Contact Dermatitis

Fragrance Allergy: Allergic Contact Dermatitis

Contact fragrance allergies are a common cause of contact dermatitis.

Fragrances are natural and artificial substances used to add scent to products. Allergic contact dermatitis is often caused due to a fragrance allergy. Allergic contact dermatitis is an allergic reaction where you can get a rash days after coming into contact with an allergen. Out of all the fragrances, Balsam of Peru (myroxylon pereirae) is probably the most notorious for causing problems. It is sap from the bark of a tree with an aroma similar to vanilla and cinnamon that is commonly used in consumer products. It is also one of the most common contact allergens.  Jasmine and lavender oil are two other frequently used fragrances.

Here is a classic story of someone who might have an allergic contact dermatitis to fragrances:

Vivian likes scented products. She enjoys trying out new shampoos and perfumes at stores to find her favorites. Recently though, she has been having redness and itching on her body, especially on her hands and scalp. She says that she has never had this happen before and there hasn’t been much change in the products she has used over the past few weeks.

In this case, we would be suspicious of Vivian’s products, specifically her shampoo and perfumes, as a potential cause for her rash. Real cases are usually much more complicated than this simplified story, but it doesn’t have to be. If this story sounds similar to yours, it might be worth investigating if you have an allergic contact dermatitis to fragrances.

What is it found in?

Fragrances are used in many products.  Chances are that if something smells good, then the product contains a fragrance.

Here are some products with high amounts of fragrances.

  • Perfumes and colognes
  • Lipsticks
  • Toothpastes
  • Concealers
  • Eye shadows
  • Shampoos
  • Conditioners
  • Soaps
  • Lotions

Fragrance can also be used in household products, such as dish detergent and air freshener. Finally, fragrances are also occasionally used to help flavor foods. One food culprit is teas.

Where will you be itching?

As with any contact allergen, itching and rashes occur at the site of contact. As we’ve mentioned above, skin and hair products often contain fragrances. the result of this is that people often get itching, redness, and scaling along their scalp and on their hands due to a fragrance allergy. Other places that might be affected are the neck and wrists from perfume or cologne. In more severe cases, these lesions can even progress to blistering. In rare cases, the rash can occur all over the body. This usually happens if you are allergic to Balsam of Peru and something in your diet is causing your allergic reaction. However, this is rare.

What is the treatment for a contact fragrance allergy?

Avoidance is the best policy. Here are some strategies you can use to avoid fragrances:

  • Do not get fooled by “unscented”. These products may actually still contain a fragrance to make them unscented. Try to look specifically for products that say “fragrance-free.”
  • Read labels. As always, reading labels is a good way to make sure the product you are using does not contain fragrances.  Here are some to look out for:
    • Balsam of Peru
    • Cinnamic alcohol
    • Coumarin
    • Eugenol
    • Farnesol
    • Lyral
    • Oak moss absolute

For those individuals who are allergic to Balsam of Peru, a special diet may be needed if a skin rash does not clear from simply avoiding contact. These people need to avoid foods containing citrus, spices (such as cinnamon, cloves, vanilla, nutmeg, anise, and ginger), chocolate, colas, liquors, and tomatoes.

Do you have a severe rash now? There are some things you can do in the meantime until you figure out the cause. Barrier creams are thick oily greasy moisturizers. Applying barrier creams, like Vaseline, can help prevent the allergen from reaching your skin. Meanwhile, topical steroids can be used to reduce the severity of your rashes.

How is a fragrance allergy contact dermatitis diagnosed?

If you think fragrances are causing your rash, you can try avoiding the products we have listed above and see if the rash goes away. For example, in our case above, Vivian could try not to use scented products and perfumes and only use products from our safe list. If the rash comes back when you reuse the substance, then you may have found your culprit.

If you are unsure whether or not you have a fragrance allergy (contact allergens can be tricky! You can talk to your dermatologist about patch testing. Patch testing is used to help doctors determine whether you have a true skin allergy (allergic contact dermatitis) or an irritant contact dermatitis (click here for the difference). This is determined by putting together your history, your job, your exposure, the environment, and your patch testing results.

Think a different contact allergen may be the culprit?

Check out our list of common contact allergens.

References

Salam, T. N., & Fowler, J. F. (2001). Balsam-related systemic contact dermatitis. Journal of the American Academy of Dermatology, 45(3), 377-381.

Schalock, PC. Common allergens in allergic contact dermatitis. In: UpToDate, Post TW(Ed), UpToDate, Waltham, MA. (Accessed on March 30, 2016.)