CD19 ‘The eyes have it’: lash lift dermatitis due to triple cosmetic allergen sensitization to para -phenylenediamine, thioglycolates and (meth)acrylates

Abstract

Cosmetic eyelash enhancement procedures are increasingly popular, with periocular allergic contact dermatitis (ACD) a recognized complication. Reported triggers include para-phenylenediamine (PPD) in tints and acrylate-based adhesives. Although glyceryl monothioglycolate (GMTG) is a well-established cause of contact allergy in hair perming products, ACD to GMTG used in lash-lifting solutions has not been widely reported. A 20-year-old woman with atopy developed marked bilateral periocular erythema and oedema within 24 h of undergoing an eyelash lift and tint, resolving within 1 week. She had previously undergone lash-lifting procedures without adverse reactions but reported a prior reaction to a black henna tattoo. Symptoms had resolved by the time of referral; however, the close temporal relationship strongly suggested ACD. Patch testing was performed using the British Society for Cutaneous Allergy (BSCA) baseline series, and local acrylates, cosmetics and hairdressing series. Patch testing demonstrated strong positive reactions to PPD 1.0% in petrolatum (pet., +++), GMTG 1% pet. (+) and multiple (meth)acrylates, including 2-hydroxyethyl methacrylate 2% pet. (+++), 2-hydroxyethyl acrylate 0.1% pet. (++), di(ethylene glycol) diacrylate 0.1% pet. (++), ethylene glycol dimethacrylate 2% pet. (+) and hydroxypropyl methacrylate 2% pet. (+). These reactions correlated with identifiable procedural exposures: eyelash tint (PPD), lash-lifting solutions (GMTG), and eyelash adhesive, fixing and laminating products [(meth)acrylates]. Symptoms have not recurred following strict allergen avoidance. This case demonstrates ACD resulting from exposure to multiple allergens during cosmetic eyelash enhancements. With increasing chemical complexity of eyelash cosmetic procedures, periocular dermatitis should prompt consideration of concurrent sensitization rather than attribution to a single ingredient. Comprehensive, exposure-led patch testing and clinician awareness of allergen groups used in eyelash enhancements are essential to guide avoidance strategies and prevent recurrence.