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Regulations in European countries are reducing the incidence of nickel allergy overseas, while the incidence continues to climb in the United States, according to the president of the North American Contact Dermatitis Group.
Fragrances and topical agents are high on the list of substances that can trigger skin reactions, says Joseph Fowler, M.D., F.A.A.D., a dermatologist and clinical professor of dermatology, University of Louisville, Louisville, Ky.
"The prevalence of nickel allergy is increasing, and (body) piercings are driving nickel allergy in general," Dr. Fowler says. "There appears to be a decrease in nickel allergy in Denmark because of the nickel directive (there)."
While the directive is not uniformly enforced, a recent publication drew a link between the declining incidence in nickel allergy and regulations in Europe reducing nickel content in costume jewelry, Dr. Fowler says.
Fragrance allergy is common, but there are disparities in fragrance allergy across countries, he notes.
Ingredients in cosmetics and skincare products such as decyl glucoside are eliciting allergic reactions that are being increasingly reported, he says.
"It (decyl glucoside) is a surfactant, and helps keep the components of the products together," he says. "There are components of skin cleansers that could be potential allergens."
Personal care products contain ingredients such as tea tree oil and have chemical compositions like fragrances, making users increasingly sensitized to such ingredients.
Dermatologists should not assume patients cannot be allergic to a topical agent such as cortisol, Dr. Fowler says. "(Topical) corticosteroids themselves are being discussed more as possible sources of allergens," he says. "Hydrocortisone is available over the counter in North America, and that represents 90 percent of the cases that we see of people who are allergic to cortisones."
Check the fine print
Dermatologists should tell patients to read labels to ensure products do not contain the offending ingredients, Dr. Fowler says. But manufacturers can circumvent labeling requirements because of the intention for the ingredient in a product.
"A product can be labeled 'fragrance free,' but can contain an ingredient that has both fragrance and preservative properties, which in the product is being used as a preservative," Dr. Fowler says.
The Contact Allergen Replacement Database lists more than 2,100 products free of chemicals that trigger allergic reactions. The database is a benefit to members of the American Contact Dermatitis Society (ACDS).
More people are using cases and covers for their cell phones to avoid developing allergic reactions, Dr. Fowler notes.
"Allergic reactions are quite common, and when individuals recognize the dermatitis on their face or ear, they then use protective measures," he says, noting that nickel in cell phones promotes allergic reactions.
The American Academy of Dermatology (AAD) is considering a proposal similar to the nickel directive in Europe. "There may be some degree of advocacy coming from the AAD and/or the ACDS," Dr. Fowler says.
Disclosure: Dr. Fowler reports no relevant financial interests.