Clinical Spectrum of Dermatoses Caused by Cosmetics in South India

Letters to the Editor emphasize that dermatofibromas may clinically resemble from August 2004 to June 2006 to estimate the frequency neurofibromas or xanthomas, further multiple tumors can of dermatoses caused by cosmetics in patients attending be effectively excised with carbon dioxide laser. dermatology OPD and to clinically characterize various types of dermatoses caused by cosmetics. DD.. SS.. KKruparupa SShankar,hankar, AA.. AA.. KKushalappa,ushalappa, KK.. SS.. SSuma,uma, SSanjayanjay AA.. PPaiai Seventy-one patients with various types of cosmetic Department of Dermatology, Manipal Hospital, dermatoses were seen. Mean age of the patients was 42.9 Bangalore, India. years with female to male ratio of 1.6:1. Kumkum alone was the responsible cosmetic product in 41 patients (57.7%). AAddressddress foorr ccorrespondence:orrespondence: Dr. Krupa Shankar DS, Department of Dermatology, Manipal Hospital, 98, Rustom Bagh, Airport Road, Sticker bindi alone was incriminated in eight patients (11.3%), Bangalore, India. E-mail: [email protected] kumkum and sticker bindi both in five patients (7%), hair dye in eight patients (11.3%), lightening creams in four patients RREFERENCESEFERENCES (5.6%) and after-shave lotion, nail polish, moisturizing cream, tilak and toothpaste in one patient each. Face was involved 1. Halpryn IH, Allen AC. Epidermal changes associated with in 69 patients (97.1%), scalp and neck were involved in eight sclerosing haemangiomas. Arch Dermatol 1959;80:160. patients each (11.3%), abdomen in five patients (7%) and 2. Bedi TR, Pandhi PK, Bhutani LK. Multiple palmoplantar infra-axillary area in one patient (1.4%). Most common type of histocytomas. Arch Dermatol 1976;122:1001-3. 3. Gonzalez S, Duarte I. Benign fibrous histiocytoma of the skin. A cosmetic dermatosis was pigmented contact dermatitis (PCD) morphologic study of 290 cases. Pathol Res Pract 1982;174:379- (40 cases), followed by allergic contact dermatitis (ACD) (24 91. cases), leukoderma seen in nine patients, hypopigmentation 4. Kuniyuki S, Shindow K. Multiple dermatofibromas accompanied seen in two patients and acneiform eruptions seen in one by eruptive benign keratosis in a patient with systemic lupus patient. erythematosus. J Dermatol 1996;23:619-22. 5. Toda S, Heasley DD, Carlson JA, Mihm MC Jr. Lentiginous Cosmetic products most commonly incriminated for melanocytic hyperplasia overlying dermatofibroma. J Dermatol .com). 1996;23:840-4. dermatitis are different in different countries and the pattern 6. Calonge E, Fletcher CD. Cutaneous fibrohistiocytic tumors: An of dermatitis is determined by the way local populations update. Adv Anat Pathol 1994;1:2. use the cosmetic products.[3] According to Pasricha,[4] most 7. Nowak KC, McCorack M, Koch RJ. The effect of superpulsed common cause of contact dermatitis due to cosmetics in carbon dioxide laser energy on keloid and normal dermal India is hair dye. Mehta et al[5] suspected sticker bindi, hair fibroblast secretion of growth factors. Plast Reconstr Surg dye and face creams to be the most common causes in that 2000;105:2039-48. .medknow order of frequency. Kumar et al[6] reported face creams as the most common (30%) cause of cosmetic dermatitis, followed by hair dye (16%) and soaps (14%). CClinicallinical spectrumspectrum ofof ddermatosesermat(wwwoses ccausedaused byby cosmeticscosmetics iinn ssouthouth Particular cosmetics, such as kumkum, bindi, tilak, are applied in India and a few other countries among the Hindus.[5] IIndia:ndia: HHighigThish pprevalencere PDFvaa lsiteen isc ehosted available ofof kumkumkum byku mforMedknow freeHence, download dermatitis Publications due to thesefrom products are reported only in Indians.[4,5] In our study, kumkum was the most common cause ddermatitisermatitis of cosmetic dermatoses (46/71 patients, 64.7%). Typically, kumkum is used by women of Indian origin (especially the Sir, Hindus).[4,7,8] But, in our study, males were also involved by Cosmetics are defined as “articles intended to be rubbed, kumkum dermatitis in significant proportion (16/46, 34.8%). poured, sprayed on or sprinkled, introduced into or They were using kumkum for religious purposes. In south otherwise applied to the human body or any part thereof for Indian states ‘kumkum’ is prepared at home by alkalizing pure cleansing, beautifying, promoting attractiveness or altering turmeric powder[4] but commercial kumkum is used more the appearance”.[1] Adverse cutaneous reactions to cosmetics often nowadays. The exact composition of commercially can be of various types.[2] available kumkum is not known, but is known to contain starch or chalk powder colored with various azodyes.[8] Other A descriptive study was conducted in the department of known components in commercial kumkum include various Dermatology and STD, in a tertiary care centre in south India dyes (coal tar dyes, toluidine red, erythrosine and lithol red

Indian J Dermatol Venereol Leprol|May-June 2007|Vol 73|Issue 3 195 Letters to the Editor calcium salt),[2] fragrances, groundnut oil, tragacanth gum, 4. Pasricha JS. Contact Dermatitis in India. 2nd ed. The Offsetters: turmeric powder, parabens,[9] and canaga oil.[7] New Delhi; 1988. p. 67-85. 5. Mehta SS, Reddy BS. Pattern of cosmetic sensitivity in Indian patients. Contact Dermatitis 2001;45:292-3. The bindi spot is traditionally worn only by married Hindu 6. Kumar P, Paulose R. Cosmetic dermatitis in an Indian city. women, but it is now regarded as a fashion accessory and Contact Dermatitis 2006;55:114-5. is worn by unmarried women and even by non-Hindus. The 7. Kumar JV, Moideen R, Murugesh SB. Contactants in ’Kum-Kum’ spot may be painted on the skin or a plastic disc secured with dermatitis. Indian J Dermatol Venereol Leprol 1996;62:220-1. adhesive may be used.[10] Contact dermatitis can develop to 8. Kumar AS, Pandhi RK, Bhutani LK. Bindi dermatoses. Int J them depending upon the material used to make the bindi Dermatol 1986;25:434-5. mark. Adhesive material in sticker bindi is also known to 9. Goh CL, Kozuka T. Pigmented contact dermatitis from ‘kumkum’. produce contact dermatitis.[11,12] Another unique product used Clin Exp Dermatol 1986;11:603-6. 10. Dwyer CM, Forsyth A. Allergic contact dermatitis from bindi. by the Hindus is tilak, which is either chandan - powdered Contact Dermatitis 1994;30:174. [4] dry wood of the sandal tree (Santalum alba) or ash. 11. Dogra A, Dua A. Cosmetic dermatitis. Indian J Dermatol 2005;50:191-5. According to an Indian study by Dogra et al,[13] the commonest 12. Baxter KF, Wilkinson SM. Contact dermatitis from a nickel- type of cosmetic dermatosis was contact allergic dermatitis containing bindi. Contact Dermatitis 2002;47:55. (29/49 cases, 59.2%), followed by contact irritant dermatitis (15 13. Dogra A, Minocha YC, Kaur S. Adverse reactions to cosmetics. cases), hyperpigmentation (eight cases), hypopigmentation Indian J Dermatol Venereol Leprol 2003;69:165-7. 14. Osmundsen PE. Pigmented contact dermatitis. Br J Dermatol (six cases), contact urticaria (five cases), acneiform eruptions 1970;83:296-301. (four cases), hair breakage (two cases) and nail breakage (one case). The most common type of cosmetic dermatosis seen in our study was pigmented contact dermatitis (40/71 patients). OOculosporidiosisculosporidiosis presentingpresenting asas anan

The term ‘pigmented contact dermatitis’ was introduced under-eyeunder-e.com).ye swellingswe lling by Osmundsen in 1970 to explain the pigmentation which followed contact dermatitis. However, the dermatitis may Sir, not be clinically overt and hyper pigmentation can be the Rhinosporidiosis is a chronic granulomatous infection of only visible manifestation of a contact allergy.[14] Kumkum mucous membranes caused by Rhinosporidium seeberi, which is emerging as an important cause of pigmented contact.medknow presents usually to the otolaryngologist for vascular friable dermatitis in recent reports.[8,10] polyps. Several cases of rhinosporidiosis have been reported from Bhilai and neighborhood in the Chhattisgarh state.[1-4] AAmiyamiya KKumarumar NNath,ath, DDevinderevinder MohanMoha(wwwn ThappaThappa We came across a patient with ocular rhinosporidiosis who Department of Dermatology and STD, Jawaharlal Institute of presented to the dermatology outpatient department with Postgraduate Medical Education and Research (JIPMER), Pondicherry, India. eyelid swelling.

AAddressddress foorr ccorrespondence:orrespThisondence: DrPDFa. De vindersite is Mohan hosted available Thappa, Depar bytment forMedknow freeAn 18-year- download oldPublications male patient from from a small village near Bhilai, of Dermatology and STD, JIPMER, Pondicherry, was referred by an ophthalmologist for a gradually progressive India. E-mail: [email protected] swelling under the right eye of 8 months duration. He felt pain in the swelling since the last two weeks. A history of bathing RREFERENCESEFERENCES regularly in the village pond with buffaloes was present. He had scanty bloody nasal discharge for 6 months, but had not 1. Engasser PG, Maibach HI. Cosmetics and skin care in dermatology practice. In: Freedberg IM, Eisen AZ, Wolff consulted any doctor. There was no family history of similar K, Austen KF, Goldsmith LA, Katz SI, editors. Fitzpatrick’s complaints. Dermatology in General Medicine. 6th ed. McGraw-Hill; New York; 2003. p. 2369-79. Cutaneous examination showed a diffuse, soft, skin colored, 2. Mehta SS, Reddy BS. Cosmetic dermatitis-current perspectives. non-tender, fluctuant swelling over the right medial canthus, Int J Dermatol 2003;42:533-42. 3. Gomez Vázquez M, Fernández-Redondo V, Toribio J. measuring about 4 cm x 3 cm in size [Figure 1]. The overlying Allergic contact eczema/ dermatitis from cosmetics. Allergy skin had an orange peel appearance albeit without any rise 2002;57:268-9. in local temperature. His systemic examination and blood

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