The prospect of slowing and/or reversing the aging process of one’s skin by applying topical over-the-counter commercial products is becoming increasingly attractive. In particular, facial wrinkle removers are generating significant consumer attention, but the potential for these products to cause permanent skin damage has not been previously addressed. This report investigates the ingredients found in a single product and correlates their presence with an adverse clinical outcome.
Chemical induced vitiligo usually occurs following skin exposure to phenol containing compounds that may be unknowingly present in worksite industrial materials, hair dyes, skin lightening creams, household cleaning products, deodorants, detergents, adhesives, rubber gloves and sandals, motor oils, and laboratory reagents [1,2]. It is clinically indistinguishable from spontaneous loss of skin pigmentation related to genetic risks and autoimmune phenomena. We report a case of periorbital vitiligo caused by a routine commercially available eye cream advertised to remove unwanted wrinkles. None of the risk factors mentioned above are relevant to this case.
A 51-year-old Caucasian female applied Lancome Renergie Lift Multi-Action Eye Cream twice a day for one week in the following locations: below her eyebrows, underneath her lower eyelids, and the lateral corners of her eyes. There was no previous history utilizing similar products, and there was no history of burning, itching, nor skin rash in the application contact areas. On the eighth day she ceased usage after noticing progressive loss of pigmentation in the areas of application (Figures 1-3). Over the next three years her periorbital vitiligo remained unimproved despite a variety of therapeutic dermatologic interventions, including laser treatments. No other areas of skin depigmentation have developed. Her only other ongoing medical problem was a four-year history of mild, non-progressive, untreated multiple sclerosis characterized by intermittent fatigue, self-limited lower extremity myalgias, occasional lack of coordination, and occasional memory lapses
There exists an exhaustive list of ingredients in the topical
product used by this patient, namely: water, dimethicone, glycerin,
isohexadecane, alcohol, squalene, cetyl alcohol, stearic acid,
mineral oil, palmitic acid, PEG-100 stearate, glycerol stearate,
PEG-20 stearate, beeswax, octyldodecanol, Ci77891, titanium
dioxide, Ci16035 (red 40), Ci19140 (yellow 5), C13-14 isoparaffin,
mica, saccharomyces (yeast), hydrolyzed linseed extract, sodium
hydroxide, soy protein, hyalauronic acid, sodium benzoate,
phenoxyethanol, adenosine, acetyl tetrapeptide, caffeine, silica,
polyacrylamide, chlorphenasin, chlorhexidine digluconate,
polyethylene dimethiconol, limonene, benzyl alcohol, linalool,
capryloyl, salicylic acid, microcrystalline wax, paraffin, shea butter,
laureth-7, coumarin, and parfum. Dimethicone and dimethiconol
are polydimethylsiloxanes (silicones), which chemically are the
same artificial organosiloxane materials present in silicone gel-filled
breast implants. These two items, in concert with octyldodecanol
(an emulsifier), readily penetrate the skin and adhere to the
subcutaneous fat, as silicones are lipophilic. Fat cells (adipocytes
and lipocytes) contain a number of mediators of inflammation,
and fat cells are also capable of converting the amino acid tyrosine
into catecholamines (epinephrine and norepinephrine). Tyrosine
is an essential ingredient used by melanocytes to produce normal
skin pigmentation (melanogenesis). Vitiligo and tachyarrythmias
are two items in a long list of proven toxic clinical phenomena
manifested by recipients of silicone gel-filled breast implants [3-5].
It is therefore hypothesized that one of the mechanisms of
vitiligo production in this patient is the localized preferential
shunting of tyrosine usage to activated adipocytes, thereby
depriving melanocytes of their substrate. A second mechanism is
silicone-induced stimulation of adipocytes to produce localized
inflammation, as panniculitis (subcutaneous fat necrosis) is
another well-known ailment occurring in implant recipients [3-5].
Localized inflammation has been shown to be lethal to melanocytes
[1,2]. Five other ingredients in this topical product are also of
critical importance in the development of vitiligo in this patient.
Two of these include salicylic acid and sodium benzoate. Salicylic
acid by itself acts as an exfoliant to reduce dry patches, and sodium
benzoate by itself is designed to kill bacteria on the skin. The other
three key ingredients are sodium hydroxide, calcium hydroxide
(present in mica), and water. When all five are mixed togethera chemical reaction ensues between salicylic acid and sodium
benzoate, whereby phenols are produced. Phenols are directly toxic
to melanocytes because they act as tyrosine analogues, thereby
inhibiting the process of melanogenesis [1,2].
All of the other ingredients in this product have varied actions.
For example, isohexadecane in an emollient and a solvent designed
to soften and smooth the skin in concert with enabling other
substances to easily dissolve into a homogeneous entity. Ci16035
(red 40) is known to cause allergic reactions, and Ci19140
(yellow 5) is known to cause purple spots on the skin. Squalene
is utilized for adding moisture but is known to clog pores in the
skin. Phenoxyethanol is a preservative known to cause skin
irritation. Silica has a long and sordid history of toxicity to the
body. Polyacrylamide absorbs water and is used as a thickener.
Chlorphenesin is utilized as a preservative and is known to cause
contact dermatitis. Chlorhexidine digluconate is an antiseptic
utilized to kill bacteria. Limonene is an antioxidant and also is
known to cause skin senisitivity. Laureth-7 is a surfactant that
contains 1,4-dioxane (a solvent that is a known toxin). Essentially,
Lancome Renergie Lift Multi-Action Eye Cream is a soup mixture
of ingredients with the clear-cut potential to damage the skin via
many adverse mechanisms. Over the past ten years the proliferation
of over-the-counter anti-aging materials are legion, and the same
is true for multiple other multi-purpose topical products such as
moisturizers, softeners, rejuvenators, make-up, lotions, shampoos,
and soaps. One can only speculate how many other consumers
may have developed permanent vitiligo upon exposure to similar
compounds encountered in this case, since many or all of these
compounds are not necessarily restricted to just wrinkle removers.
With regard to cosmetics, using a make-up remover at the end
of the day may paradoxically enhance an adverse skin reaction,
because many removers contain an emulsifier known as TEA
(triethanolamine). TEA temporarily changes the pH of the skin to
alkaline, thereby transiently loosening the tight bonds between skin
cells. Thus, a certain proportion of what is on the skin may actually
wind up being impacted below it. The induction of wrinkle remover
induced vitiligo may be more likely to occur if the user does not
experience skin burning, itching, and or rashes on initial contact.
Under these circumstances (as noted in this case) a consumer is
more likely to continue further applications beyond the first day
or two of usage. Once subclinical inflammation and melanocyte
damage become obvious, it is probably too late to reverse the
unsightly cosmetic outcome.
Consumers need to be aware of the complexity of topical skin
products they are purchasing, as these products may contain
potentially harmful ingredients capable of causing unwanted and
permanently altered dermatologic appearances.