Sensitization to benzyl salicylate and other allergens in patients with frontal fibrosing alopecia.

Introduction Contact sensitization is frequent among frontal fibrosing alopecia (FFA) patients (52-76%). Objective To evaluate the frequency of sensitization/photosensitization among an FFA population. Material and methods A population of FFA patients were patch tested (GEIDAC baseline; cosmetic and fragrance series), and photopatch tested (sunscreens series). Results 36 patients (mean age: 64.6 years old; 35/36: women) were studied. History of dermatitis was recorded in 69.4% (frequently involving the face). Overall, 80.5% patients showed positive patch test reactions. The most frequently positive allergens were nickel sulphate (25%); benzyl salicylate (22%); gallates (16.6%); propolis (16.6%); and limonene hydroperoxides (13.8%). Benzyl salicylate was likely relevant to the dermatitis (labelled on personal care products and most patients reporting clinical improvement with allergen avoidance). Patch tests with sunscreens showed positive reactions to 11 materials (5 patients). Photopatch tests were positive in one case. Discussion We speculate a possible relationship between sensitization to benzyl salicylate and FFA. Hypothetically, the most likely explanation is that sensitization to benzyl salicylate involving FFA patients is a consequence of increased exposure to it. It is unclear whether allergenic avoidance may impact the prognosis of alopecia. However, it seems to significantly improve the patients' quality of life by lessening dermatitis and pruritus. This article is protected by copyright. All rights reserved.