Cosmetics Induced Dermatitis due to Facial Mask 甘草酸苷美白面膜导致的皮炎

Facial whitening masks/creams/gels are used commonly by Asian women who expects the aesthetic effect on their coloured skin. However, many natural products contain high concentrations of botanical extracts that are a leading cause of both irritant and allergic contact dermatitis and photosensitisation [1,2]. We herein present a case of cosmetics induced dermatitis attributed to the prolonged (3 years) use of facial mask containing glycyrrhizic acid 甘草酸苷 (Licorices Glycyrrhiza Glabra extracts甘草提取物) and resveratrol 白藜芦醇 (Polygonum Cuspidatum extract 虎杖提取物).

Case: A 30-year-old woman presented with infiltrative erythema on face and neck. The symptoms appeared 1 year ago, the patient went for skin allergy test and found out nothing positive. Her blood investigation and urine analysis were normal. She was treated with laser therapy, erythema papule subsided but rebound again. She had been treated with steroid ointment and improved although the eruptions later recurred. She has used various kinds of over-the-counter cream which produced no satisfiable results. She was administrated with immunosuppressant cream Protopic (tacrolimus) which cause the face burning and more reddish.
licorice glycyrrhizic
Clinical examination revealed erythema accompanied by pruritus on the face and neck, mostly around the cheek, which still persists. Possible diagnoses included allergic contact dermatitis, photo-contact allergy, and photosensitivity disorder. The patch test and photo-patch test was negative. The minimal erythema dose (MED) and minimal response dose (MRD) were both within the normal range. Additional patch testing with the ingredients of the cosmetic cream/gel/mask produced a negative reaction too. Her serum ANA test was normal.
licorice dermatitis A3
In re-investigation of her history, she disclosed that she had begun using a cosmetic whitening mask on her face over three years. We suspected cosmetics induced dermatitis due to facial mask active ingredients which contain glycyrrhizic acid 甘草酸苷 (licorice Glycyrrhiza Glabra extracts甘草提取物) and resveratrol 白藜芦醇 (Polygonum Cuspidatum extract 虎杖提取物). Skin-whitening agents are mostly thought to be safe, but there are some reported cases of allergic contact dermatitis due to the ingredients of these agents [3-6]. Glycyrrhetic acid, the active metabolite in licorice, inhibits the enzyme 11-ß-hydroxysteroid dehydrogenase enzyme type 2 with a resultant cortisol-induced mineralocorticoid effect [7]. The glycyrrhizic acid and resveratrol are more popular ingredient of facial cosmetics in Asia, as they produce corticosteroids like action, eg. anti-allergic and anti-inflammation [8,9] which produced a negative reaction on patch test, but long term abuse may damage the skin barrier.

The patient discontinued face mask and was treated with Tangs herbal medicine in our clinic and the lesions healed completely after 5 months.

licorice dermatitis B5

亚洲女性痴迷于皮肤美学，指望用面膜、乳霜、凝胶等美白产品让皮肤靓丽一新。但是，许多天然产品都含有高浓度的植物提取物，这些提取物也可能是过敏性接触性皮炎以及光敏性皮炎的主要原因[1,2]。我们在此介绍一例面膜诱发皮炎，该病例归因于一款长期使用（超过3年）的面膜，该面膜含有甘草酸苷（甘草提取物）和白藜芦醇（虎杖提取物） 。

病例：一名30岁的女性在脸上和脖子上出现了渗透性红斑。该症状出现于一年前，患者进行了皮肤过敏测试，未发现任何阳性反应。她的血液检查和尿液分析正常。她接受了激光治疗，红斑丘疹消退但又反弹。她接受了皮质类固醇药膏的治疗，尽管病情好转，但是停药后再次发作。她使用了各种非处方药，但效果均不令人满意。她也曾涂抹免疫抑制剂他克莫司乳霜Protopic，不幸的是该乳霜导致她的脸部灼热和泛红加重。

临床检查：脸部出现红斑并伴有瘙痒，大部分出现在脸颊周围，颈部少许，仍在继续扩散。可能的诊断包括过敏性皮炎、接触性皮炎和光敏性疾病。斑贴试验和光斑贴试验为阴性。最小红斑剂量（MED）和最小反应剂量（MRD）均在正常范围内。使用过的美容霜/凝胶/面膜的成分进行了贴剂测试也没有产生阳性反应。她的血清ANA检验都正常。

在对她的病史进行重新调查时，她透露，三年来，她一直使用一款化妆品美白面膜，美白的效果令她痴迷。我们怀疑这款面膜中含有的甘草酸苷（甘草甘草提取物）和白藜芦醇（虎杖提取物）引发了皮炎。美白化妆品通常被认为是安全的，但是有临床报告显示有些试剂的成份会引发过敏性接触性皮炎[3-6]。甘草中的活性代谢产物甘草次酸抑制2型酶11-ß-羟基类固醇脱氢酶，从而产生皮质醇诱导的盐皮质激素效应[7]。甘草酸苷、甘草次酸和白藜芦醇在亚洲是美容化妆品中受欢迎的成份，因为它们会产生类似皮质类固醇样的抗过敏和抗发炎作用[8,9]，所以斑贴试验呈现阴性，但是长期滥用可能会损害皮肤。

患者停用了令她寝食难安的面膜，并在我们的诊所接受治疗，面部红斑皮疹在5个月后完全消退。

 

Reference:

  1. Kiken  DA, Cohen  DE.  Contact dermatitis to botanical extracts.  Am J Contact Dermat. 2002;13(3):148-152.
  2. Rubin CB, Brod B. Natural Does Not Mean Safe—The Dirt on Clean Beauty Products. JAMA Dermatol.2019;155(12):1344–1345. doi:10.1001/jamadermatol.2019.2724
  3. Haramoto I, Mizoguchi M. [Clinical evaluation of the cream formulated oilsoluble licorice extracts for the patients of melasma]. [Nishinihon J Dermatol] 1995;57:594e600 (in Japanese).
  4. Matsunaga K, Fujisawa Y. 2 cases with allergic contact dermatitis due to whitening agents. Aesthet Dermatol 1995;5:81e6.
  5. Nishioka K, Seguchi T. Contact allergy due to oil-soluble licorice extracts in cosmetic products. Contact Dermat 1999;40:56.
  6. Yagami A, Suzuki K, Morita Y, Iwata Y, Sano A, Matsunaga K. Allergic contact dermatitis caused by 3-o-ethyl-L-ascorbic acid (Vitamin C ethyl). Contact Dermat 2014;70:376e7.
  7. Omar HR, Komarova I, El-Ghonemi M, et al. Licorice abuse: time to send a warning message. Ther Adv Endocrinol Metab. 2012;3(4):125–138. doi:10.1177/2042018812454322
  8. Victor Pena Ribeiro, Caroline Arruda, Mohamed Abd El-Salam, Jairo Kenupp Bastos. (2018) Brazilian medicinal plants with corroborated anti-inflammatory activities: a review. Pharmaceutical Biology 56:1, pages 253-268.
  9. S.Teelucksing, etc. Potentiation of hydrocortisone activity in skin by glycyrrhetinic acid. The Lancet. Volume 335, Issue 8697, 5 May 1990, Pages 1060-1063