Allergic contactdermatitis to panthenoland cocamidopropylPG dimonium chloridephosphate in a facialhydrating lotion

Contact Dermatitis 2006: 55: 369–370

Hugh Roberts1, Jason Williams1 andBruce Tate2

1Occupational Dermatology Research andEducation Centre, Skin and CancerFoundation, Melbourne, Victoria, VIC 3053,Australia, and 2Skin and Cancer Foundation,Skin and Cancer Foundation Melbourne,Victoria, VIC 3053, Australia

Dexpanthenol is the alcohol correspond-

ing to pantothenic acid (the water-soluble

vitamin B5). Although it is a common

ingredient in many pharmaceuticals and

cosmetics, contact allergy is relatively

uncommon. Cocamidopropyl PG dimo-

nium chloride phosphate is a phospholipid

complex derived from pure coconut oil,

and contact allergy is rare.We report a case

of allergic contact dermatitis to panthenol

and cocamidopropyl PG dimonium chlo-

ride phosphate in a facial hydrating lotion.

Key words: coconut oil; cosmetic; dexpan-thenol; site specificity; vitamin B5.

Case report

A 55-year-old woman presented withthree episodes of severe erythema andswelling of the face, eyelids, and neck.Each episode lasted approximatelyfour days and responded rapidly toshort courses of oral corticosteroids.The causative agent was unclear,although the patient had attributedthe reactions to the use of variousperfumes. Apart from a history ofhay fever, she was otherwise welland taking no medications.

Patch tests to a modified Euro-pean standard series, supplemen-tary, cosmetic, and hairdressingseries, were all negative. Patch test-ing to the patient’s own cosmeticsrevealed a weak (few papules) 1þreaction to Aveda� Botanical Kinet-ics hydrating lotion, present on day2 (D2) and D4. The manufacturerwas contacted, and individual ingre-dients at appropriate dilutions wereobtained for further patch testing.The patient developed a 2þ reactionto cocamidopropyl PG dimoniumchloride phosphate 2.5% aqueousand a 1þ reaction to dexpanthenol0.5% aqueous (both D4). Repeattesting to the Aveda� BotanicalKinetics hydrating lotion, sited onthe arm, gave a stronger 1þ reaction(significantly more papules but novesicles) on both D2 and D4.

Discussion

Dexpanthenol (International No-menclature of Cosmetic Ingredients

CONTACT POINTS 369

(INCI) name panthenol) is the alco-hol corresponding to pantothenicacid (the water-soluble vitamin B5).It is a common ingredient in manypharmaceuticals and cosmetics.Topical dexpanthenol acts as a mois-turizer and maintains skin softnessand elasticity (1). It reduces transe-pidermal water loss, improveshydration of the stratum corneum,and stabilizes the epidermal barrierfunction (2). Dexpanthenol has alsobeen shown to accelerate skin re-epithelialization and activation offibroblast proliferation and is usedfor the treatment of minor skin disor-ders including sunburn and burns (2).It is a frequent component of sham-poos and hair conditioners as it coatsand seals the hair surface, making hairappear more shiny. Although dexpan-thenol is widely used, contact allergyis relatively uncommon (3–4). Onestudy has shown positive reactions in0.34% of patients tested (5/1474),with relevance found in four of thesefive cases (5). It is also a cause of con-tact urticaria (6).

Cocamidopropyl PG dimoniumchloride phosphate is a phospholipidcomplex derived from pure coconutoil. It has skin conditioning properties,broad-spectrum antimicrobial activity,and minimal irritant properties (7).Contact allergy is rare, and to the bestof our knowledge, there has been only1 other reported case (7). However, inthis paper, the authors were aware ofother unreported cases (7).

We are not aware of contact allergyto dexpanthenol and cocamidopropylPG dimonium chloride phosphatebeing reported in combination. Thiscase highlights the importance ofobtaining individual ingredients fromthe product manufacturer, particu-larly in cosmetics with multiple com-mon ingredients. It also points to thepotentially difficult issue of site spec-ificity of patch testing when initialreactions are weak.

Acknowledgements

The Occupational DermatologyResearch and Education Centre isfunded by the Australian Govern-ment Department of Health and Age-ing as the National CollaborativeCentre for Research and Educationinto Occupational Contact Dermati-tis. Dr Jason Williams is in receipt ofresearch grants from the BritishOccupational Health Research Foun-

dation and the Skin and CancerFoundation, Vic Inc.

References

1. Stables G I, Wilkinson S M. Allergiccontact dermatitis due to panthenol.Contact Dermatitis 1998: 38: 236–237.

2. Ebner F, Heller A, Rippke F, Tausch I.Topical use of dexpanthenol in skindisorders. Am J Clin Dermatol 2002:3: 427–433.

3. Gollhausen R, Przybilla B, Ring J.Contact allergy to dexpanthenol. Con-tact Dermatitis 1985: 13: 38.

4. Jeanmougin M, Manciet J R, MoulinJ P et al. Contact allergy to dexpanthe-nol in sunscreens. Contact Dermatitis1988: 18: 240.

5. HemmerW,BracunR,Wolf-AbdolvahabS et al. Maintenance of hand eczemaby oral pantothenic acid in a patientsensitized to dexpanthenol. ContactDermatitis 1997: 37: 51.

6. Schalock P C, Storrs F J, Morrison L.Contact urticaria from panthenol inhair conditioner. Contact Dermatitis2000: 43: 223.

7. Lorenzi S, Placucci F, Vincenzi C,Tosti A. Contact sensitization to coca-midopropyl PG-dimonium chloridephosphate in a cosmetic cream. Con-tact Dermatitis 1996: 34: 149–150.

Address:Dr Jason WilliamsPO Box 132Carlton SouthVic 3053Australiae-mail: jwilliams@occderm.asn.au

370 CONTACT POINTS