INTRODUCTION: Cosmetic intolerance syndrome is a condition attributed to multiple exogenous and endogenous factors.m Although considered a wastebasket diagnosis by some, it has proven to be a highly challenging, if not frustrating, condition for both the dermatologist and the patient. It is believed to be quite common, but underreported.
CASE SUMMARY: A 22-year-old Filipino woman presented with a 2-year history of recurrent facial redness and itching. Flare-ups of social symptoms and signs are associated with the application of cosmetics. Exacerbations have also been perceived to occur with the intake of bread, milk chocolate, cheese and shrimp, as well as handling of coins. The patient also has comedonal acne for which she has been using various topical anti-acne medications, such as benzoyl peroxide and tretinoin. She has a history of seborrheic dermatitis, allergic contact dermatitis (ACD) due to jewelry, and chronic hand dermatitis. She has a personal and family history of atopy. Diagnostic patch test was performed using the 70-allergen series. Reading after 48 hours revealed strong reactions to fragrance mix, formaldehyde, nickel sulfate, benzoyl peroxide, and thimerosal. Given the recurrent nature of facial tightness, discomfort, erythema and pruritus, noted to increase in severity with application of various cosmetics, the documentation of the above allergies, and the concomitant presence of atopy, acne vulgaris, and seborrheic dermatitis, the diagnosis of cosmetic intolerance syndrome is made.
CONCLUSION:Increasing awareness and recognition of cosmetic intolerance syndrome is important. Controlling concurrent endogenous conditions, together with correct identification of exogenous triggers, as well as patient education on avoidance and substitution of culprit substances, are the cornerstones to successful management of this challenging condition.