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Cosmetics and Dermatology
This section of the text aims to discuss both the art and science of colored cosmetics to provide a fund of knowledge useful to the physician in tackling problems related to appearance and dermatologic disease. Facial foundations are designed to add color, to cover blemishes, and to blend uneven facial color in women of all skin colors. Facial foundations available for Caucasian skin must be formulated in at least 7-8 shades; however, facial foundations for black skin must be formulated in at least 10-12 or more shades to cover the tremendous variation in skin pigmentation. In basic terms, a facial foundation is a pigmented moisturizer, which can be customized to meet the needs of a variety of skin types. Facial foundation is applied to the entire face, used on a daily basis, and worn for an extended period of time. For this reason, facial foundation plays an important role in skin treatment, but it is also the facial cosmetic most likely to be problematic. Facial foundation is a relatively modern product, invented and patented by Max Factor in 1936 in the form of a cake makeup used primarily in the film industry. Popular demand for this cosmetic developed shortly thereafter as women found the excellent coverage, velvety look, and added facial color desirable. Since that time, the variety and popularity of facial foundations has expanded tremendously. Formulation Four basic facial foundation formulations are available, oil-based, water-based, oil-free, and water-free or anhydrous forms. Oil-based products are designed for dry skin, while water-based products can be adapted for all skin types. Oil-free formulations are used in oily skin foundations, while anhydrous forms are extremely long wearing and used for camouflage or theatrical purposes. Oil-based foundations are water-in-oil emulsions containing pigments suspended in oil, such as mineral oil or lanolin alcohol. Vegetable oils (eg, coconut, sesame, safflower) and synthetic esters (eg, isopropyl myristate, octyl palmitate, isopropyl palmitate) also may be incorporated. The water evaporates from the foundation following application, leaving the pigment in oil on the face. This creates a moist skin feeling, especially desirable in patients with a dry complexion. Oil-based foundations do not shift color as they mix with sebum, since the color is fully developed in the oily phase of the formulation. These foundations are easy to apply, since the pigment can be spread over the face for up to 5 minutes prior to setting. Water-based facial foundations are oil-in-water emulsions containing a small amount of oil in which the pigment is emulsified with a relatively large quantity of water. The primary emulsifier is usually soap (eg, triethanolamine, nonionic surfactant). The secondary emulsifier, present in smaller quantity, is usually glyceryl stearate or propylene glycol stearate. These popular foundations are appropriate for minimally dry to normal skin. Since the pigment is already developed in oil, this foundation type also is not subject to color drift. The playtime is shorter than with oil-based foundations because of the lower oil content. These products usually are packaged in a bottle. Oil-free facial foundations contain no animal, vegetable, or mineral oils. They contain other oily substances, such as the silicones dimethicone, or cyclomethicone. These foundations usually are designed for individuals with oily complexions, since they leave the skin with a dry feeling. Silicone is noncomedogenic, nonacnegenic, and hypoallergenic, accounting for the tremendous popularity of this type of facial foundation formulation. These products usually are liquids packaged in a bottle. Oil control facial foundations should not be confused with oil-free facial foundations. All facial foundations contain a blotter designed to absorb sebum. Oil control facial foundations simply contain additional blotters, such as talc, kaolin, starch, or other polymers designed to absorb sebum in higher concentration. Usually, they are based on dimethicone; however, mineral oil may be added to some formulations. Thus, oil-control foundations are not necessarily oil-free. Water-free or anhydrous foundations are waterproof. Vegetable oil, mineral oil, lanolin alcohol, and synthetic esters form the oil phase, which may be mixed with waxes to form a cream. High concentrations of pigment can be incorporated into the formulation, yielding an opaque facial foundation. The coloring agents are based on titanium dioxide with iron oxides, occasionally in combination with ultramarine blue. Titanium dioxide acts as a facial-concealing or covering agent. These products can be dipped from a jar, squeezed from a tube, wiped from a compact, or stroked from a stick. These foundations are well suited for use in patients with facial scarring who require camouflaging. Surface characteristics Facial foundations are manufactured in a variety of finishes, including the following: matte, semimatte, moist semimatte, and shiny. The finish is the surface characteristic of a cosmetic. Matte finish foundations yield a flat look with no shine and generally are oil-free. They are good for patients with oily skin who tend to develop some shine after a foundation has been applied. A semimatte finish has minimal shine and is generally an oil-free foundation or water-based foundation with minimal oil content. This finish performs well on slightly oily to normal skin. A foundation with more shine is known as a moist semimatte foundation and generally is water-based with moderate oil content. This finish performs well on normal to dry skin. Shiny finishes are found in oil-based foundations and are only appropriate for persons with dry skin. The shinier foundations with increased oil content also have increased moisturizing ability. Application The foundation selected should match the natural facial color as closely as possible. This can be difficult, since the nose and cheeks have redder tones than the forehead and chin. The foundation is matched to the skin along the jawline because this is where the color must be blended carefully beneath the chin. Mismatched facial foundations generally leave a line at the jawline. A foundation color should be selected in natural sunlight; the bright, artificial fluorescent lights used in most stores will distort color perception. In general, facial foundation should be applied with the fingertips. A dab of foundation should be placed on the forehead, nose, cheeks, and chin, and then blended with a light circular motion until it is spread evenly over all the facial skin, including the lips. Finally, a puff or sponge should be used, stroking in a downward direction, to remove any streaks and to flatten vellus facial hair. Special care should be taken to rub the foundation into the hairline, over the tragus, and beneath the chin. Foundation also should be blended around the eyes and, if desired, may be applied to the entire upper eyelid. The foundation should be allowed to set or dry until it can no longer be removed with light touch. If additional coverage is desired, a second layer of foundation can be applied Adverse reactions Facial foundations are a rare cause of allergic and irritant contact dermatitis. Usually, the fragrance or preservative ingredients account for most cases of allergic contact dermatitis reported. Irritant contact dermatitis is much more common, since this product is worn by patients with dermatitic skin for 8 hours or more on a daily basis. Facial foundation can be open or closed patch tested "as is." Some facial foundations are labeled for "sensitive skin." It is unclear exactly what this marketing claim delineates. Evaluation of these products fails to reveal avoidance of any particular chemicals or group of allergens. These products sometimes contain a substance known to soothe skin, such as allantoin. Perhaps this formulation is designed to minimize any dermatitis resulting from use of the product, allowing the patient to continue wearing the facial foundation. FACIAL POWDERSFacial powders provide coverage of complexion imperfections, oil control, a matte finish, and tactile smoothness to the skin. Originally, facial powder was applied over a moisturizer to function as a type of powdered foundation. Liquid foundations have largely replaced the powdered foundation; however, for patients who wish sheer coverage with excellent oil control, a powdered foundation performs excellently. An appropriate moisturizer for the patient's skin type is first applied and allowed to set or dry, followed by application of a full coverage, translucent powder. Formulation Full coverage powders contain predominantly talc (hydrated magnesium silicate) and increased amounts of covering pigments. The covering pigments used in face powder can be listed in order of increasing opaqueness, as follows: titanium dioxide, kaolin, magnesium carbonate, magnesium stearate, zinc stearate, prepared chalk, zinc oxide, rice starch, precipitated chalk, and talc. It generally is accepted that the optimum opacity is achieved with a particle size of 0.25 microns. Magnesium carbonate also can be used to improve oil blotting, to keep the powder fluffy, and to absorb any added perfume. Kaolin (hydrated aluminium silicate) also may function to absorb oil and perspiration. Full coverage face powders usually are packaged in a compact and applied to the face with a puff. Transparent facial powders are more popular today to add coverage and to improve oil-blotting abilities of a previously applied liquid foundation. Transparent powders have the same formulation as full coverage powders except that they contain less talc, titanium dioxide, or zinc oxide, since coverage is not a priority. Transparent facial powders commonly have a light shine, produced by nacreous pigments, such as bismuth oxychloride, mica, titanium dioxide coated mica, or crystalline calcium carbonate. Facial powder usually uses iron oxides as the main pigment, but other inorganic pigments, such as ultramarine, chrome oxide, and chrome hydrate, also may be used. These powders are designed to augment the underlying skin and foundation tones; therefore, transparent powders can be used by patients who have difficulty finding an appropriately tinted facial foundation. Application Facial powders are removed from a compact with a puff or dusted loosely from a container with a brush. They impart a matte finish to the face. Patients who desire a shiny or moist semimatte facial appearance should avoid powder since it will absorb the oil in the foundation, thus destroying the "dewy" look. Patients with dry complexions also may wish to avoid facial powder since it can further dry the skin. The oil-absorbing abilities of facial powder are extremely valuable in the patient with an oily complexion prone to develop a facial shine. Adverse reactions The incidence of allergic contact dermatitis to facial powder itself is low; however, added fragrances may pose a problem. A more common problem with facial powders is irritant contact dermatitis due to coarse particulate matter, such as nacreous pigments, in the formulation. Inhalation of the powders may cause problems in patients with asthma or vasomotor rhinitis. Facial powder may be open or closed patch tested as is. FACIAL BLUSHESFacial blushes, also known as rouges, are designed to enhance rosy cheek color. In many cases, rosy cheeks simply indicate vasomotor instability or fine telangiectatic mats from actinic damage; however, cheek color remains fashionable. Formulation Blush and rouge are actually synonyms for a cosmetic designed to add color to the cheeks; however, to many consumers, blush denotes a powdered product, while rouge denotes a cream product. Powdered blushes are more popular and are formulated identically to compact face powder, except more vivid pigments are added. Since color rather than coverage is desired, powdered blushes do not contain much zinc oxide. Cream rouges are formulated like anhydrous foundations that contain light esters, waxes, mineral oil, titanium dioxide, and pigments. Application For a natural appearance, cheek color should be applied beginning at a point directly beneath the pupil on the fleshy part of the cheek, sweeping upward beyond the lateral eye. This placement is designed to create or accentuate high cheekbones, which are a desired quality among women. Adverse reactions The adverse reaction concerns with blushes and rouges are identical to
that for facial powders. The products can be open or closed patch tested
as is. Self-tanning creams produce a golden skin color overnight without sun exposure. The golden color is quite acceptable on persons with blonde or light brown hair who tend to have golden hues to their skin, but it is not attractive on Mediterranean individuals with an olive complexion or extremely fair persons with pink skin tones. Formulation The active ingredient in self-tanning creams is 3-5% dihydroxyacetone incorporated into a glycerin and mineral oil base to form a white cream that turns the stratum corneum golden. Chemically, the dihydroxyacetone acts as a sugar to interact with amino acids in the stratum corneum to produce melanoidins. Formulations are available for the face and body, but most do not incorporate a sunscreen and the golden skin color is minimally protective against actinic damage. Higher concentrations of dihydroxyacetone are used to produce darker coloring of the stratum corneum. The color is not permanent and is lost as the stratum corneum desquamates; thus, continued use is necessary. The major disadvantage of the product is that it stains all contacted skin surfaces, including the palms of the hands, if it is not removed, and will produce deeper staining of the follicular ostia, seborrheic keratosis, actinic keratosis, porokeratosis, and ichthyotic skin. Many patients are not aware that they have these skin conditions until the self-tanning cream highlights the irregularity. Adverse reactions Allergic contact dermatitis from use of the product is infrequent, but several cases of dihydroxyacetone allergy have been reported. Self-tanning creams can be open or closed patch tested as is. FACIAL COSMETICS FOR CAMOUFLAGINGCamouflaging facial cosmetics are designed to minimize contour and color abnormalities of the face based on the same principles used by an artist in painting a picture. Contour abnormality camouflaging The correction of abnormal facial surface contours is based on the principle that dark colors make protuberances appear to recede, while light colors make surface depressions appear shallower. Creating an even-appearing surface on a scarred face is achieved through artist shading. Powdered blush-type products are best suited for this purpose. Areas of the face that need to be lightened should be brushed with a light pink or peach pearled blush or buffer. Areas of the face that need to be darkened should be brushed with a deep plum or bronze matte finish blush or highlighter. These same principles can be used to optimize the shape of the face, the size of the forehead and chin, or the contour of the nose, based on established concepts of the perfect facial proportions. The perfect facial shape is oval and symmetrical about the midline. An oval face is one and one-half times as long as it is wide and should taper gradually from its widest dimension at the forehead to its smallest dimension at the chin. The face should be divided into equal thirds from superior to inferior, as follows: forehead to the glabella, glabella to the subnasale, and subnasale to the base of the chin. The face should divide equally into fifths from ear to ear, with each fifth being the width of one eye. For example, a round face can be camouflaged to appear to be more oval by shading the lateral margins with a darker colored blush to deemphasize the increased width. An oblong face is shaded with a darkly colored blush along the forehead and chin to deemphasize the increased length. A square face is darkened bilaterally at the jaws. This same shading technique also can be used to correct a poorly formed forehead and chin. Low-set foreheads should have a light blush applied beneath the hairline, while high foreheads should have a dark blush applied at this location. A receding chin should have a light blush applied at the tip and sides. A double chin should be shaded with a dark blush under the entire jawbone. Unfortunately, the artistic application of facial cosmetics is no substitute for a perfect face, and, in some cases, patients should be advised to consider surgical revision. Facial cosmetics also can be used to camouflage color abnormalities. Color abnormality camouflaging Pigmentation defects can be camouflaged by either applying an opaque cosmetic that allows none of the abnormal underlying skin tones to be appreciated or by applying foundations of complementary colors. For example, red pigmentation defects can be camouflaged by applying a green foundation, the complementary color to red. The blending of the red skin with the green foundation yields a brown tone, which can be covered readily by a more conventional facial foundation. Furthermore, yellow skin tones can be blended with a complementary colored purple foundation to yield brown tones. Skin areas that are lighter or darker than desired can be camouflaged by applying facial foundations with the appropriate amount of brown pigment to hide the defect. Application technique for camouflaging facial foundations The most popular camouflage facial foundations are creamy products that are scooped from a jar or tin with a spatula and applied to the hand for warming. These products are the easiest to use since they exhibit a long playtime, good blending characteristics, minimal application skill, excellent coverage, and adequate wearability for most individuals. Initially, a makeup base must be selected that is closest to the patient's natural skin color. Blending usually is necessary, but no more than 3 colors should be combined, as this produces muddy final color quality. If the patient has an underlying pigmentation problem, this counts as 1 color. Once the closest foundation color has been selected, it may be necessary to blend in yellow if the individual has a sallow complexion or reds if the patient has a ruddy complexion. All facial tones should be represented in the final foundation blend if a good color match is to be obtained. Blending usually is performed by applying a small amount of the makeup to the back of the hand. This provides a good surface for blending, which can be held up easily to the face to evaluate the color match, and also warms the product, which allows easier mixing and application. The final foundation color mix is dabbed, not rubbed, over the scarred area and then applied from the central face outward into the hairline for approximately one fourth of an inch and blended over the ears and beneath the chin. It is necessary to feather the cosmetic where application ends to achieve a more natural appearance. The importance of dabbing cannot be overemphasized because scars do not contain appendiceal structures, such as follicular ostia, that are necessary for good cosmetic adherence. Rubbing will remove the makeup as it is applied. The cosmetic should be pressed into the skin and allowed to dry for 5 minutes. Following this brief drying period, the cosmetic must be set with an unpigmented, finely ground, talc-based powder to prevent smudging, to improve wearability, to provide waterproof characteristics, and to impart a matte finish. Camouflaging makeup is designed to be worn with this powder and does not function properly without it. The powder should be pressed, not dusted, on top of the foundation. Lastly, shading and highlighting principles, as previously discussed, are employed to minimize the scar contour abnormalities. Unfortunately, the camouflage foundation may actually accentuate the surface irregularities of the scar and normal skin structures, such as pores and wrinkles. Depressed scars usually appear darker than the surrounding skin, even though the same color foundation has been applied, because of the presence of shadows. Thus, a lighter powdered rouge is applied over the scar. If the scar is elevated, a darker powdered rouge is applied. Other colored facial cosmetics (eg, eye shadow, eyeliner, mascara) are usually necessary to give an attractive final appearance. In general, removal of camouflaging cosmetics requires more than soap
and water washing because of the waterproof nature of the product. Most
companies provide an oily cleanser for cosmetic removal and then recommend
soap and water cleansing of the skin. The cosmetic should only be worn
when needed and thoroughly removed at bedtime.
Lip color has been used since the time of the Sumerians dating to 7000 BC. The practice has been handed down through many generations from the Egyptians to the Syrians to the Babylonians to the Persians to the Greeks to the Romans to present day civilizations. Present day lipstick was introduced around 1920 when the "push-up" holder, still used today, was invented. Formulation Lipsticks are mixtures of waxes, oils, and pigments in varying concentration to yield the characteristics of the final product. For example, a lipstick designed to remain on the lips for a prolonged period of time is composed of high wax, low oil, and high pigment concentrations. On the other hand, a product designed for a smooth creamy feel on the lips is composed of low wax and high oil concentrations. The waxes commonly incorporated into lipstick formulations are white beeswax, candelilla wax, carnauba wax, ozokerite wax, lanolin wax, ceresin wax, and other synthetic waxes. Usually, lipsticks contain a combination of these waxes that are selected and blended carefully to achieve the desired melting point. Oils then are selected, such as castor oil, white mineral oil, lanolin oil, hydrogenated vegetable oils, or oleyl alcohol, to form a film suitable for application to the lips. The oils are also necessary for dispersion of the pigments. Several types of coloring agents are used in lipsticks. Indelible coloring, or lip staining, is achieved through the use of bromo acids, consisting of fluoresceins, halogenated fluoresceins, and related water-insoluble dyes. Other pigments consist of insoluble dyestuffs and lake colors. Metallic lakes are insoluble dyes precipitated or "laked" on a metallic substrate, such as aluminium. For example, Food, Drug, and Cosmetic (FD&C) Blue No. 1 is an azo dye precipitated on aluminium, which transforms the insoluble dye to a pigment. Other lake colors are based on calcium or barium salts. Adverse reactions Several ingredients unique to lipstick formulation can cause difficulty in the sensitized patient. Castor oil, found in almost all lipsticks due to its excellent ability to dissolve bromo acid dyes, rarely can cause allergic contact dermatitis. More common lipstick sensitizers in the mid-1920s were the bromo acid dyes, one of which is eosin (Drug and Cosmetic [D&C] Red No. 21). Eosin was used commonly in the indelible red lipsticks popular at that time. These indelible lipsticks are now making a comeback because active professional women want a long-wearing lip product. The safety of the coloring agents used in lipsticks has received a great deal of attention because of the inevitable entry of lipsticks into the mouth. The Food and Drug Administration (FDA) divides certified colors into the following 3 groups: FD&C colors, D&C colors, and External Drug and Cosmetic colors. Only the first 2 groups can be used in lipsticks. The External Drug and Cosmetic colors can only be used in locations where they are not likely to enter the mouth. Lip cosmetics can be open or closed patch tested as is since their
irritating potential is low.
Eye shadow is a cosmetic designed to impart color primarily to the upper eyelid. Eyelid cosmetic use dates into antiquity, recorded as early as 4000 BC. Green powder made from malachite was applied heavily to both the upper and the lower eyelids. Eyelid glitter composed of ground beetle shells was also popular. Modern eye shadow cosmetics became popular between 1959 and 1962. Formulation Eye shadows are available as pressed powders, anhydrous creams, emulsions, sticks, and pencils. Color variety is extensive, but no coal tar derivatives can be used in the eye area. Pressed powder eye shadows are the most popular formulation and are applied to the eyelid by lightly stroking a soft sponge-tipped applicator across the skin. These eye shadows are predominantly talc with pigments and zinc or magnesium stearate used as a binder. Kaolin or chalk may be added to improve oil absorption and to increase wearability. Variation in eye shadow surface texture can range from matte to a pearled shine to a metallic shine. Titanium dioxide is used in pastel matte-finish eye shadows to improve coverage. However, it is not found in pearled shine finish eye shadows, since it tends to mask the desired pearled effect. Bismuth oxychloride, mica, and fish scale essence are the standard materials used to produce a pearly shine. A metallic shine is obtained by adding copper, brass, aluminum, or silver powders. Adverse reactions The eyelid skin is the thinnest on the body and frequently affected by both irritant and allergic contact dermatitis. The North American Contact Dermatitis Group has determined that 12% of cosmetic reactions occur on the eyelid, but only 4% of them could be linked to eye makeup use. Furthermore, it may be difficult to determine the etiology of the eyelid dermatitis with routine patch testing. Many substances can be transferred to the eye area by the hands, such as nail polish, complicating dermatologic evaluation. Once it has been determined that eye cosmetics are the source of the dermatitis, the distinction between irritant and allergic contact dermatitis must be made. Irritant contact dermatitis is more common than allergic contact dermatitis. Open or closed patch testing can be performed as is with eye shadows; however, use testing is recommended. Use testing is performed by placing the eye shadow at the corner of the eye for 5 consecutive nights followed by evaluation of the skin for allergic or irritant contact dermatitis. MASCARAMascara, whose application dates to Biblical times, is the most commonly used eye cosmetic. The original mascara worn by women of many ancient civilizations was kohl, based on antimony trisulfide. The purpose of modern mascara formulations is to darken, lengthen, and thicken the eyelashes. Formulation Mascara must be formulated carefully to allow easy and even application without smudging, irritancy, or toxicity. The US FD&C Act prohibits coal tar colors for use on the eyelashes. Therefore, mascara colorants must be selected from vegetable colors or inorganic pigments and lakes. Colors employed include iron oxide to produce black, ultramarine blue to create navy, and umber or burnt sienna or synthetic brown oxide to create brown. Liquid mascara is the most popular modern formulation. They can be divided into water-based, solvent-based, and water/solvent hybrid varieties. These products are unique in that they are applied from an automatic mascara tube consisting of a round brush that is inserted through a small aperture to remove a metered amount of product. Water-based mascaras are so named because they are formulated of waxes (eg, beeswax, carnauba wax, synthetic waxes), in addition to pigments (eg, iron oxides, chrome oxides, ultramarine blue, carmine, titanium dioxide) and resins dissolved in water. They are classified as oil-in-water emulsions. The water evaporates readily, creating a fast-drying product that thickens and darkens the lashes. The product is water-soluble, allowing for easy removal, but unfortunately smudges with perspiration and tearing. Some water-based mascaras are labeled "water-resistant" if they contain an increased amount of wax or a polymer to improve adherence of pigment to the lashes. Water-based mascaras are contaminated easily with bacteria, which readily grow in water, and must include preservatives, usually parabens. Thus, these products may cause an allergic reaction in individuals who are sensitive to parabens; however, water-based mascaras are generally the least sensitizing of the mascara types. Some patients may experience a contact irritancy from the emulsifiers required to maintain the pigment in solution. Solvent-based mascaras are formulated with petroleum distillates to which pigments (eg, iron oxides, chrome oxides, ultramarine blue, carmine, titanium dioxide) and waxes (eg, candelilla wax, carnauba wax, ozokerite, hydrogenated castor oil) are added, making them waterproof. As a result, the product performs well with perspiration and tearing, but removal is difficult and requires an oil-based lotion or cream. Deposits may form on the lashes if the product is incompletely removed. Care must be taken to avoid smudging the product immediately after application because solvent-based mascaras have a prolonged drying time. Preservatives are still added to solvent-based mascaras, but microbial contamination is not a great problem since the petroleum-based solvent is antibacterial. Some products also contain talc or kaolin to improve lash thickening and nylon or rayon fibers to lengthen lashes. Solvent-based mascaras can irritate the eye. Some mascaras combine both solvent-based and water-based systems to form either a water-in-oil or oil-in-water emulsion. The idea is to create an optimal product that thickens with a short drying time, such as water-based mascaras, but provides waterproof lash separation, such as solvent-based mascaras. The water in the formulation requires incorporation of a good preservative system. Adverse reactions Modern liquid mascaras provide an applicator that is inserted into the tube between uses, providing numerous opportunities to inoculate bacteria into the mascara. The most feared adverse reaction to mascaras is that of infection, particularly Pseudomonas aeruginosa corneal infections, which can permanently destroy visual acuity. Staphylococcus epidermidis and Staphylococcus aureus organisms also may proliferate in contaminated mascaras. Infections are more common if the eyeball is traumatized with the infected mascara. Even though mascaras contain preservatives, it is still wise to discard all mascara tubes after 3 months and not allow multiple persons to use the same mascara tube. Individuals with recurrent bacterial infections due to colonization should select solvent-based mascaras. Fungal organisms also can contaminate mascaras and result in eye infection. This is rare and usually only found in patients who are immunocompromised or wear contact lenses. The pigment contained within mascaras can result in conjunctival pigmentation, if the mascara is washed into the conjunctival sac by lacrimal fluid. This colored particulate matter can be observed on the upper margin of the tarsal conjunctiva. Histologically, the pigment is seen within macrophages and extracellularly with varying degrees of lymphocytic infiltrate. Electron microscopy suggests that ferritin, carbon, and iron oxides are present within the tissues. Unfortunately, no treatment is available for the condition, which fortunately is usually asymptomatic. Allergic contact dermatitis has been reported to rosin (colophony) and dihydroabietyl alcohol (Abitol) contained in some mascaras. Mascaras can be open or closed patch tested as is, but they should be allowed to thoroughly dry prior to closed patch testing to avoid an irritant reaction from the volatile vehicle. Summary Colored cosmetics are an important part of the dermatologic armamentarium. They can camouflage contour and pigment abnormalities, provide moisturization, create a sense of personal well-being, and induce disease. Familiarity with these products results in better patient care. REFERENCES
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