Formaldehyde a top allergen obscured on many product labels

David E. Cohen, MD, MPH: “Just because you don't see the term ‘formaldehyde' doesn't mean the product doesn't contain formaldehyde.”

David E. Cohen, MD, MPH: “Just because you don’t see the term ‘formaldehyde’ doesn’t mean the product doesn’t contain formaldehyde.”

Formaldehyde, long known as a preservative linked to contact dermatitis, was named the 2015 Allergen of the Year by the American Contact Dermatitis Society. The dangers of formaldehyde and the many products it is linked to were reviewed Friday during “Hot Topics.”

“This preservative is used in cosmetics and personal hygiene products such as shampoos, soaps, and lotions. The use of wipes is on the increase, and they tend to be pretty heavily preserved. Formaldehyde might be one of those important preservatives that can cause contact dermatitis,” said session director David E. Cohen, MD, MPH, who also presented the contact dermatitis review.

Complicating the issue is the fact that formaldehyde is not clearly listed on the labels of many products, said Dr. Cohen, the Charles C. and Dorothea E. Harris professor of dermatology at New York University’s Langone Medical Center.

“Other preservative systems may appear on the labels, and just because you don’t see the term ‘formaldehyde’ doesn’t mean the product doesn’t contain formaldehyde, so there are caveats,” he said. “Formaldehyde is present in things like nail hardeners, and it may even be present in low concentrations in clothing that has been treated to prevent wrinkling, or in fire retardants. It is everywhere.”

Instead of formaldehyde, what may be listed on product labels is a long, complicated name, such as Quaternium 15, imidazolidinyl urea, bromo-nitropropane, or DMDM hydantoin. This continues a trend of recent years in which preservatives in products are hard to track, such as the 2013 Allergen of the Year, methylisothiazolinone.

“We need to be aware of the importance of preservatives and fragrances in contact dermatitis. Fragrances are an issue that is very important,” Dr. Cohen said. “The main issue is not only that fragrances are an important cause, but the labeling of fragrance products is becoming very complicated.

“It used to be that a product would just say ‘fragrance’ or ‘no fragrance.’ Now, labels are starting to list individual fragrance chemicals, and it is no longer clear that those chemicals are fragrances. The patient — and even the dermatologist — reading it is unaware that these chemicals are there as fragrances because they are listed by chemical name and they are no longer identified as fragrance. We have to have a much more sensitive radar to look for chemicals that represent fragrances.”

Because so many obscure chemicals are camouflaged, growing numbers of people are becoming patients with contact dermatitis.

“It affects almost every dermatologist’s daily practice because people come in with eczema and irritated skin and don’t know what is causing it,” Dr. Cohen said, adding that “Hot Topics” has become a key in helping dermatologists in their practices.

“Dermatology has pivoted to a point in history where we face such a sharp change in the way we are getting information on the pathophysiology of diseases and the advancement of treatment. It is happening at such a breakneck speed that ‘Hot Topics’ is a useful tool to have the membership caught up to speed.”

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