Although the ingredient is widely used in skincare, the American Contact Dermatitis Society (ACDS) wants clinicians to take special considerations when patch testing for lanolin contact allergy.
Lanolin, known mainly for its emollient properties, has been named by the American Contact Dermatitis Society as the Contact Allergen of the Year for 2023.1 Lanolin is a complex mixture of high molecular weight esters, aliphatic alcohols, sterols, fatty acids, and hydrocarbons that has been widely used for centuries for its emollient properties. The prevalence of lanolin contact allergy in dermatitis patients varies from 1.2% to 6.9%.2
Donald V. Belsito, MD, professor of dermatology, Columbia University, New York, announced the Allergen of the Year at the American Contact Dermatitis Society (ACDS) Annual Meeting in New Orleans, LA, on March 16, 2023 and published the results in the journal Dermatitis. The author noted that patients with statis dermatitis, leg ulcers, perianal/genital dermatitis and atopic dermatitis (AD) may be more at risk for a lanolin allergy.
Children and older adults are also at greater risk of developing contact allergy to lanolin, but this is likely due to a higher prevalence of AD in children and stasis dermatitis/leg ulcers in older people. Among the children and adults who have an allergic reaction to lanolin, the most common primary body sites affected are the hands, scattered generalized distribution, and face.2
Jonathan Silverberg, MD, PhD, MPHS, associate professor of dermatology at the George Washington University School of Medicine and Health Sciences in Washington, D.C. spoke to Dermatology Times® about lanolin's role in treating common skin conditions and what clinicians should know about lanolin allergies.
Jonathan Silverberg, MD, PhD, MPH: So lanolin is an allergen that we've been dealing with now for a long time. And it's something that we have seen an increase in over the years, although, you know, it may be relatively stable in how common it is right now. But it's particularly relevant because it is so commonly found in over-the-counter emollients, moisturizers, and topical medications, it has certain properties that make it potentially soothing to the skin. But if someone's allergic to it, it can be really problematic. So what we often see is patients who are using products with lanolin, included as an ingredient in order to address either dry skin or some other inflammation, perhaps like atopic dermatitis. But then over time, with that chronic use, can pick up a contact allergy. There's many other scenarios where lanolin exposures will occur as well. But it's something that we have to be cognizant of, not only from the perspective of patch testing and identifying those allergens, but also recognizing that many of our own recommendations to patients around their over-the-counter personal care products could intersect with this. If we are recommending products that have lanolin in there, in theory, we might be increasing a little bit of their risk of getting contact dermatitis to lanolin. So it's certainly something that I'm cognizant of and pay attention to when I'm making my own topical product recommendations. But certainly, if patients are using certain over-the-counter products that have lanolin, they may feel like it might be making things worse. Don't ignore that historical account from patients because they may be right, where the initial soothing properties might help, but as the repetitive exposure to the allergen kicks in, it may just make it worse over time. And that should be something that prompts potential patch testing.
Transcript edited for clarity
1. Jenkins B, Belsito D. Contact Allergen of the Year. Dermatitis. February 2023. doi:doi.org/10.1089/derm.2022.0002
2. Silverberg JI, Patel N, Warshaw EM, et al. Lanolin Allergic Reactions: North American Contact Dermatitis Group Experience, 2001 to 2018. Dermatitis. 2022 May-Jun 01;33(3):193-199. doi: 10.1097/DER.0000000000000871. Epub 2022 Apr 28. PMID: 35481824. CopyDownload .nbibFormat: AMA APA MLA NLM