Two patients with contact cheilitis demonstrated strong patch test reactions to a Kat Von D lipstick.
Patient A, a 27-year-old woman, presented with a several-month history of outbreaks of small blisters on the lips. She was unsure what initiated the rash but noted resolution of symptoms after discontinuing lip products. However, the eruption returned upon reintroduction of lipstick and Burt's Bees lip balm. Patient B, a 69-year-old woman, presented with a similar lip rash that began shortly after using Kat Von D Everlasting Liquid Lipstick. Before this, she wore lipstick and Carmex daily without issues. Prednisone and several topicals including clotrimazole, hydrocortisone, mupirocin, and tacrolimus failed to control outbreaks, but switching her makeup and lip products seemed to improve symptoms.
Because of concern for allergic contact cheilitis (ACC), both patients were patch tested to the North American Contact Dermatitis Group standard series in addition to our series for personal care products (including makeup), preservatives, emulsifiers, flavors, select food-related allergens, and their facial and lip-related personal products.
Both patients exhibited several positive reactions on their day 7 reading. Patient A had strong reactions (+++) to nickel and tea tree oil and a bullous reaction to Kat Von D Everlasting Liquid Lipstick in “Bachelorette”; mild (+) reactions to cobalt, cetrimonium chloride, yellow beeswax, synthetic wax, candelilla wax, abitol, Blistex lip balm, and Burt's Bees lip balm; and doubtful reactions to limonene and shellac. Patient B also had a strong (+++) bullous reaction to Kat Von D Everlasting Liquid Lipstick in “Miss Argentina” (Fig. 1); mild (+) reactions to fragrance mix I, balsam of Peru, linalool, and shellac; and doubtful reactions to iodopropynyl butylcarbamate, yellow beeswax, cetrimonium chloride, and carmine.
Kat Von D is a vegan cosmetic company that sells products free of carmine and beeswax.1 Everlasting Liquid Lipstick has been sold for 4 years and is one of the company's best-selling product lines.2 Company representatives denied known consumer reports of ACC from these lipsticks.
It is unclear which ingredient(s) in the lipsticks caused such profound reactions in our patients. Fragrance (specifically cinnamates) could be considered the common causative agent because both patients reacted to markers of fragrance allergy in addition to the Everlasting Liquid Lipstick and ACC most frequently occurs from fragrance.3 Of the other product ingredients (Fig. 2), tocopheryl acetate and iron oxides were available for testing, to which both patients tested negative. Company representatives were contacted for further information and refused to disclose the composition of the individual shades or to send individual ingredients for testing on our patients. There are no reports of allergic contact dermatitis from most ingredients in the lipstick that were not tested including isododecane, disteardimonium hectorite, hydrogenated styrene/isoprene copolymer, polyethylene, propylene carbonate, synthetic fluorphlogopite, and dicalcium phosphate; however, there are reports of ACC from Red Lake 74 and allergic contact dermatitis from caprylic/capric triglyceride,5 which were not able to be tested.
Although it is possible that both patients reacted to an untested ingredient, the exuberance of the reactions to this lipstick was unexpected and reinforced the importance of testing personal products. Physicians should be aware of the potential for strong reactions to Kat Von D Everlasting Liquid Lipsticks and its association with contact cheilitis.
Kat Von D Everlasting Liquid Lipsticks may cause strong contact reactions and ACC. These cases also highlight the importance of testing to personal products.
3. Zug KA, Kornik R, Belsito DV, et al. Patch-testing North American lip dermatitis patients: data from the North American Contact Dermatitis Group, 2001 to 2004. Dermatitis
4. Ha JH, Kim HO, Lee JY, et al. Allergic contact cheilitis from D&C Red no. 7 in lipstick. Contact Dermatitis
5. Laube S, Davies MG, Prais L, et al. Allergic contact dermatitis from medium-chain triglycerides in a moisturizing lotion. Contact Dermatitis