Research letter
Allergic contact dermatitis to cocamidopropyl betaine in Colombia
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Moreno-Ancillo, A.C. Gil-Adrados" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Á." "apellidos" => "Moreno-Ancillo" ] 1 => array:2 [ "nombre" => "A.C." "apellidos" => "Gil-Adrados" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054611001558?idApp=UINPBA00004N" "url" => "/03010546/0000004000000002/v1_201304101104/S0301054611001558/v1_201304101104/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Research letter</span>" "titulo" => "Allergic contact dermatitis to cocamidopropyl betaine in Colombia" "tieneTextoCompleto" => true "saludo" => "To the Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "126" "paginaFinal" => "128" ] ] "autores" => array:1 [ 0 => array:5 [ "autoresLista" => "J.J. Yepes-Nuñez, F.E. Gómez Rendón, R. Nuñez-Rinta" "autores" => array:3 [ 0 => array:4 [ "nombre" => "J.J." "apellidos" => "Yepes-Nuñez" "email" => array:1 [ 0 => "juanjoseyepesnunez@une.net.co" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn0005" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "F.E." "apellidos" => "Gómez Rendón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "R." "apellidos" => "Nuñez-Rinta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Clinical Allergology Service, Academic Group of Allergology and Clinical Experiment (GRACE), University of Antioquia, Medellín, Colombia" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Dermatology Institute, Medellín, Colombia" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Faculty of Medicine, Universidad Pontificia Bolivariana, Medellín, Colombia" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "fn0005" "etiqueta" => "1" "notaPie" => "<p class="elsevierStyleNotepara">Master of Clinical Science with emphasis in Clinical Epidemiology. Third-year resident of Clinical Allergology. Member of Academic Group Allergology and Clinical Epidemiology (GRACAE), Group of Clinical Allergology and Experimental (GACE), and Academic Clinical Epidemiology Group (GRAEPIC).</p>" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 889 "Ancho" => 1333 "Tamanyo" => 241943 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous scaly plaques in cheek.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Shampoos, soaps and intimate hygiene products have been considered infrequent causes of allergic contact dermatitis (ACD) because they are preparations eliminated with water and their permanence on the skin is very brief. Allergens usually contained have a low sensitising capacity due to their low concentration and brief contact. An exception to this rule is cocamidopropyl betaine (CAPB), a non-ionic tensoactive agent that has been a relatively frequent cause of ACD to shampoos and other products that are eliminated with water in Europe and the US in the last 20 years.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Currently, the advantages of synthetic detergent based products have gradually resulted in their greater popularity over common soaps. Recent studies in the US, Australia and Israel, suggest that CAPB allergy persists as a clinical problem, and that such compounds should be included among extracts used in standardised cutaneous patch tests.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Detergents in general contain tensoactive agents which are believed to decrease water's superficial tension. On the other hand, surfactants are classified by their ionic properties in water as anionic, cationic, non-ionic or amphoteric.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Amphoteric surfactants, of which betaine is the classical example, contain elements with both positive and negative charges within a same molecular structure, producing less irritant effects than those anionic tensoactive agents. CAPB is the main non-ionic tensoactive agent that contains ammonia and was originally introduced in personal hygiene products by Johnson & Johnson<span class="elsevierStyleSup">®</span> in 1967 with the “no more tears” characteristic, mainly in children's shampoo ingredients. CABP is composed of a combination of fatty acids obtained from coconut oil with 3-dimethylamine propylamine (DMAPA). The initial substance obtained is cocamidopropyl dimethylamine, which is an amidoamine derivative (AA). The AA is then processed with sodium monochloroacetate, obtaining the final product: CABP (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The purpose of CABP addition to personal hygiene products is as a foam booster, thickener and softener.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Since the beginning of the 1980s, a series of reports have appeared, indicating the CABP may act as a contact allergen. The sensitisation prevalence to this substance is currently unknown in our country, however, a high frequency of sensitisation is known to present in hair dressers and those people who use shampoos, liquid soaps, hair dyes, contact lens solutions, shower gels and skin cleansers, given the presence of this component in these products.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a> It must be highlighted that various studies have demonstrated that the true sensitising agents could be intermediate products in the synthesis of CABP such as DMAPA and AA, more than CAPB itself. During many years this issue has been highly controversial and numerous North American studies<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a> have demonstrated that AA was the cause of DCA while numerous European studies<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> show that DMAPA is the true sensitising substance. In our milieu, in which we probably have an under-registration of sensitisation to this substance, the purpose of the present study is to describe the role of CABP as a cause of ACD.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">A 61-year-old patient presented with a six month history of pruriginous lesions on the cheeks and chin (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), without occupational related risk factors and no history of atopia. Topical steroids had been used with clinical response, but presented with frequent relapses consisting of desquamative erythematous lesions at the sites previously described. An epicutaneous test (patch test) was applied on the upper back with the American standard series (Trolab<span class="elsevierStyleSup">®</span> Patch Test Allergens) and improved quality chamber (Finn Chambers<span class="elsevierStyleSup">®</span> for Patch Testing), showing a ++ positive reaction the D1 to CABP, balsam of Peru, balsam of Tolu and mixed fragrances, which persisted until D2 reading. The interview following the tests allowed for identification of a daily use of shaving shampoo containing CABP. Avoidance of this product during the skin care regimen resulted in resolution of the skin lesions and associated symptoms. The patient was finally diagnosed with an ACD to CABP present in the commercial CABP (shampoo).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">To date, this is the first Colombian case report to describe ACD produced by sensitisation to CABP in a patient who routinely used liquid soap during shaving. Sensitisation to CABP clinically presents as a recurrent chronic dermatitis that involves the head (scalp, face and eyelids) and neck. International case reports exist which describe occupational ACD in hair dressers and health care personnel who present with forearm and hand involvement<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>. However, more diffuse presentations may present when liquid soaps, shampoos and shower gels are used, as in our case. With respect to CABP sensitisation, various studies have used allergenic extracts in the intermediate product of CABP synthesis patch test in patients allergic to this substance. Of these, DMAPA has been concluded to possibly have a significant role in CABP allergy.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> In our country, these intermediate substances are not available, which limits the determination of these elements (DMAPA or AA) as causative agents in the clinical manifestations in our case. Given the current conditions of contact dermatitis knowledge in our environment, as is the absence of prevalence studies, this study provides a better understanding of this type of pathologies and specifically with respect to CABP.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Finally, in light of international literature, even though it is important to perform this type of studies, which aid the scientific population in the understanding of allergic cutaneous pathology, we must stress the need for more research studies that provide information regarding the frequency and prevalence of contact allergens in our population with the purpose of intervening with public health measures that impact not only in the health-disease process of our patients, but also in the health-related quality of life.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 889 "Ancho" => 1333 "Tamanyo" => 241943 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous scaly plaques in cheek.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1653 "Ancho" => 2618 "Tamanyo" => 189473 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Synthesis of cocamidopropyl betaine (CAPB).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contact allergy to 3-dimethylaminopropylamine and cocamidopropyl betaine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. 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Rigano" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Contact Dermatitis" "fecha" => "2003" "volumen" => "48" "numero" => "April" "paginaInicial" => "194" "paginaFinal" => "198" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12786723" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pure cocamidopropylbetaine is not the allergen in patients with positive reactions to commercial cocamidopropylbetaine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "G. Angelini" 1 => "L. Rigano" 2 => "C. Foti" 3 => "P. Rossi" 4 => "G.A. Vena" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Contact Dermatitis" "fecha" => "1996" "volumen" => "35" "numero" => "October" "paginaInicial" => "252" "paginaFinal" => "253" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8957652" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cocamidopropyl betaine: the significance of positive patch test results in twelve patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.F. Fowler Jr." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Cutis; Cutaneous Medicine for the Practitioner" "fecha" => "1993" "volumen" => "52" "numero" => "November" "paginaInicial" => "281" "paginaFinal" => "284" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25786077" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03010546/0000004000000002/v1_201304101104/S0301054611001236/v1_201304101104/en/main.assets" "Apartado" => array:4 [ "identificador" => "5550" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Research letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03010546/0000004000000002/v1_201304101104/S0301054611001236/v1_201304101104/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054611001236?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 15 | 1 | 16 |
| 2024 October | 114 | 15 | 129 |
| 2024 September | 130 | 15 | 145 |
| 2024 August | 103 | 26 | 129 |
| 2024 July | 100 | 12 | 112 |
| 2024 June | 85 | 6 | 91 |
| 2024 May | 95 | 7 | 102 |
| 2024 April | 95 | 10 | 105 |
| 2024 March | 134 | 12 | 146 |
| 2024 February | 129 | 12 | 141 |
| 2024 January | 682 | 14 | 696 |
| 2023 December | 108 | 26 | 134 |
| 2023 November | 168 | 10 | 178 |
| 2023 October | 199 | 17 | 216 |
| 2023 September | 140 | 21 | 161 |
| 2023 August | 135 | 11 | 146 |
| 2023 July | 137 | 9 | 146 |
| 2023 June | 121 | 29 | 150 |
| 2023 May | 156 | 23 | 179 |
| 2023 April | 192 | 11 | 203 |
| 2023 March | 215 | 30 | 245 |
| 2023 February | 129 | 17 | 146 |
| 2023 January | 124 | 18 | 142 |
| 2022 December | 131 | 28 | 159 |
| 2022 November | 146 | 21 | 167 |
| 2022 October | 140 | 21 | 161 |
| 2022 September | 130 | 23 | 153 |
| 2022 August | 145 | 33 | 178 |
| 2022 July | 86 | 22 | 108 |
| 2022 June | 115 | 27 | 142 |
| 2022 May | 104 | 22 | 126 |
| 2022 April | 105 | 32 | 137 |
| 2022 March | 142 | 30 | 172 |
| 2022 February | 147 | 27 | 174 |
| 2022 January | 152 | 32 | 184 |
| 2021 December | 111 | 37 | 148 |
| 2021 November | 93 | 31 | 124 |
| 2021 October | 110 | 38 | 148 |
| 2021 September | 95 | 35 | 130 |
| 2021 August | 82 | 21 | 103 |
| 2021 July | 89 | 25 | 114 |
| 2021 June | 91 | 20 | 111 |
| 2021 May | 73 | 25 | 98 |
| 2021 April | 183 | 37 | 220 |
| 2021 March | 74 | 33 | 107 |
| 2021 February | 46 | 32 | 78 |
| 2021 January | 24 | 35 | 59 |
| 2020 December | 2 | 31 | 33 |
| 2020 November | 0 | 16 | 16 |
| 2020 October | 0 | 9 | 9 |
| 2020 September | 0 | 7 | 7 |
| 2020 August | 0 | 13 | 13 |
| 2020 July | 0 | 8 | 8 |
| 2020 June | 0 | 4 | 4 |
| 2020 May | 0 | 18 | 18 |
| 2020 April | 0 | 9 | 9 |
| 2020 March | 0 | 15 | 15 |
| 2020 February | 0 | 14 | 14 |
| 2020 January | 0 | 3 | 3 |
| 2019 December | 0 | 10 | 10 |
| 2019 November | 0 | 10 | 10 |
| 2019 October | 0 | 7 | 7 |
| 2019 September | 0 | 10 | 10 |
| 2019 August | 0 | 16 | 16 |
| 2019 July | 0 | 11 | 11 |
| 2019 June | 0 | 21 | 21 |
| 2019 May | 0 | 60 | 60 |
| 2019 April | 0 | 17 | 17 |
| 2019 March | 0 | 1 | 1 |
| 2019 February | 0 | 23 | 23 |
| 2019 January | 0 | 1 | 1 |
| 2018 December | 0 | 9 | 9 |
| 2018 August | 0 | 1 | 1 |
| 2018 March | 2 | 2 | 4 |
| 2018 February | 44 | 8 | 52 |
| 2018 January | 56 | 8 | 64 |
| 2017 December | 29 | 6 | 35 |
| 2017 November | 64 | 17 | 81 |
| 2017 October | 32 | 10 | 42 |
| 2017 September | 55 | 11 | 66 |
| 2017 August | 40 | 11 | 51 |
| 2017 July | 46 | 10 | 56 |
| 2017 June | 48 | 18 | 66 |
| 2017 May | 66 | 27 | 93 |
| 2017 April | 51 | 34 | 85 |
| 2017 March | 60 | 26 | 86 |
| 2017 February | 62 | 35 | 97 |
| 2017 January | 59 | 6 | 65 |
| 2016 December | 46 | 14 | 60 |
| 2016 November | 68 | 19 | 87 |
| 2016 October | 90 | 29 | 119 |
| 2016 September | 97 | 18 | 115 |
| 2016 August | 61 | 17 | 78 |
| 2016 July | 38 | 1 | 39 |
| 2016 June | 36 | 19 | 55 |
| 2016 May | 44 | 39 | 83 |
| 2016 April | 53 | 23 | 76 |
| 2016 March | 46 | 25 | 71 |
| 2016 February | 43 | 22 | 65 |
| 2016 January | 41 | 25 | 66 |
| 2015 December | 44 | 13 | 57 |
| 2015 November | 65 | 20 | 85 |
| 2015 October | 35 | 24 | 59 |
| 2015 September | 34 | 17 | 51 |
| 2015 August | 69 | 5 | 74 |
| 2015 July | 91 | 9 | 100 |
| 2015 June | 41 | 7 | 48 |
| 2015 May | 43 | 14 | 57 |
| 2015 April | 38 | 11 | 49 |
| 2015 March | 36 | 16 | 52 |
| 2015 February | 16 | 23 | 39 |
| 2015 January | 17 | 2 | 19 |
| 2014 December | 21 | 4 | 25 |
| 2014 November | 10 | 4 | 14 |
| 2014 October | 21 | 5 | 26 |
| 2014 September | 25 | 5 | 30 |
| 2014 August | 10 | 1 | 11 |
| 2014 July | 16 | 2 | 18 |
| 2014 June | 20 | 0 | 20 |
| 2014 May | 10 | 2 | 12 |
| 2014 April | 8 | 2 | 10 |
| 2014 March | 90 | 33 | 123 |
| 2014 February | 86 | 39 | 125 |
| 2014 January | 99 | 50 | 149 |
| 2013 December | 80 | 37 | 117 |
| 2013 November | 66 | 29 | 95 |
| 2013 October | 72 | 26 | 98 |
| 2013 September | 65 | 15 | 80 |
| 2013 August | 73 | 18 | 91 |
| 2013 July | 81 | 18 | 99 |
| 2013 June | 49 | 21 | 70 |
| 2013 May | 58 | 20 | 78 |
| 2013 April | 48 | 17 | 65 |
| 2013 March | 35 | 5 | 40 |
| 2013 February | 25 | 7 | 32 |
| 2013 January | 8 | 7 | 15 |
| 2012 December | 6 | 8 | 14 |
| 2012 November | 2 | 8 | 10 |
| 2012 October | 1 | 3 | 4 |
| 2012 September | 1 | 1 | 2 |
| 2012 March | 416 | 0 | 416 |
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