Is it really fragrance-free?

Background: Fragrance allergy is the most common cause of cosmetic contact dermatitis. Many occult sources of fragrance exist. Those which cause the most concern are some "fragrance-free" products that contain fragrance raw ingredients. Thus, the very patients requiring fragrance-free items may be exposed to potential perfume allergens or cross-reactors in seemingly safe products. Additionally, medications dermatologists recommend, both prescription and over-the-counter, sometimes contain fragrance.

Objective: This report describes a patient with chronic hand dermatitis sensitized to multiple fragrance ingredients including rose oil, present in the "fragrance-free" soap she used. Additionally, the tar soaks recommended to her also contained fragrance.

Conclusion: It is no longer sufficient to recommend the use of products labeled fragrance-free to fragrance-sensitive patients. These patients must be educated to read labels and look for plant extracts that are potential perfume sensitizers and cross-reactors. Rose oil, which has been felt to be a rare sensitizer, may be a more common allergen than previously recognized, perhaps because of its existence in a popular "fragrance-free" soap and, conceivably, in many "all-natural" products. Further testing with rose oil should be conducted in the future. Finally, manufacturers need to be more forthright in the labeling of their products.