Abstract and Introduction
Abstract
Background: In the past, sorbitan sesquioleate (SSO) was reported as an uncommon allergen, but recent data suggest SSO may be an important sensitizer.
Objective: To present data on 13 of 112 dermatitis patients who reacted to SSO and/or sorbitan monooleate (SMO) on patch testing.
Methods: A retrospective data analysis was conducted on data from 112 dermatitis patients patch-tested from December 2006 to May 2007. All patients were tested with a modified North American Contact Dermatitis Group standard series, a cosmetic series, and a fragrance series.
Results: Of 112 patients, 10 (8.9%) reacted to SSO, 1 (0.9%) to SMO, and 2 (1.8%) to both. Nine of 12 (75%) SSO-positive patients were using topical corticosteroids emulsified with sorbitan derivatives or sorbitol; 2 of the 13 sorbitan-allergic patients were allergic to one or more corticosteroid screening chemicals tested.
Conclusion: SSO is a common emulsifier derived from sorbitol and is used in many high- to super-potent corticosteroids. It has only recently been identified as an important contact allergen. The high prevalence of reactions to sorbitol derivatives in this small group of patients suggests that these chemicals may be sensitizing when applied to dermatitic skin. Larger studies should be conducted to confirm these findings.
Sorbitan sesquioleate (SSO), derived from monoesters and diesters of oleic acid and hexitol anhydrides of sorbitol, is a common non-ionic emulsifier used in numerous medications and cosmetic products. Sorbitan monooleate (SMO) is also a non-ionic emulsifier but is derived from monoesters of oleic acid and hexitol anhydrides from sorbitol. SSO, in particular, functions as an emulsifier in a number of creams and lotions as well as in many topical corticosteroid preparations. In addition, SSO 5% is currently used as an emulsifier in fragrance mix I (FM I) for patch testing.[1,2,3] In the past, SSO has been reported as an uncommon allergen. In two large studies of patch testing with emulsifiers conducted approximately 20 and 30 years ago, the prevalence of allergy to SSO (tested at 20% in petrolatum) among dermatitis patients ranged from 0.5 to 0.9%.[4,5]
Case reports have described contact allergy to both SSO and SMO. Contact dermatitis from SSO has been reported to be caused by wound dressings and a topical corticosteroid preparation (patch-test concentrations of 20% and 10% in petrolatum, respectively).[6,7] A recent case series of children also noted contact allergy to SSO (20% in petrolatum) in certain pediatric products as well as in topical corticosteroid preparations.[8] Case reports have further reported that patients with leg ulcers had positive patch-test reactions to SSO 2% in petrolatum (pet), SMO 2% pet,[9] and SMO 20% pet.[10] A larger series of 23 leg ulcer patients found that 17% were allergic to SMO (10% pet) and that 13% were allergic to SSO (20% pet).[11]
We report on 13 of 112 dermatitis patients who reacted to SSO 20% pet and/or SMO 5% pet from December 2006 to May 2007. In our study, 75% of sorbitan-positive patients were using a topical corticosteroid emulsified with SSO or sorbitol derivatives. We believe that the exposure to SSO in many topical corticosteroid preparations is responsible for the high prevalence of SSO reactions in our small series.
Dermatitis. 2008;19(6):323-327. © 2008 American Contact Dermatitis Society
Cite this: Sorbitan Sesquioleate, a Common Emulsifier in Topical Corticosteroids, Is an Important Contact Allergen - Medscape - Dec 01, 2008.
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