Cosmetic Allergies (Makeup Allergy)

Cosmetics may irritate the skin directly (by far the most common type of reaction) or induce an immune-mediated allergic response.

Cosmetics are substances applied to the surface of the skin (moisturizers and makeup), hair (shampoos and conditioners), or nails (polish and lacquer) designed to alter one's appearance temporarily. Cosmetics do not change the skin, hair, or nails' structure or function.

They are often a complex mixture of perfumes, emulsifiers, sunscreens, pigments, metals, resins, preservatives, and a variety of inert materials. They also frequently contain an array of exotic botanical substances (for example, essential oils) for which the manufacturer may ascribe some obscure benefit. Generally, individuals should remove cosmetics after use.

Cosmetics are different from permanent makeup, which is a pigment tattoo placed into the deeper layers of the skin with a needle. The FDA and the USDA are responsible for administering laws involving the safety and purity of cosmetics. The revenue of the U.S. cosmetics industry is rapidly growing and is expected to reach about $128 billion in 2028.

Adverse reactions to cosmetics are reasonably common considering their extensive use. A physician will distinguish documented allergic sensitivity from simple irritation. The true prevalence of cosmetic sensitivity is unknown because affected individuals may just stop using the offending product rather than complain to a professional.

Cosmetics may irritate the skin directly causing an inflammatory dermatitis (by far the most common type of reaction) or induce an immune-mediated allergic response. Usually, irritation would occur the first time an individual applies a cosmetic, as opposed to an allergic reaction that would require repeated exposures. Some individuals have extremely sensitive skin that seems to be intolerant to many cosmetics. Individuals with rosacea seem to be especially sensitive to many cosmetics and makeup brands.

Since people commonly apply cosmetics to the face, this site is most commonly involved in cosmetic skin reactions and inflammatory dermatitis. Women are more frequently affected than men because they tend to use more cosmetics.

The rash produced by such a reaction often appears as a scaling, dry, itchy red area, eczematous dermatitis, usually confined to the areas where the cosmetic was applied (for example, the eyelids may become irritated after applying eye shadow). Occasionally, cosmetic skin reactions can appear as hives (welts). This reaction (contact urticaria) can be either allergic or non-allergic. It is often very difficult to distinguish whether the reaction is allergic or irritant based on appearance. Sometimes there may be a stinging sensation soon after an individual applies the offending cosmetic, or the individual experiences a reaction a day or two later. Less commonly, reactions may appear as blackheads, folliculitis, and darkened skin.

A severe allergic reaction (anaphylaxis) can be life-threatening. Symptoms of anaphylaxis include shortness of breath, lightheadedness, loss of consciousness, difficulty swallowing, chest pain, a rapid and weak pulse, nausea, and vomiting. Call 911 and seek emergency medical attention immediately (do not drive yourself). If you have been prescribed an epinephrine auto-injector (Epi-Pen) you should use it while waiting for medical help to arrive.

The ingredients in a cosmetic appear on the label in order of decreasing quantity. Any ingredient could potentially produce a reaction, but certain ingredients seem to be more likely to cause problems.

Common allergens found in cosmetics include:

• Natural rubber (latex)
• Fragrances
• Preservatives
• Dyes, chemicals in dyes, and color additives
• Metals such as nickel and gold

The use of the terms hypoallergenic, pure, and natural on the label have very little scientific meaning and are essentially marketing jargon. Cosmetics that use the term organic must be manufactured according to certain USDA criteria that have little to do with consumer safety.

Dermatologists have the most experience in dealing with makeup and cosmetic intolerance.

If a cosmetic is considered a potential cause of a reaction, the patient can perform a "use" test over 3-4 days by repeatedly applying the substance to the same site on forearm skin. If a reaction appears, a healthcare professional can perform allergy testing to determine the precise identity of the offending substance in the cosmetic mixture. One can then avoid the product as well as avoid further exposure to the same allergenic component in other cosmetic products.

Several common skin diseases are likely to be confused with cosmetic rashes. The best way to distinguish these is often to avoid using the particular cosmetic in question for 2-3 weeks.

If the rash resolves and then recurs when an individual uses the cosmetics again, it is reasonably likely the problem is the cosmetics. If the rash persists, then it is probably due to a skin disease such as seborrheic dermatitis, atopic dermatitis, or some other problem.

Mild cosmetic reactions usually will resolve with no treatment as long as the person avoids the offending product. More serious responses often respond to treatment with 1% hydrocortisone cream that can be purchased without a prescription. If this fails, it will be necessary to visit a healthcare professional for a more potent topical steroid.

If the source of a cosmetic reaction is an irritant chemical, avoiding that substance, when present in other products, would be prudent. The immediate reaction subsides in a few days. A dermatologist can help decide which ingredient on the label is likely to be a problem.

If a reaction is due to an allergy to an ingredient that is documented by patch testing, then it is very important to avoid that particular ingredient by carefully reading cosmetic labels. Sometimes this can be challenging because certain additives in beauty products may have several brand names.

Although the immediate allergic reaction to the chemical will resolve within a few weeks, the propensity to react on re-exposure always exists.

The best way to avoid a cosmetic reaction is to avoid cosmetics entirely. Since this is impractical, however, using cosmetics with a minimal number of ingredients might be helpful. Some cosmetics may contain labeling using the terms unscented or fragrance-free. This distinction can be important because unscented products often contain fragrance chemicals that disguise odor whereas fragrance-free products are supposed to be devoid of fragrances entirely.

No government body certifies the safety or non-allergenicity of cosmetics or makeup.

According to the U.S. Food and Drug Administration (FDA), there are no Federal standards or definitions for the use of the term “hypoallergenic,” so it can mean whatever a company wants it to mean. There is no requirement for manufacturers of cosmetics to submit substantiation of their hypoallergenicity claims to the FDA. For this reason, the FDA states there is no such thing as a "nonallergenic" cosmetic that can be guaranteed never to produce an allergic reaction.

The FDA does require ingredients used in cosmetics to be listed on product labels, so consumers can avoid substances that have caused them problems.

• From the FDA's website: "FDA does not have the legal authority to approve cosmetic products and ingredients (other than color additives) before they go on the market. We also do not have a list of tests required for any particular cosmetic product or ingredient. However, a manufacturer or distributor of a cosmetic is legally responsible for ensuring that a marketed product is safe when consumers use it according to the directions in the labeling or in the customary or expected way. FDA can take action against the manufacturer of a cosmetic on the market if we have reliable information to show that a cosmetic does not meet the legal requirement for safety."