AN EPIDEMIC OUTBREAK OF PAPULAR AND FOLLICULAR CONTACT-DERMATITIS TO TOCOPHERYL LINOLEATE IN COSMETICS

Background: In Spring 1992, an epidemic outbreak of papular and follic ular rashes caused by a new line of cosmetics occurred throughout Swit zerland. Objective: Epidemiological and clinical data were collected i n order to identify the offending agent and to specify the pathophysio logical mechanisms. Methods: The data concerning 263 patients seen by dermatologists plus 642 additional cases directly reported by consumer s to the manufacturer wee analyzed. Seventy-seven patients were patch- tested, 26 extensively and 15 performed a repeated open application te st for a duration of 4 weeks. Control patch and use tests were perform ed in 73 and 25 patients, respectively. The results were analyzed stat istically. In addition, 12 skin biopsies were performed for histologic al examination. Biochemical studies on the cosmetics (final products a nd offending ingredient) supplemented the clinical studies. Results: T he lesions were mainly papular and follicular, widely distributed, wit h pronounced pruritus, which was aggravated by sweating or heat exposu re, and were long lasting. In a few cases, the papules were located on intensely erythematous, well-defined plaques, suggesting irritation r ather than allergy. Both immediate and delayed onsets of the lesions w ere observed. Skin biopsies showed signs of folliculitis and perifolli culitis with little alteration of the interfollicular epidermis. Patch and use testing disclosed Vitamin E linoleate (R) (a mixture of tocop heryl esters, mainly tocopheryl linoleate) as the offending agent. An in vitro time-dependent formation of oxidative products under storage or oxidation-stimulating conditions was observed. Conclusion: Though v itamin E eaters have been widely and safely used for decades in dermat ological preparations and in cosmetics, vitamin E linoleate was the ca use of about 1,000 cases of unusual papular mainly follicular contact dermatitis. Oxidized vitamin E derivatives could act in vivo as hapten s and/or irritants, possibly with synergistic effects.