Sensitive Skin, Rashes, and Allergens.

The term hypoallergenic on a label has almost no meaning

Manufacturers may put the term hypoallergenic on a label to suggest that these products are gentler, are less likely to cause allergic reactions, and are safer for those with sensitive skin. However, there are neither concrete federal standards nor unequivocal definitions that govern the use of the term hypoallergenic. Moreover, manufacturers are "not required to submit substantiation of hypoallergenicity claims to FDA". Therefore, this term has no meaning, and its presence on a product label should not impact a patient's choice of skin care products.

The term fragrance-free does not equate to free of fragrance allergens

Avoiding fragrance in skin care products is a much more daunting task than one might suspect. Although patients associate fragrance mainly with perfume or cologne, fragrance is ubiquitous, and is added to most of the personal care products sold in the United States. Any product that contains fragrance usually contains a mix of several different ingredients. However, individual fragrance ingredients are considered proprietary information. Therefore, the label need only indicate "fragrance," "perfume," or "parfum." Also, some ingredients that serve as fragrance allergens may not easily be recognized as such. This includes ingredients such as benzaldehyde and benzyl alcohol. Making the task even more complex is that "fragrance-free" does not equate to "free of fragrance allergens." Many dermatologists recognize that unscented products often contain masking fragrance. However, even fragrance-free products may legally contain fragrance allergens. If the manufacturer states that a fragrance allergen is used in a product "to serve another purpose," then it may legally carry the label of fragrance-free. Some fragrance allergens serve as preservatives, and some fragrant botanical extracts may serve as moisturizers. A review of popular brands and products reveals that many fall into these categories.

Baby products smell better, but are not necessarily safe for sensitive skin

Patients and physicians may presume that products designed for babies are designed to be gentle to the skin. This is why some patients with eyelid dermatitis are commonly instructed by ophthalmologists to stop using soap and to instead cleanse their eyelids with Johnson's® Baby Shampoo. Patients with perianal dermatitis or generalized eczema may also switch to this "gentle" cleanser. However, Johnson's® Baby Shampoo still contains three major allergens, including fragrance, quaternium-15 (a formaldehyde releasing preservative), and cocamidopropyl betaine (a surfactant). Fragrance and quaternium-15 are among the top 10 allergens in the NACDG study. Cocamidopropyl betaine is considered an emerging allergen in the pediatric population and was named the contact allergen of the year in 2004 by the American Contact Dermatitis Society in recognition of its increasing importance as an allergen.

Soft, pure, and natural 100 percent cotton is not necessarily the fabric of choice

Certain morphologic clues suggest textile dermatitis. Generalized dermatitis, with accentuation at the lateral neck, the waistband, and the periaxillary region with sparing of the axillary vault, is suggestive of textile dermatitis. In this type of allergy, dermatitis is more prominent at areas where sweat and friction enhance contact with the allergen. In some cases, the dermatitis is more pronounced on the inner thighs, the posterior thighs, the upper inner arms, or under the socks.

Given the presence of these clues, one should advise patients that clothing may be the culprit, specifically the dyes or the formaldehyde finishes in the fabric. Many patients are skeptical. The common response is: "Because of my sensitive skin, I only wear 100 percent cotton, so that can't be it."

Of course, cotton clothing has a reputation for being soft, pure, and natural. However, unfinished cotton wrinkles very easily. Thus, formaldehyde, in the form of textile resins, is added to many items of cotton clothing. Some of these items are labeled wash and wear, permanent press, or wrinkle free. However, some cotton items won't be labeled in any specific manner. While garment tags will indicate the fabric used, garment tags will not indicate the presence of formaldehyde finishes.

Although patients are advised to wear loose clothing, and avoid sweating and friction as much as possible, counseling focuses on choosing garments that are made of certain fabrics.

When concerned about formaldehyde, patients should be advised to completely avoid cotton/polyester blends, rayon, and corduroy. Some 100-percent cotton fabrics, particularly those that wrinkle easily, may be safe to use. From a practical standpoint, though, because there is no way to tell for sure if a garment has been finished with a formaldehyde resin, patients need to exercise a great deal of caution with these garments; it may be easier to avoid them altogether. Patients may instead use certain alternative fabric types that are unlikely to be finished with formaldehyde resins. These include 100 percent silk, 100 percent polyester, 100 percent linen (that wrinkles easily), 100 percent wool, and 100 percent denim.

Some individuals may switch to organic cotton thinking that it will be better for their skin. A number of major retailers now sell garments made of organic cotton, including Walmart, Target, Victoria's Secret, and Patagonia. However, organic cotton refers to how the cotton is grown. Because pesticides are not used, this type of cotton is almost surely better for the environment. However, organic cotton garments may still be treated with chemical finishes and dyes. A better choice for patients would be to seek out garments labeled "chemical-free." These are much harder to locate and are usually sold through specialty retailers found on the Internet.

All-natural does not equate to safer

This misconception demonstrates the power of marketing. Even a cursory review of drugstore shelves discloses many products termed all-natural therapy and often touted as calming creams or for eczema care. In recent years, many patients seem to be turning to such all-natural products in an effort to avoid the chemicals that they perceive are worsening a dermatitis. In reality, most patients need to be specifically admonished that all-natural does not equate to safe (or even safer).

One allergen of major significance is balsam of Peru, which would be considered a natural substance. Balsam of Peru is an aromatic fluid obtained by cutting the bark of the tree Myroxolon balsamum. It and its constituents are used commonly as fragrance and flavoring agents. In a study analyzing data from the North American Contact Dermatitis Group (NACDG), after accounting for both the proportion of the population allergic to the allergen and the likelihood of relevance to the patient's complaint, the investigators found that fragrance mix ranked highest of all the allergens tested. Balsam of Peru was ranked third.

There are a number of other natural products such as botanical extracts and essential oils that can serve as fragrance allergens or as allergens in their own right. An Internet search reveals innumerable products marketed for those with sensitive skin that utilize such substances. Oak moss absolute, geraniol, ylang-ylang oil, and sandalwood oil, while considered natural, are important allergens. This point must be emphasized to patients. As we should all recall, poison ivy is all natural.

Information taken from: http://dermatology-s10.cdlib.org/144/commentary/contact_dermatitis/katta.html  If you would like to read the full article, please click the link.


In conclusion, if you have sensitive skin or a tendency to rash...there is not a definitive answer to solve your skin issues.  Trial and error at times may be the only way.  Speaking to a dermatologist may help.  There is also the option of trying to find a product to which you know each ingredient in it. The less ingredients sometimes the better.  However, remember that just because it is organic or natural does not mean that it cannot irritate your skin.  Peppermint essential oil is wonderful and natural, but it can also cause issues to the skin among other things.  Knowing about a product/ingredient is crucial for the sensitive skin type.  You cannot be lazy if you want to avoid a rash and allergic reactions.  Do your homework.  Know what you are ingesting and what you are putting on your skin.  It could be the food you are eating, it could be the nail polish you are wearing, it could be the thing you touched that somehow transferred to your face, etc.  I wish you the best in your pursuit to be rash and allergen free! It is not an easy thing to do!