Anisha Riggs
Fragrances and perfumes are frequently cited as causing eczema reactions, and can lead to allergic contact dermatitis. Fragrances are not limited to perfumes and cosmetics, but are also found in personal care products and household products. Dermatitis caused by fragrances often appears on the hands, face, neck, armpits, and patches of skin where perfumes are applied, such as behind the ears, the upper chest, and the wrists. The severity of the allergic reaction can range from mild to severe, and can sometimes require immediate medical attention.
| Characteristics | Values |
|---|---|
| Frequency | Fragrance allergy is believed to affect around 1% of adults. Rates in children and adolescents are around 1.8%. |
| Symptoms | Itchiness, rash, swelling in the mouth, lips, or tongue, anaphylaxis. |
| Treatment | Oral antihistamines like cetirizine (Zyrtec), diphenhydramine (Benadryl), or loratadine (Claritin). Topical corticosteroid creams. |
| Prevention | Avoid the substance causing the allergy. Choose perfumes with minimal ingredients. |
| At-risk groups | Women, especially on the hands, face, and neck. Men, especially on the hands, face, and lower legs. |
| Other affected areas | Armpits, perianal skin, behind the ears, upper chest, elbow flexures, and wrists. |
| Other products containing fragrances | Body wash, lotions, shampoos, conditioners, deodorants, baby wipes, sanitary pads, laundry detergents, fabric softeners, air fresheners, cleaning agents, candles, etc. |
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What You'll Learn
Fragrance allergy and dermatitis
Fragrances and perfumes are among the most frequently cited substances in personal and cosmetic care products that cause eczema reactions. They can be made from natural extracts or be synthesised and produce a pleasant scent or disguise an unpleasant odour. Fragrance allergy is an allergic contact dermatitis to a fragrance chemical. This requires prior sensitisation to the fragrance chemical, and subsequent skin contact with the chemical causes a delayed hypersensitivity reaction in the hours to days after exposure.
Fragrance allergy is believed to affect around 1% of adults, with rates in children and adolescents being around 1.8%. It is the second most common cause of allergic contact dermatitis after nickel allergy. However, the frequency of relevant positive reactions in dermatology departments is falling due to the reduced use of oakmoss absolute as a fragrance. Fragrance allergy presents as a dermatitis which is often in a streaky pattern where there has been direct contact with the fragrance allergen. In women, the hands, face, and neck are most commonly affected, whereas in men, it is the hands, face, and lower legs. The fragrance chemical can be transferred to an unexpected site, for example, via the hands onto the face. Involvement of the armpits is common in both sexes. Other locations affected include perianal skin if perfumed toilet paper wet wipes, or haemorrhoid preparations are used.
Fragrances are not limited to perfumes and cosmetics. They are also found in personal care products such as body wash, lotions, shampoos, conditioners, deodorants, baby wipes, and sanitary pads. They are also found in household products such as laundry detergents, fabric softeners, air fresheners, cleaning agents, candles, potpourri, and toilet paper. Flavours added to food and drinks, lipsticks, lip balms, and toothpaste may also contain fragrances. Work-place chemicals may also have aromas added to cover unpleasant smells, for example, coolant oils, histology solvents, and industrial solvents. Occupational dermatitis due to fragrance allergy is seen in hairdressers, chefs and bakers due to flavouring agents and citrus fruit, and in aromatherapists and masseurs due to the use of scented natural oils.
Patch tests can be used to determine specific allergic triggers. Once an individual knows what they are allergic to, they can try to avoid any perfumes that contain those ingredients. Treatment for a perfume allergy should be based on symptoms and the substance that causes the allergy. The first thing to do is to avoid the substance causing the allergy. Medications such as oral antihistamines like cetirizine (Zyrtec), diphenhydramine (Benadryl), or loratadine (Claritin) can help with itching and stuffiness. Topical corticosteroid creams can also be applied to itchy areas or rashes.
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Symptoms of perfume allergy
Fragrance allergies are a type of abnormal immune reaction to ordinarily harmless substances in fragranced products. This type of allergy generally causes symptoms on the skin that can be treated with medication. Fragrance allergy is common and is believed to affect around 1% of adults, with rates in children and adolescents being around 1.8%.
Perfumes can cause allergic contact dermatitis, which is a type of delayed hypersensitivity reaction that occurs in the hours to days after exposure. This reaction can cause a rash on the skin that has been directly exposed to the irritating substance. The rash is often itchy and uncomfortable but is not contagious. In addition to the rash, other symptoms of perfume allergy can include itching without a rash, a mild headache, and sneezing.
The most common areas for allergic contact dermatitis to appear are the hands, face, neck, and armpits. This is because these areas are often exposed to fragrances through direct application or transfer via the hands. In women, the face and neck are especially commonly affected, while in men, the lower legs are also commonly affected.
More severe symptoms of perfume allergy can include swelling in the mouth, lips, or tongue, which may make it harder to breathe, eat, or talk. Anaphylaxis is a rare but serious reaction that can occur, where the airways become inflamed and close up, making it difficult or impossible to breathe. If you experience any of these severe symptoms, seek immediate medical attention.
If you suspect you have a perfume allergy, you can undergo patch testing to identify specific allergens that trigger your allergy. This involves exposing the skin to small amounts of different allergens to determine which substances cause a reaction. Once you know your specific triggers, you can avoid perfumes and fragranced products that contain those ingredients.
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Eczema and perfume
Eczema is a skin condition that can be triggered by various factors, including allergies to fragrances found in perfumes. Fragrances and perfumes are one of the most frequently cited substances in personal and cosmetic care products that cause eczema reactions.
Perfumes and fragrances are made from natural extracts or synthesised chemicals that produce a pleasant scent or disguise unpleasant odours. While natural ingredients like German chamomile or Roman chamomile are not considered true fragrances, some people may be sensitised to these ingredients, and since they are often clearly labelled, they can be avoided. However, products labelled "unscented" or "fragrance-free" may still contain fragrance components known as masking fragrances, which can include allergens such as rose oil, vanilla, and sweet almond oil.
Fragrance allergy is a form of allergic contact dermatitis, and it is the second most common cause of allergic contact dermatitis after nickel allergy. Fragrance allergy affects around 1% of adults and 1.8% of children and adolescents. It occurs when the body identifies an ingredient in the perfume as a foreign substance and releases an inflammatory reaction. This reaction can manifest as an itchy red rash, itching without a rash, or more severe symptoms like swelling in the mouth, lips, or tongue, and anaphylaxis. The severity of dermatitis can range from mild to severe and may affect the hands, face, neck, armpits, and patches where perfumes are typically applied, such as behind the ears, the upper chest, elbow flexures, and wrists.
To diagnose a fragrance allergy, patch tests are used to expose individuals to small amounts of different allergens and determine their specific triggers. Once an individual knows their triggers, they can avoid perfumes containing those ingredients and opt for natural, plant-based perfumes with minimal ingredients to reduce the chance of allergic or sensitive reactions. While it can be challenging to entirely avoid perfumes that cause allergic reactions, treatments for mild, temporary symptoms include oral antihistamines and topical corticosteroid creams.
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Natural ingredients and allergens
Fragrances and perfumes are one of the most frequently cited substances in personal and cosmetic care products that cause eczema reactions. Fragrance allergy is an allergic contact dermatitis to a fragrance chemical. Fragrances can be made from natural extracts or be synthesised. They can produce a pleasant scent or disguise an unpleasant odour.
Natural ingredients with a scent such as Bisabolol (German Chamomile) or Anthemis Nobilis (Roman Chamomile) are not true fragrances. However, some people may be sensitised to these ingredients, and since they are clearly labelled, they can be avoided. Personal care products that are labelled “unscented” or “fragrance-free” may still contain fragrance components, sometimes called masking fragrances. These products may contain allergens such as rose oil, vanilla, and sweet almond oil.
Some natural extracts that are considered high risk for causing sensitisation are balsam of Peru, Fragrance Mix I (FM I), and Fragrance Mix II (FM II). Isoeugenol is the most common positive allergen in FM I, and hydroxyisohexyl 3-cyclohexene carboxaldehyde (Lyral) in FM II. Other fragrance ingredients that have been associated with allergic reactions include jasmine absolute, ylang-ylang oil, cananga oil, benzyl salicylate, hydroxycitronellal, sandalwood oil, geraniol, and geranium oil.
It is important to note that not all ingredients in perfumes that cause a reaction are allergens. Many are simply synthetic or chemical irritants. Allergens are technically proteins that the body reacts to with an inflammatory response. Therefore, a true perfume allergy occurs when an organic protein in a perfume ingredient causes the reaction. Symptoms of a perfume allergy include an itchy red rash, itching without a rash or irritation, and shortness of breath.
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Treatment and avoidance
The primary treatment for a perfume allergy is avoidance. This involves steering clear of fragrances that trigger symptoms. Reading product labels and opting for fragrance-free options can help. It is important to note that products labelled as "unscented" or "fragrance-free" may still contain fragrance components, sometimes called masking fragrances, to cover up offensive odours. These products may contain allergens such as rose oil, vanilla, and sweet almond oil.
If complete avoidance is not possible, over-the-counter (OTC) treatments like antihistamines, corticosteroids, and decongestants can help alleviate symptoms. For skin reactions, topical steroids, emollients, or ointments may be prescribed to manage symptoms of allergic contact dermatitis. Oatmeal baths can also help. If symptoms persist despite OTC treatments and avoidance strategies, a doctor may recommend immunotherapy. This involves putting a small amount of the allergen under the tongue to help the body build resistance.
To avoid triggering a perfume allergy, it is important to educate oneself and others about the condition. This includes understanding one's triggers and being vigilant, especially in public spaces and social situations. This might mean skipping certain events or requesting scent-free spaces.
To diagnose a perfume allergy, it is recommended to consult a healthcare provider. They may use a patch test or a skin prick test. A patch test involves placing patches with small amounts of suspected allergens on the skin for 48 hours, then examining the skin for reactions such as redness, bumps, or blisters. A skin prick test involves pricking the skin with a tiny amount of the suspected allergen and observing for any reaction. Self-diagnosis can lead to more skin inflammation and worsening symptoms.
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Frequently asked questions
A perfume allergy is when your body has a specific immune system response to an ingredient or a chemical in the perfume. This response usually develops over a course of days and manifests as itchiness or a rash.
Most allergic reactions typically result in an itchy red rash that goes away soon after exposure to the perfume. Some mild symptoms can last for a few weeks. Other reactions are much more severe and can happen quickly. Some of these symptoms might need immediate medical attention. They are, however, extremely rare. Some severe, emergency symptoms to watch out for are swelling in your mouth, lips, or tongue.
You can get a patch test to expose yourself to small amounts of different allergens to determine your specific allergic triggers. Once you know what you are allergic to, you can avoid any perfumes that contain those ingredients.
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