Erin M Warshaw, Jenna L Ruggiero, Joel G DeKoven1, Jonathan I Silverberg2, Howard I Maibach3, James S Taylor4, Amber R Atwater5, Kathryn A Zug6, Denis Sasseville7, Joseph F Fowler8, Anthony F Fransway9, Melanie D Pratt10, Donald V Belsito11, Vincent A DeLeo12, Margo J Reeder13. 1. Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada. 2. Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC. 3. Department of Dermatology, University of California, San Francisco. 4. Department of Dermatology, Cleveland Clinic, OH. 5. Department of Dermatology, Duke University Medical Center, Durham, NC. 6. Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH. 7. Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada. 8. Division of Dermatology, University of Louisville, KY. 9. Associates in Dermatology, Fort Myers, FL. 10. Division of Dermatology, University of Ottawa, Ontario, Canada. 11. Department of Dermatology, Columbia University Irving Medical School, New York. 12. Department of Dermatology, Keck School of Medicine, Los Angeles, CA. 13. Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison.
Abstract
BACKGROUND: Vitamin E (tocopherol) a naturally occurring mixture of antioxidants commonly used in topical skin care products, may cause allergic contact dermatitis. OBJECTIVE: The aim of this study was to characterize positive patch test reactions to tocopherol and tocopherol acetate. METHODS: This is a retrospective analysis of North American Contact Dermatitis Group patch test data to tocopherols (dl-α-tocopherol 100% and/or dl-α-tocopherol acetate 100%) from 2001 to 2016. RESULTS: Of the 38,699 patients patch tested to tocopherol and/or tocopherol acetate, 349 (0.9%) had positive reactions; of these, 87.6% were currently relevant. Most (51.4%) were weak (+) and/or not related to occupation (99.1%). Compared with tocopherol-negative patients, tocopherol-positive individuals were more likely to be female (72.5% vs 67.2%, P = 0.0355), have a final primary diagnosis of allergic contact dermatitis (74.2% vs 52.6%, P < 0.0001), and have dermatitis in a scattered generalized distribution (23.8% vs 18.2%, P = 0.0072); they were also less likely to have hand involvement (16.6% vs 22.3%, P = 0.0064). The most common source of tocopherol was personal care products, especially moisturizers. CONCLUSIONS: Positive patch test reactions to tocopherols were relatively rare given their widespread use. When positive, current clinical relevance was high. Tocopherol-positive patients were more likely to be female and presented with dermatitis on the face or in a scattered generalized pattern.
BACKGROUND: Vitamin E (tocopherol) a naturally occurring mixture of antioxidants commonly used in topical skin care products, may cause allergic contact dermatitis. OBJECTIVE: The aim of this study was to characterize positive patch test reactions to tocopherol and tocopherol acetate. METHODS: This is a retrospective analysis of North American Contact Dermatitis Group patch test data to tocopherols (dl-α-tocopherol 100% and/or dl-α-tocopherol acetate 100%) from 2001 to 2016. RESULTS: Of the 38,699 patients patch tested to tocopherol and/or tocopherol acetate, 349 (0.9%) had positive reactions; of these, 87.6% were currently relevant. Most (51.4%) were weak (+) and/or not related to occupation (99.1%). Compared with tocopherol-negative patients, tocopherol-positive individuals were more likely to be female (72.5% vs 67.2%, P = 0.0355), have a final primary diagnosis of allergic contact dermatitis (74.2% vs 52.6%, P < 0.0001), and have dermatitis in a scattered generalized distribution (23.8% vs 18.2%, P = 0.0072); they were also less likely to have hand involvement (16.6% vs 22.3%, P = 0.0064). The most common source of tocopherol was personal care products, especially moisturizers. CONCLUSIONS: Positive patch test reactions to tocopherols were relatively rare given their widespread use. When positive, current clinical relevance was high. Tocopherol-positive patients were more likely to be female and presented with dermatitis on the face or in a scattered generalized pattern.