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ALLERGEN FOCUS A REVIEW OF COLOPHONIUM Rosin, also known as colophony, is the term collectively used for the solidified, distilled form of resins from pines, cedars, spruce, firs and junipers.

ASHLEY A. HAMSTRA, MD, AND SHARON E. JACOB, MD

Epicutaneous patch testing provides a theranostic, or individual, assess- ment of each patient. Although ACD is not “curable,” many individuals will achieve complete remission with as- siduous avoidance. In this section focus, we highlight ACD and explore top relevant allergens, regional-based dermatitis presentations, topic-based dermatitis presentations and clinical tips and pearls for diagnosis and treatment. This article focuses on colophonium.

HISTORY OF THE TREE’S SCAB Colophony surrounds us. It is in the makeup we apply to our faces, the ten- nis rackets we clutch and the cleaning products we use to scrub our homes. Colophony’s ubiquity likely contributes to its prevalence as one of the most common allergens in ACD. Plant resins are uniquely different in composition from sap and other plant- based secretions. While saps have an in- trinsic nourishing function (containing water, glucose, minerals and hormones), resins support the plant through important protective functions.6 Primar- llergic contact dermatitis unable to comply with the avoidance ily, they ward off pathogens, insects and (ACD) is an important disease regimen are at risk for recurrent or other animals by sealing puncture sites that notably affects 14.5 mil- sustained dermatitis or progression to on the tree. This blocks entry for invasive A 1 2,3 lion Americans each year. The eco- a systematized presentation. organisms. The puncture wound could nomic impact of this disease is high The 2 main types of contact dermati- be secondary to an assailing animal or in terms of both patient morbidity tis are irritant and allergic, with irritant a blunt trauma from a neighboring tree. and loss of income, school and work contact dermatitis (ICD) being the most Sticky resins can also flush out or trap and significant expenditures for visits common. ICD may occur in anyone unwelcome organisms. The volatile tur- to healthcare providers and for medi- who is exposed to an irritating substance pentine oils of the secreted resin quickly caments. A correct diagnosis of ACD with significant duration or in significant evaporate. The remaining resin forms a will improve, prevent or “cure” the concentrations such as chronic or fre- scab. Additionally, resins have antiseptic dermatitis and decrease overall costs quent water exposure, abrasive cleansers, and water retaining properties.7,8 to the healthcare system.1 Once patch detergents and soaps. It is important to Rosin (also known as colophony) testing is performed and a culprit has note that ICD can at times precede or is the term collectively used for the been identified, education becomes be a concomitant diagnosis with ACD4,5 solidified, distilled form of resins from the critical intervention to ensure ACD is a delayed-type IV hypersensi- pines, cedars, spruce, firs and junipers. adherence to an avoidance regimen. tivity reaction that can occur to a large The proper name, colophonium, is With allergen avoidance, remission of number of chemicals from poison ivy to noted by the International Nomen- the dermatitis ensues. Patients who are fragrances in shampoos. clature of Cosmetic Ingredients.9,10

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Both names are derived from colophon. Table 1. ALTERNATE NAMES OF COLOPHONY12,14 Colophon, which means summit, was an ancient city of Ionia, modern day Abietic acid Hercolyn D Turkey. Colophon was situated along a ridgeline with surrounding pine Abietic alcohol Methyl abietate alcohol trees. The term Colophonia resina has been traced back to these pines.7 Col- ophony is also known by several other Abietyl alcohol Pentalyn names listed in Table 1. There are 3 methods of procur- Abitol Resin terebinthinae ing rosin, which result in different forms of rosin; all forms can cause Colophonium Rosin ACD. Gum rosin is the most common form, which is obtained from Dercolyte ZS Rosin gum live trees in the form of tapped fresh resin oils. These are then distilled to Dermtomal 18 Rosin solder flux flume yield turpentine oil and gum rosin. Alternatively, dead pine stumps can Disproportionated rosin Staybelite 10 be distilled to produce wood rosin. However, this labor-intensive meth- Foral 105 Tall oil od, with low yield, is the least common form of procurement. Lastly, Gum rosin Wood rosin tall oil rosin is a processed, liquefied byproduct of tree pulp. This pulp is Granolite SG more cellulose and used to make paper. Tall is Swedish for pine.11-13 The term “resin” that is also applied cover it inside and out with pitch.” has lapsed and synthetic resins in bow in modern day to denote synthetic res- Pitch is a colloquialism for non- making are now common.19 ins, like epoxy, which share the physi- wood resources derived from coni- Stringed instruments are not the only cal property of being a thick liquid that fers.15,16 Leonardo da Vinci is docu- area where rosin is frequently added to hardens into a lacquer or enamel. How- mented to have used colophony in a augment friction. In sports, colopho- ever, that is the limit of the similarity, remedy for ailments. “A remedy for nium is used to improve the traction as these compounds have no relation to scratches taught me by the Herald to of ballet shoe tips and racket handles.8 plant-derived resins. the King of France. Four ounces of When allergy to wood products is in virgin wax, 4 ounces of colophony, 2 question, both the wood pulp and the HISTORICAL NOTATIONS ON COLOPHONY ounces of incense. Keep each thing varnish should be suspect. Historically, mankind has long uti- separate; and melt the wax, and then lized resins for their sealant properties. put in the incense and then the col- COLOPHONY’S COMPOSITION In fact, rosin varnished and lacquered ophony, make a mixture of it and put Rosin is largely comprised of resin objects have been found in ancient cul- it on the sore place.”17 acids, namely abietic acid, dehydroabi- tures including Egypt, China and Japan. Also, after decades of debate re- etic acid, neoabietic acid, dihydroabi- Prior even to its success as a varnish, garding the composition of the wood etic acid, palustric acid, levopimaric it has been traced back to the Egyp- and the famous luthier Stradivarius’ acid and pimaric acid.11,20 The specific tian embalming methods of the Old methods, a 2009 study laid the query balance of this mixture is dependent on Kingdom era (3050-2181 bc). Notably, to rest by determining that the vio- the species of the tree, climate, method through scientific analysis of ancient ar- lins indeed contained a pine resin in of extraction and how it is stored.21,22 tifacts, it was discovered that they would the varnish.18 At the time, Stradivar- The most common sensitizing resin soak strips of linen in rosin prior to ius’ painting resin onto the wood of acid is abietic acid.21,23 molding them around the corpse.14 The the violin’s body was novel and in- Colophony’s widespread applications researchers also noted that the Egyptians novative — setting them above the exploit its properties of adhesion and would often use powdered limestone in rest and forever changing the sound hard enamel or lacquer finishes. These the mummification wrapping technique of music. Today, it is common to ap- finishes require colophony to be first as a composite cement to improve adhe- ply rosin to the bows of stringed in- converted into solvents. It easily dis- sive properites.14 struments. The reason resin is applied solves in alcohol or petrolatum, not wa- Interestingly in Genesis 6:14, Noah to the strings is to produce friction ter. These solvents can then be applied as was instructed to “Make for your- and augment vibration, and thus a sealant paint layer. The non-resin com- self an ark of gopher wood; you shall sound quality. In 1982, epoxy resins pounds, typically turpentine oils, will make the ark with rooms, and shall for bows were patented. This patent soon evaporate, leaving the varnish.8

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Table 2. COMMON PRODUCTS Table 3. SUBSTANCES WITH CROSS-REACTING COMPONENTS TO COLOPHONIUM11,12 CONTAINING COLOPHONY 14,16 Balsam of Peru (Myroxylon pereirae) Oil of turpentine Asphalt products Essential oils Rosin esters Axle greases Evergreen trees other than pines Spices (cloves, mace, nutmeg, paprika) Bows of string instruments Car waxes, furniture waxes and stains Fragrances Wood tars Cements and putties 11 Ceramic inks, marking pens, felt-tip pens, prink ink MODERN UTILIZATION and edema are reported. Furthermore, The spectrum of colophonium ap- an Italian woman developed generalized Chewing gum plications is immense (Table 2). Its urticaria after applying an unnamed col- pervasiveness likely contributes to its ophony containing homeopathic oint- Cold sore creams ranking as 1 of the top 10 allergens ment to her wrist for tendonitis.21 Corrosion inhibitors in many countries and make it an im- In western medicine, colophony portant source of occupational contact is commonly found in sutures, tape, Cosmetics (lipsticks, mascaras, rouges) dermatitis.15,24,25 In the varnish industry, dentistry products, namely sealants Dental flosses colophony is widely used. For example, and topical medications.21 Cosmet- a “light colored oak tree” toilet seat ics, including mascara, blush and lip- Epilating waxes that was actually ash wood varnished stick potentially contain colophony. Floor polish with colophony to appear oaken was Much like ink, the colophony helps recently reported to trigger a localized the makeup hold together and not Fly strips buttock eruption that then generalized. “bleed.” Toiletries like dental floss, The patient found resolution with a sunscreen and depilatories also com- Glues new non-wooden toilet seat.26 monly contain colophony. A recently Hemorrhoid creams The 3 largest sources are paper print- reported source of colophony aller- ing industries, adhesives and varnish- gy is the absorbent core material of Laundry detergent es.21,22 Pens and markers often incor- sanitary pads. The core materials may Machine belts (industry) porate colophony in the ink to prevent contain wood cellulose and or tall feathering and spreading.12 These have oil resin from spruce or pine trees.32 Newspapers, glossy papers, photographic glossy caused reactions at inked grids drawn Glycerol esters of rosins may be ap- finish paper for patch testing, which may limit the plied to chewing gum as softeners.33 interpretation.27 There are some other Recently in Turkey, neoprene ther- Oil-free sunscreens important sources that may not be so mal sauna shorts were reported to obvious. For example, colophony has contain colophony. Because of this Ostomy appliances also caused airborne contact dermatitis, newly recognized source, it has been asthma, eye irritation and rhinitis.21,22,28 proposed that other neoprene products Paint, lacquers, varnishes, sealants Furthermore, 3 documented sources of should be considered when assessing Postage stamp adhesives airborne contact dermatitis are linoleum for colophony associated ACD. One of floors, floor polish and a factory manu- the principle components of neoprene Salicylic acid plasters (wart removers) facturing dairy product cartons.28 surgical gloves is colophony. More spe- Besides its use as a poultice for sores, cifically, they contain dehydroabietic Sawdust from pine trees dating back to da Vinci, colophony has acid. In neoprene, dehydroabietic acid Shoes been notably used in a wide range of is used in processing the aqueous dis- medical applications, from the treat- persion of neoprene polymers into a Shoe polishes ments for urinary problems, bronchitis gel.34-36 and bone fractures, to boils, tinea cor- Soft yellow bar soaps poris and rheumatism.29-31 In a recent SENSITIZATION AND TESTING Soldering fluxes and soldering agents report, a concoction named Tako-no- Patch testing is the diagnostic mo- Suidashi, an old homeopathic remedy dality of choice in confirming a con- Sport racket handles from Japan, was used to treat pustular tact allergy to a number of agents. Sticking plasters and tapes skin dermatoses, such as carbuncles and Colophony is included on the Thin- cystic acne. Historically this salve con- layer Rapid Use Epicutaneous test as Tiles, linoleum tains a mixture, which is 31.5% rosin. 1200 mcg/cm2 of colophony, which Topical medications In cases describing its use in cystic acne, corresponds to 972 mcg of colophony side effects of significant facial erythema per patch. (T.R.U.E. Test, SmartPrac-

® 40 August 2015 | The Dermatologist | www.the-dermatologist.com ALLERGEN FOCUS tice, Phoenix, AZ).13 The American 2. Hsu JW, Matiz C, Jacob SE. Nickel allergy: lo- doctor.com.au. Accessed July 18, 2015. Contact Dermatitis Society Core 80 calized, id, and systemic manifestations in children. 25. Martin-Garcia C, Conde Salazar L, Gonzalez- Pediatr Dermatol. 2011;28(3):276-280. Mendioca R, Hinojosa M, Sanchez-Cano H. allergen screening panel also includes 3. Salam TN, Fowler JF Jr. Balsam-related sys- Contact dermatitis due to Edding 3000. Allergy. colophony at a concentration of 20% temic contact dermatitis. J Am Acad Dermatol 2004;59(2):235-236. in petrolatum.9 2001;45(3):377-381. 26. Raison-Peyron N, Nilsson U, Du-Thanh A, 4. Nijhawen RI, Matiz C, Jacob SE. Contact der- Karlberg AT. Contact dermatitis from unexpected CLINICAL PEARLS matitis: from basics to allergodromes. Pediatr Ann. exposure to rosin from a toilet seat. Dermatitis. 2009;38(2):99-108. 2013;24(3):149-150. It is important to be aware of the 5. Militello G, Jacob SE, Crawford GH. Allergic 27. Sanchez-Pedreño P, Martínez-Mechón T, increased prevalence of masked, yet contact dermatitis in children. Curr Opin Pediatr Frías-Iniesta J. Contact allergy to a permanent relevant, contact allergies in patients 2006;18(4):385-390. marker. Dermatitis. 2012;23(2):96-97. with any component of the atopic 6. Khan A. Plant Anatomy and Physiology. New Del- 28. Karlberg AT, Gäfvert E, Meding B, Stenberg triad (asthma, allergic rhinitis and hi, India: Gyan Publishing House; 2001. P. Airborne contact dermatitis from unexpected 7. Langerheim J. Plant Resins: Chemistry, Evolution, exposure to rosin (colophony). Rosin sources re- atopic dermatitis). Colophony is one Ecology, and Ethnobotany. Portland, OR: Timber vealed with chemical analyses. Contact Dermatitis. of the reported allergens of increased Press; 2003. 1996;35(5):272-278. incidence in these patients. Therefore, 8. Nix. S. 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Wujanto L, Wakelin S. Allergic contact der- nents to colophonium. hi H. Allergic contact dermatitis caused by gum matitis to colophonium in a sanitary pad— Recall response is a lesser-known rosin and wood rosin in Tako-no-Suidashi oint- an overlooked allergen? Contact Dermatitis. pearl of ACD. Exposure to a previously ment. J Dermatol. 2011;38(10):993-995. 2012;66(3):161-162. sensitized allergen cannot only induce 12. Rietschel RL, Fowler JF Jr, eds. Fisher’s Contact 33. Food additives permitted for direct addi- an inflammatory response at the current Dermatitis. 6th ed. Hamilton, ON: BC Decker Inc; tion to food for human consumption; change 2008:609-611. in specifications for gum or wood rosin deriva- site, but also at the previous sites of ACD 13. T.R.U.E. TEST #7 Colophony—Patient In- tives in chewing gum base. FDA. http://www. 40 to the particular substance. Patch test- formation. https://www.truetest.com/Patient- fda.gov/ohrms/dockets/98fr/CF0126.pdf. Ac- ing can also elicit this response. Asking PDF/Colophony-Patient-Info.pdf. Accessed July cessed July 18, 2015. the patient about their chronic dermati- 19, 2015. 34. Özkaya E, Elinc-Aslan MS, Mirzoyeva L. Al- tis severity during the patch test may be 14. Lucas A, Harris JR, Harris J. Ancient Egyptian lergic contact dermatitis caused by p-tert-butyl- Materials and Industries. Mineola, NY: Dover Pub- phenol formaldehyde resin and colophonium in a clue that one of the positive results is lications; 2011. neoprene thermal sauna shorts.Contact Dermatitis. clinically relevant. n 15. Jacob SE, Chimento S. Focus on T.R.U.E. 2010;63(4):230-232. test allergen #7: Colophony. The Dermatologist. 35. Siegel PD, Law BF, Fowler JF Jr, Fowler Dr. Hamstra is clinical instructor in derma- 2005;13(9):25-28. LM. Disproportionated rosin dehydroabietic tology at Medical University of South Caro- 16. Mirov NT, J Hasbrouck. The Story of Pines. acid in neoprene surgical gloves. Dermatitis. 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