Letter: Pretty but Painful: Allergic Cheilitis Caused by Phenoxyethanol in a Lip Gloss in a Young Girl

To the Editor:

Allergic cheilitis (AC) to cosmetics is characterized by inflammation of the lips, vermillion border, and surrounding tissue. AC to phenoxyethanol (PE), a preservative in cosmetics, is uncommon in adults and has not been previously documented in children. ¹ We describe the youngest case of AC triggered by PE in lip gloss.

A 4-year-old girl presented with recurrent cheilitis evolving for 9 months. Her medical history was unremarkable, with no history of atopy or tics. Examination revealed swollen, reddened, and fissured plaques with mild crusting involving the perioral skin, including the lower and upper lips (Fig. 1A). No additional skin abnormalities were observed. During a detailed discussion with her father, he reported that her condition began a few weeks after she started using her mother’s Silk Matte Lip Gloss (Flormar®, Istanbul, Turkey). Following established guidelines from the International Contact Dermatitis Research Group, patch tests were performed on the patient’s back and arms. The tests utilized the European Baseline Series and Cosmetics Series (Chemotechnique, Vellinge, Sweden), applied using IQ Ultra Chambers®. Readings were conducted on days 2 and 3, revealing a positive reaction (++/++) to PE (1% pet.) (Fig. 2A). The reaction to PE was relevant given its presence in the ingredient of the lip gloss. A confirmatory Repeated Open Application Test with the patient’s lip gloss resulted in a positive reaction beyond 5 days of application (Fig. 2B). Lip gloss avoidance led to symptom improvement within 3 weeks, leaving only mild xerosis (Fig. 1B).

Figure 1.

(A) Swollen, reddened, and fissured plaques involving the perioral skin including the lower and upper lips. (B) Symptom improvement upon lip gloss avoidance.

Figure 2.

(A) A positive patch test reaction (++) to phenoxyethanol (1% pet.) (D2). (B) A positive ROAT test with the patient’s lip gloss beyond 5 days of application.

This report details a case of AC triggered by PE in Silk Matte Lip Gloss (Flormar®, Istanbul, Turkey). The patient’s positive patch test and subsequent symptom improvement upon lip gloss avoidance confirm the diagnosis of AC to PE. While PE is a common preservative in cosmetics and pharmaceuticals with a generally safe reputation, allergic reactions, though uncommon, are still a possibility.^1,2

Kolodziej et al. reported a case of a male toolmaker with PE-induced hand dermatitis from his hand cream. ² In our experience, this case represents the youngest child reported to develop AC from contact with an adult lip gloss (unsuitable for pediatric use). Notably, the Scientific Committee on Consumer Safety considers 1% PE safe as a preservative, with a margin of safety of about 50 for children, calculated by comparing the no observed adverse effect level with the estimated systemic exposure dose. ³ However, individual sensitivities can arise, highlighting the importance of age-appropriate product use.

This case highlights the importance of patch testing in diagnosing AC in children. The child’s significant improvement after avoidance of the identified allergen underlines the effectiveness of this approach. If flare-ups recur in the future, additional patch testing with the child’s personal care products might be necessary to identify potential allergens and prevent future reactions.

Though considered safe in many cosmetics and pharmaceuticals, PE has been linked to allergic reactions following cosmetic use. Health care providers should be aware.