A review of some of the best-selling over-the-counter moisturizers finds that most products contain at least one allergen that could worsen the very skin condition it is designed to treat.
The review, published online Sept. 6 in JAMA Dermatology, found that of 153 products, 88 percent contained at least one allergen of the North American Contact Dermatitis Group (NACDG) series, such as fragrances, parabens and tocopherol. Most of these contained more than one allergen: 43 percent contained three to four allergens and 13 percent contained five or more allergens.
Over-the-counter moisturizes are often recommended by dermatologists to treat skin conditions, such as atopic dermatitis, allergic contact dermatitis, contact dermatitis and psoriasis. These recommendations are made by physicians who may not realize they may be exposing patients to a myriad of ingredients that could possibly cause an allergic reaction.
“The concept of hypoallergenic as perceived by lay people and physicians is often misunderstood,” says senior author Jonathan Silverberg, M.D., Ph.D., MPH, an assistant professor of dermatology at Northwestern University Feinberg School of Medicine in Chicago. “For instance, physicians who recommend certain products to patients believe that the patient will not be allergic to them and, therefore, the products will be safe to use. But in fact, with enough exposure and an underlying predisposition, patients can develop allergies to many of these personal care products.”
“Our analysis of best-selling moisturizers across three major online retailers reveals products that differ substantially in price and characteristics. Given the wide number of product choices and inherent challenges in interpreting ingredient lists for consumers, dermatologists may have to provide specific product and manufacturer recommendations to guide patients toward the most appropriate moisturizer,” Dr. Silverberg and authors wrote.
Especially concerning is the practice of recommending moisturizers to patients with sensitive skin, underlying eczema and other inflammatory skin conditions, where patients frequently apply topical agents to areas with an impaired skin barrier. “For these patients, I tend to recommend products that have a minimal ingredient profile to try to decrease the exposure that the patient will have long term,” he says.
When a patient is allergic to one fragrance, the risk of having a reaction to other fragrances is much higher, according to Dr. Silverberg, because of the chemical similarity between ingredients. “We notice a comparable scenario with formaldehyde-releasing agents, whereby ingredients will degrade to the same chemical (formaldehyde) or there are enough chemical similarities to cause cross-reactions,” he says.
Consumers instinctively rely on product labels simply because they are visible, though, not necessarily verifiable. In fact, commercial claims for the moisturizers included in this study often did not fully reflect or even match the actual ingredient profile. “Several products contained well established, classical fragrances in their ingredient list, yet the commercial label stated fragrance-free. That is a complete disconnect. I am not sure how the claim of fragrance-free is justifiable in those products,” he said.
For moisturizers labeled dermatologist-recommended, “there is no major requirement to substantiate that claim,” Dr. Silverberg says. “It could be the recommendation of one dermatologist or it could be the recommendation of 100 dermatologists. Hence, it is not really a meaningful term, but rather a term that companies are allowed to use fairly liberally. As a dermatologist, I would not put too much stock into the claim.”
Yet, Dr. Silverberg said, consumers are paying a premium price for moisturizers with claims of dermatologist recommended, hypoallergenic or fragrance-free.
The study found that the three most affordable moisturizers that were free of ingredients listed by the North American Contact Dermatitis Group (NACDG) included Ivory raw unrefined shea butter; Vaseline original petroleum jelly; and, Smellgood African shea butter. “These are pretty safe and effective options for physicians to recommend to patients,” he said.
A more complex issue is that some allergens may have dual purposes. “They may be used as preservatives as well as fragrances,” Dr. Silverberg says.
Recognizing the concept of cross-reactions is also important. “Outside the world of contact dermatitis, I do not think there is enough awareness about cross-reactions in the medical community, particularly within the dermatologic community,” Dr. Silverberg says.
For instance, a person can be allergic to one main ingredient, as well as being allergic to other ingredients, “because there are enough chemical similarities between those ingredients,” Dr. Silverberg explains. “Fragrances are a classic example of this.”