Compositae-associated allergic contact dermatitis from bisabolol

Background: Compositae-related chemicals cause allergic contact dermatitis (ACD) in children with atopic dermatitis (AD). Moisturizers can be an overlooked exposure source. Objective: To evaluate ACD in children with recalcitrant AD and a reported history of intolerance to Aquaphor Healing Ointment (AHO) moisturizer. Methods: We retrospectively reviewed charts of children patch-tested to the ingredients of AHO moisturizer who had a history of intolerance, as well as of additional patch-tested patients with exposure to bisabolol in their personal hygiene products and without a history of product intolerance. Results: Seven patients, six of whom had AD, had been referred to our clinic with a history of intolerance to the moisturizer. They were patch-tested with their moisturizer and the components provided by Beiersdorf. Of these, four had positive reactions to their AHO moisturizer and to bisabolol, a Compositae derivative. Conclusion: Bisabolol, a sesquiterpene alcohol, should be considered a potential cause of ACD in children with AD and a history of moisturizer intolerance.