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.
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.
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 . 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.
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