Two cases of photocontact allergy to the new sun filter octocryleneContact dermatitis and drug allergy unit, Department of Dermatology, Hospital clínic, Barcelona. firstname.lastname@example.org
Antoni Bennàssar MD, Ramon Grimalt, Carlos Romaguera, Joan Vilaplana
Dermatology Online Journal 15 (12): 14
We report two cases of photocontact allergy to a cinnamate sun filter, octocrylene. In the last few years otocrylene has been broadly used in the manufacturing of many cosmetics and UV filters. Therefore, the recognition of octocrylene as an emerging cause of contact and photocontact allergy is reported.
Contact allergy and photoallergic reactions to ultraviolet (UV) filters contained in widely avaliable sunscreens have been well documented. Octocrylene (2-ethylhexyl-2-ciano-3, 3-diphenyl acrylate) is a relatively new solar filter belonging to the cinnamate family. Because this compound is photostable and thought to be non-allergenic and non-irritating it has found widespread use in the manufacture of sunscreens and cosmetic products. However, many instances of contact allergy (CA) and photocontact allergy (PCA) to octocrylene have recently been reported. We report two photoallergic eruptions to octocrylene and review the literature.
Patients and methods
Patch test and photopatch tests were performed with the Spanish Contact Dermatitis Group and the Spanish Society of Photodermatology standard, non-steroidal anti-inflammatory drugs (NSAID) and sunscreens series. Patches were removed after 1 day (D) and one set was irradiated with UVA (5 J/cm²). Readings were performed according to the International Contact Dermatitis Research Group (ICDRG) guidelines at day 2 and day 3 after irradiation.
Case 1. A 57-year-old, woman hairdresser, otherwise healthy, presented with generalized severe pruritus and an edematous, erythematous and vesicular eruption affecting the face, arms, and shoulders. The rash appeared after intense sun exposure at the sites of application of a sunscreen (Anthélios XL 60+®). She was currently taking no medication. However she described a history of a cutaneous "allergic" reaction after systemic intake of ketoprofen 2 years before.
Patch tests showed negative reactions to standard, NSAID, and sunscreen elements. A positive reaction to octocrylene (++) in the photopatch test was observed at days 2 and 4. Anthélios XL 60+® contains octocrylene as UV filter.
Case 2. A 35-year-old female school teacher presented with an erythematous, vesicular eruption limited to the face and neck. These were the areas where she had applied a sun filter (ISDIN®30 anti-wrinkles) and received what she described as a moderate sun exposure. She was taking no medication. However, she described several non-specific skin rashes and generalized pruritus after sun exposure over the last few years. Patch tests showed negative reactions to standard, NSAID, and sunscreen series. A positive reaction to octocrylene (++), parsol 1789 (++), and ketoprofen (++) in the photopatch tests were observed at days 2 and 4. Octocrylene is present in the ISDIN®30 anti-wrinkles sun cream.
People are becoming more aware of the skin cancer risks with sun exposure. Thus, we are observing a widespread use of UV filters not only in sunscreens but also in many cosmetics, including facial moisturizers and make-up. The incidence of irritant reactions and sensitization to these agents is expected to increase in the coming years.
In an epidemiological survey, Pigatto et al.  observed that even though photoinduced or photoaggravated dermatoses are quite common in the general population, PCA accounts for just 10 percent of all cases. However, photopatch testing is underutilized in the clinical evaluation of suspected PCA patients; consequently, photoallergy cases are underdiagnosed.
A recent multicenter study  concluded that drugs account for most PCA cases and that ketoprofen is largely the most implicated drug, followed by organic UV filters. Strikingly, sensitization to ketoprofen was present in 40 percent of the studied patients, with a high clinical relevance. That fact could be explained by the common use of topical ketoprofen on mild injuries in Southern Europe.
Although in previous epidemiological surveys  octocrylene did not appear among the main causes of PCA to UV filters, its broad use in the last few years has led octocrylene to be the prime photoallergen of this group. Other solar filter sensitizers in decreasing order of frequency, were benzophenone-10, benzophenone-3, ethylhexyl methoxycinnamate and butyl methoxy dibenzoyl methane . Cases of CA and PCA to octocrylene were equally distributed; some patients also have positive photopatch test to others UV blockers [2, 4, 5, 6]. The clinical relevance of CA/PCA to sun filters was found to be high .
Furthermore, Myroxylon perirae extract (formerly named balsam of Peru), preservatives, and some perfumes included in the fragance mix series are widely used in UV filters and can induce allergy. Interestingly, patients with CA/PCA to UV filters frequently exhibit positive patch test reactions to more than one of these agents [7, 8] however, the clinical relevance for perfumes is low. That amount of positive rections with low grade relevance could be explained by cross-reactions in ketoprofene sensitized patients.
Octocrylene is a cinnamate solar filter that mostly blocks ultraviolet light in the UVB range. It has attractive properties including significant molecular stability, low-irritability, and hydrophobicity . Hence, octocrylene has become a common UVB-blocking agent in suncare and cosmetic products in the last 10 years. On the other hand, octocrylene was considered to be a non-allergenic molecule. Nevertheless, many cases of octocrylene sensitization have been recently reported. This fact has led Chemotechnique to include octocrylene in the patch testing sunscreen series to allow better recognition and classification of this potential allergen. The aim of our report is also to highlight the increasing number of PCA/CA reactions to octocrylene and remind practitioners about sensitization to fragances and preservatives that are used in solar filters and in ketoprofen-containing products. Moreover, simultaneous positive allergic reactions to fenticlor, octocrylene and benzophenone-10 should be regarded as co-sensitizations and not as cross-reactions because the chemical structures are completely different . Therefore, we wish to note the value of performing both the standard and UV filter series patch and photopatch tests.
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