis MD,†††; Zirwas, Matthew J. MD,††; Fowler, Joseph F. Jr MD,‡‡; DeKoven, Joel G. MD,§§; Fransway, Anthony F. MD,‡‡‡; DeLeo, Vincent A. MD,§; Marks, James G. Jr MD,∥∥; Pratt, Melanie D. MD,¶¶; Storrs, Frances J. MD***

doi: 10.1097/DER.0b013e3182983845
Studies

Background Both active and inactive ingredients in sunscreen may cause contact dermatitis.

Objectives This study aimed to describe allergens associated with a sunscreen source.

Methods A cross-sectional analysis of patients patch tested by the North American Contact Dermatitis Group between 2001 and 2010 was performed.

Results Of 23,908 patients patch tested, 219 (0.9%) had sunscreen coded as an allergen source. Patients who were male, with occupational dermatitis, or older (older than 40 years) had significantly lower rates of allergic reactions to sunscreens; the most commonly affected areas were the face and exposed sites (P < 0.0001). The top 3 most frequent allergens in sunscreens were benzophenone-3 (70.2% for 10% concentration, 64.4% for 3% concentration), DL-alpha-tocopherol (4.8%), and fragrance mix I (4.0%). Less than 40% of positive patch test reactions were detected by the North American Contact Dermatitis Group screening series of 65 to 70 allergens.

Conclusions A supplemental antigen series is important in detecting allergy to sunscreens.

From the *Department of Dermatology, Veterans Affairs Medical Center, University of Minnesota; †University of Minnesota Medical School, Minneapolis, Minn; ‡Department of Dermatology, University of California San Francisco; §Department of Dermatology, Columbia University, New York, NY; ∥Dartmouth-Hitchcock Medical Center, Lebanon, NH; ¶Department of Dermatology, Cleveland Clinic; **Department of Dermatology, University of Cincinnati; ††Dermatology Department, Ohio State University, Columbus; ‡‡University of Louisville, KY; §§Dermatology Department, University of Toronto, Canada; ‡‡‡Associates in Dermatology, Fort Myers, Fla; ∥∥Department of Dermatology, Pennsylvania State University, Hershey; ¶¶Division of Dermatology, University of Ottawa, Ontario, Canada; ***Department of Dermatology, Oregon Health Science University, Portland; and †††Division of Dermatology, Royal Victoria Hospital, McGill University, Montreal, Canada.

Address correspondence to Erin M. Warshaw, MD, MS 1 Veterans Dr, 111K-Dermatology, Minneapolis, MN 55417. E-mail: erin.warshaw@va.gov.

The authors have no funding or conflicts of interest to declare.

Disclaimer: This material is the result of work supported with resources and the use of facilities at the Minneapolis Veterans Affairs Medical Center, USA. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

© 2013 American Contact Dermatitis Society
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