Fisher described "status cosmeticus" (modeled after status asthmaticus) for a patient who has a reaction to all cosmetics or soaps applied to the face.


Key point: The condition is a reaction to irritants in the cosmetics and not caused by an allergic reaction.


Clinical features:

(1) Irritant symptoms (itching, burning, stinging) affect facial skin after exposure to a cosmetic or soap. The symptoms may be severe in the absence of objective signs of inflammation.

(2) The symptoms have been caused by exposure to all or almost all cosmetics and soaps.

(3) Facial skin color may range from normal to focal erythema to butterfly erythema.

(4) Some patients may develop a follicular eruption.

(5) Skin patch testing is negative.

(6) "Use" tests on the forearm are negative.

(7) Symptoms may be more pronounced if facial sweating is present.

(8) Symptoms may be more pronounced with sunburn or facial dermatitis from another cause.


Agents used in cosmetics that may cause irritant symptoms:

(1) benzoic acid

(2) bronopol

(3) cinnamic acid compounds

(4) Dowicill 200

(5) formaldehyde

(6) lactic acid

(7) nonionic emulsifiers

(8) propylene glycol

(9) quarternary ammonium compounds

(10) sodium laural sulfate (SLS)

(11) sorbic acid

(12) urea


Differential diagnosis:

(1) neurosis

(2) atopic dermatitis

(3) physical urticaria

(4) photocontact dermatitis

(5) SLE or other autoimmune disorder


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