Patch test reactions associated with sunscreen products and the importance of testing to an expanded series: Retrospective analysis of North American Contact Dermatitis Group data, 2001 to 2010

Background: Both active and inactive ingredients in sunscreen may cause contact dermatitis. Objectives: This study aimed to describe allergens associated with a sunscreen source. Methods: A cross-sectional analysis of patients patch tested by the North American Contact Dermatitis Group between 2001 and 2010 was performed. Results: Of 23,908 patients patch tested, 219 (0.9%) had sunscreen coded as an allergen source. Patients who were male, with occupational dermatitis, or older (older than 40 years) had significantly lower rates of allergic reactions to sunscreens; the most commonly affected areas were the face and exposed sites (P < 0.0001). The top 3 most frequent allergens in sunscreens were benzophenone-3 (70.2% for 10% concentration, 64.4% for 3% concentration), DL-alpha-tocopherol (4.8%), and fragrance mix I (4.0%). Less than 40% of positive patch test reactions were detected by the North American Contact Dermatitis Group screening series of 65 to 70 allergens. Conclusions: A supplemental antigen series is important in detecting allergy to sunscreens.