We all want to smell nice, that’s why there is such a massive perfume industry! It adds that va va voom to your personal wardrobe, it makes a statement, it can even identify you as a unique individual. Unfortunately, dermatologically approved products should never contain fragrance. Anyone with a dermatological condition that has seen a dermatologist will recognise this. Why? Because the population of people or patients that we see generally have a faulty skin barrier and so are at increased risk of becoming sensitised or allergic to allergens of which perfume is a big one. Hence, everything we prescribe or recommend for your skin will generally not lather or smell particularly nice – sorry.
But should everyone avoid fragrance? Well, no. If you have normal skin with no skin disease then perfumed or fragranced products should be fine. It was however interesting to read in the January 2022 edition of the journal Pediatric Dermatology of a severe irritant contact dermatitis to perfume in a 10-year old girl.
[Zhong L-S, Huang B-Q, Tang W-T et al. Bullous impetigo-like irritant contact dermatitis caused by perfume. Pediatr Dermatol 2022;00:1-2.]
What’s an irritant contact dermatitis vs an allergic contact dermatitis?
An allergic contact dermatitis happens when an allergen lands on the skin (airborne or direct application) which then stimulates an immunological response. The second time the allergen lands on the skin is when a reaction happens. This typically looks like a worsening of eczema usually at the site of application or touching. If you remove the allergen, then the problem should improve though the person will probably still have eczema.
An irritant contact dermatitis can happen to anyone, it just requires irritating the skin enough to damage the skin barrier. The most simplistic way of thinking about this would be to think of someone with normal skin sticking their hands in a bucket of bleach. Bleach is an irritant to the skin and so you get damage to the skin barrier and the skin of the hands which were in contact with the bleach will be affected. If you take the irritant away, the skin should improve back to normal.
So what happened in this case?
The 10-year old girl had spilt the contents of an aroma reed diffuser oil bottle onto her undershirt which she then wore for a nap about an hour later. After she woke from her nap around 2 hours later, she complained of red, painful skin which later went on to blister and peel (desquamate) in the areas of contact with the perfume soaked undershirt.
How did they know it was perfume that caused it?
Well, the girl was investigated to see if there were any bacteria or fungi implicated (there were none) and her blood tests were largely okay. She improved with a mixture of intravenous and oral steroids.
The authors deduced it was the concentrated perfume in the aroma seed oil that caused an irritant contact dermatitis, not an allergic contact dermatitis because she had no prior history of skin disease, had not been in contact with the perfume before and there was a very short interval between contact with the perfume and the skin problems developing.
So what does this case tell us?
I think it highlights to medics and non-medics the importance of taking a history and not just going by what you can see on examination as the pictures in the article do look alarming and could easily be treated as impetigo or even one of the immunobullous disorders.
Also, it highlights to the everyone that perfumes, like everything in life, are safe in small to moderate amounts (in those without skin disease!) but if you spill a whole bottle full on your clothes, don’t go to sleep in them and wash them straight away!
Dr Sandy Flann, Consultant Dermatologist