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Allergic contact dermatitis to Iris germanica root in a “natural” cosmetic

A 45-year-old atopic woman with a history of allergic contact dermatitis to nickel was referred for evaluation of an acute itchy, erythematous, and edematous facial eruption that had appeared a few days after the application of “Iris hydrating Day Cream” (Weleda, Arlesheim, Switzerland). Patch tests were performed on the upper back using IQ Ultra chambers (Chemotechnique Diagnostics, Vellinge, Sweden) occluded for 2 days with Opertape (Iberhospitex, Innovative Health Technologies, Barcelona, Spain). Tests were conducted with the European baseline series along with additional series from the REVIDAL group, cosmetics series, and the patient's cosmetics, and they were read on day (D)2 and D3 according to ESCD recommendations. Positive reactions to cobalt chloride (+ on D2 and D3), nickel sulfate (+++ on D2 and D3), linalool hydroperoxide (1% pet.), and limonene hydroperoxide (0,2% pet.) (+/− on D2, + on D3), and with the “Iris Hydrating Day Cream” (+ on D2, ++ on D3) (Figure 1) were observed. Specific patch tests with individual ingredients of the “Iris Hydrating Day Cream” could not be performed. Yet, the patient tolerated a pomegranate firming day cream from the same brand that shared common ingredients with the “Iris Hydrating Day Cream,” especially linalool and limonene. However, cera alba, cocoa seed butter, cetearyl alcohol, hectorite, Iris germanica root extract, and Hamamelis Virginia distillate were not present in the pomegranate cream. The patient tolerated all cosmetics/topical drugs containing cera alba, hectorite, cocoa seed butter, and cetearyl alcohol, thereby leaving Iris germanica root extract and Hamamelis virginia distillate as possible culprit allergens. Both were obtained from Aroma-Zone (Paris, France), as a powder and a