Fragrance-free skin care is widely recommended for patients with atopic dermatitis (AD) because barrier dysfunction increases vulnerability to irritant and allergic contact dermatitis. However, fragrance and odor-relevant ingredients encompass heterogeneous synthetic, botanical, and plant-derived compounds with differing sensitization potential, biological activity, and clinical implications. This review evaluates fragrance classification, sensitization risk, anti-inflammatory and barrier-supportive mechanisms, clinical efficacy and safety, and regulatory and labeling considerations relevant to AD. Synthetic fragrances and essential oils carry the greatest sensitization risk. Hydrosols, naturally scented botanicals, and deodorized plant-derived emollients may have lower sensitization potential and possible anti-inflammatory benefits, although AD-specific clinical evidence remains limited. Product labeling further complicates counseling because terms such as “fragrance-free,” “unscented,” and “hypoallergenic” are inconsistently defined and may not reliably exclude allergenic exposures. Fragrance avoidance remains appropriate for patients with active dermatitis or confirmed fragrance allergy, but fragrance and odor-relevant ingredients should not be treated as a uniform risk category. A provisional risk-stratified framework incorporating ingredient composition, formulation quality, disease activity, sensitization history, patch-test results, and patient tolerance may support individualized counseling while maintaining clinical safety.
Background: Allergic contact dermatitis (ACD) from 2-hydroxyethyl methacrylate (HEMA), a common ingredient in US gel nail products, has risen by 50% among patients with dermatitis in North American. However, the current landscape of cutaneous adverse reactions, including contact dermatitis, from at-home gel nail products remains poorly defined. Objective: To evaluate consumer knowledge, practices, and outcomes related to cutaneous adverse reactions from at-home gel nail kits. Methods: This was a cross-sectional, anonymous online survey posted on Reddit subgroups, targeting individuals interested in nail cosmetics or those impacted by adverse reactions. Results: One hundred sixty-three of 189 respondents had used at-home nail kits in the last year; 54% of users experienced an adverse skin reaction. The most common reactions were itching, redness, swelling, and blisters, primarily involving the fingers. Google and social media were the most commonly consulted sources of advice, and 46% consulted a health care professional. Adverse skin reactions were significantly more common among respondents unaware of the risks of acrylates in gel nail products than among those who were aware (88% vs 36%; P < 0.001). Conclusions: The high rate of adverse reactions among at-home users highlights a significant consumer safety issue. The strong association between risk awareness and lower incidence of reactions found in our study suggests that consumer education could be a highly effective preventive strategy.
