December 29, 2020Skincare

Skin Allergies and Irritations: Conversation between two Leading Dermatologists


Dr. Whitney Bowe interviews Dr. Sandy Skotnicki

When I published The Beauty of Dirty Skin, not many people – including dermatologists – were focusing on our skin microbiome. So, when I met Dr. Sandy Skotnicki and she shared my passion, we had an immediate connection! Dr. Skotnicki’s area of expertise is contact dermatitis – which means, skin allergies and irritations. We took a deep dive together into this subject matter as specifically, how it impacts skincare product decisions. I’m excited to share this conversation with you!

Dr. Bowe: For my patients who don’t want to give up fragrances in skincare, and prefer clean products, what do you recommend as a compromise: a way to enjoy those products but minimize the risk of developing an allergy over time? 

Dr. Skotnicki: The first thing to get patients to understand is fragrance on a bottle is a placeholder term- fragrance or perfume on a label means another 20-30 individual ingredients. Most companies do not disclose what is in their fragrance due to trade secrets. What makes Pantene smell like Pantene? Well, it is not one chemical but all you will see on the bottle is the term fragrance.

So some individual fragrance molecules have very low allergy risk. Or the opposite -there are 26 individual fragrance molecules in particular that are identified and controlled in the European Union. Examples of these allergenic individual fragrance molecules would be cinnamon, geraniol, linalool, oak moss etc. Avoidance of those in formulas would be the first step. 

Next are plant extracts or essential oils. These ingredients are complex mixes of multiple chemicals- they are not one chemical. If you extract something from a plant or remove the “essence” of a plant – which is done in essential oils- you end up with something that contains a multitude of individual chemicals, sometimes numbering in the 20-30s.

 If an individual ingredient in a plant extract is identified as helpful – what should be done is to isolate that one chemical and use it or copy it in a synthetic variant. This way, you don’t get all the other parts of the extract. All the other chemicals are unknown and could be problematic i.e. allergic, irritant or hormone disruptive (like lavender and tea tree essential oil; Note: more on this below).

A good example of this technique is the famous medical plant, Centella Asiatica, also known as Gotu Kola. It has very well established wound healing and antioxidant properties. But the main active ingredient in this plant that affords these healing properties is Madecassoside. So, companies use this ingredient only and not the whole plant extract. This is how it should be done for better safety.  Naturally, this is a more difficult and expensive process than just using the plant extract. 

So what is the best way to have some fragrance in skincare and still have a natural and clean product? Choose one or two individual fragrance ingredients that have low allergy potential and/or use individual plant ingredients for fragrance and not essential oils or plant extracts. 

Dr. Bowe: During COVID, so many of my patients have gravitated more towards fragrances and aromatherapy.  Using a diffuser, or applying a skincare product that has a lovely, calming fragrance can really affect our moods, ease anxiety, and enrich an experience making it feel more like self care.  Many of my patients are surprised to learn that botanical, or “natural” fragrances, such as extracts and essential oils, are a very common cause of skin allergies.  What are the most common botanical ingredients that you’re seeing come up during your patch tests as the cause of skin allergies in adults?

Dr. Skotnicki: If I could show you some of my severe diffuser contact allergy cases, you would be floored! It’s a mini-epidemic. Severe facial swelling, sometimes so bad they can’t open their eyes.

Allergic contact dermatitis to essential oils has increased dramatically over the past years coinciding with their huge use and distribution in North America .The essential oil industry is set to continue to rise. The scary part is they market them for children. Undiluted essential oils should not be used on children and particularly not in a diffuser in their bedroom.

I get that fragrance is about self-care and not everyone has an issue.  But it is the assumption that ” it’s all natural so it can’t be bad for you” is what is troubling and causes many of my patients to suffer for many months until I patch test them and tell them they are allergic to their all natural essential oil.  

Some of the most common botanical allergens include ylang-ylang,( the base fragrance of Aveda) linalool ( which is a terpene in many essential oils), lavender, eucalyptus, tea tree oil, Jasmine, menthol and peppermint, lemon, lemongrass, rose, sandalwood, rosemary, feverfew, clove oil and many more.

It’s not just about skincare reactions from botanicals and essential oils. Several essential oils – tea tree and lavender – have been associated with hormone disruption and breast development in young boys.

Dr. Bowe: Tell me about your book, Beyond Soap, and why you decided to write it?  Having written a book myself, I know what a huge undertaking that can be!

Dr. Skotnicki: I decided to write my book to help explain why so many of my patients were reacting to their skincare and haircare.  Over the years I was being sent the same type of patient with the same problem and I got frustrated for them and for me!. I also live in Canada, where we have less than 600 Dermatologists in the country and only a handful that specialize in what I do- Contact Dermatitis.

So, I wanted to write a book on the topic to try and help inform patients who couldn’t get to a Dermatologist or had to wait and suffer for months before seeing one.  The main purpose of my book was to highlight what in skincare actually causes reactions?  It is not what the public thinks. 

What I found the most rewarding was the path my book took. I decided to do a broad research dive into the topic and I ended up reading outside of Dermatology- I read microbiology, immunology, general science, and what I learnt really shifted the way I view not only Dermatology but medicine.  It’s not just what is in skincare that is causing increased reactions, it’s the way we take care of our skin.  Washing and cleaning has increased over the past 150 years and along with it has come increased skin disease as well as other inflammatory conditions.  I think we realize in medicine that there is a connection but it is not clear- having said that the microbiome has something to do with it.

Thank you so much for sharing your insight and thoughts on these key topics with me and with my audience! I value your work so much and I can’t wait to share our live with my Instagram audience!


Dr. Whitney