title: Topical botanically derived products: use, skin reactions, and usefulness of patch tests. A multicentre Italian study.
abstract: BACKGROUND
  The evidence on the safety of topical preparations containing botanical extracts is limited.
  
  
  OBJECTIVE
  To assess (i) the use of botanically derived compounds in a large population, (ii) the incidence of cutaneous side-effects, and (iii) the diagnostic usefulness of patch testing.
  
  
  METHODS
  A questionnaire was used in 2661 patients to assess both the prevalence and type of topical botanical preparations used, and the occurrence of adverse skin reactions. Patients declaring adverse reactions were patch tested with (i) the Italian (SIDAPA) baseline series, (ii) an additional botanical series, and (iii) the patients' own products.
  
  
  RESULTS
  Of the patients, 1274 (48%) reported the use of topical botanical products; 139 patients (11%) commented on adverse cutaneous reactions; 75 (54%) showed positive reactions with the Italian baseline series. Among the 122 patients tested with the botanical series, 19 (16%) showed positive reactions, in many cases with concomitant relevant positivity to at least one allergen of the Italian series connected with cosmetics. The commonest botanically derived allergens were propolis, Compositae extracts, and Melaleuca alternifolia (tea tree) oil.
  
  
  CONCLUSIONS
  Contact allergy is a possible adverse effect of natural products. Baseline series supplemented with the commonest botanical allergens may be adequate for detecting most of the cases of contact allergy to natural topical products.
authors.affiliation: Department of Medical Sciences, Section of Dermatology, University of Ferrara, I-44121, Ferrara, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Corazza
authors.forename: Alessandro
authors.initials: A
authors.lastname: Borghi
authors.forename: Rosella
authors.initials: R
authors.lastname: Gallo
authors.forename: Donatella
authors.initials: D
authors.lastname: Schena
authors.forename: Paolo
authors.initials: P
authors.lastname: Pigatto
authors.forename: Maria Michela
authors.initials: MM
authors.lastname: Lauriola
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Guarneri
authors.forename: Luca
authors.initials: L
authors.lastname: Stingeni
authors.forename: Colombina
authors.initials: C
authors.lastname: Vincenzi
authors.forename: Caterina
authors.initials: C
authors.lastname: Foti
authors.forename: Annarosa
authors.initials: A
authors.lastname: Virgili
mesh_terms: D000279:Administration, Cutaneous; D000293:Adolescent; D000328:Adult; D019659:Asteraceae / Q000009:adverse effects; D003358:Cosmetics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D003877:Dermatitis, Contact / Q000209:etiology*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010328:Patch Tests; D008517:Phytotherapy / Q000009:adverse effects / Q000706:statistics & numerical data*; D010936:Plant Extracts / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011429:Propolis / Q000008:administration & dosage / Q000009:adverse effects; D012871:Skin Diseases / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D020947:Tea Tree Oil / Q000008:administration & dosage / Q000009:adverse effects; D055815:Young Adult
chemical_list: D003358:Cosmetics; D010936:Plant Extracts; D020947:Tea Tree Oil; D011429:Propolis
keywords: adverse effects; botanical products; contact dermatitis; herbal remedies; herbal therapies; patch test