A new review identifies overlooked allergen exposures in LGBTIQA+ populations and calls for more tailored dermatology care.
A growing range of gender-affirming therapies, cosmetics, compression garments, and sexual health products may expose LGBTQI+ people to overlooked contact allergens, according to a new review that maps the unique dermatological risks associated with gender expression and care.
Published in the Australian Journal of Dermatology, the narrative review by Brisbane consultant dermatologist Dr Nicholas van Rooij brings together evidence from registry data, systematic reviews, and case reports to examine how sexual and gender minority (SGM) populations may experience distinctive patterns of exposure to common contact allergens.
While many of the allergens are already well known to dermatologists, Dr van Rooij said that the contexts in which patients encountered them were often not explored during routine consultations.
“[S]tandard dermatology literature rarely addresses exposures specific to LGBTQI populations,” he wrote.
“Individuals in these communities engage in practices – such as use of gender-affirming hormone therapies (GAHT), surgical care, binding, tucking, cosmetic and performance makeup, sexual health product use, and tattooing – that can amplify exposure to established allergens.
“Chronic occlusion, friction, moisture, and layering of products may increase sensitisation risk, resulting in dermatitis at sites relevant to gender expression, including the chest, face and anogenital region.
“Patch-testing registries rarely collect SOGI data, limiting the ability to quantify allergen prevalence and inform tailored clinical care.
“This review integrates established contact dermatitis literature with emerging SGM-specific evidence to characterise allergens relevant to LGBTQI populations and highlight practical considerations for clinicians.”
Allergic contact dermatitis affects an estimated 15% to 20% of people over their lifetime and remains one of the most common inflammatory skin diseases.
Standard patch testing frequently identifies nickel, fragrances, preservatives, rubber accelerators, topical antibiotics, and acrylates, but these baseline panels may not fully capture exposures associated with gender-affirming care and gender expression, Dr van Rooij wrote.
He said gender-affirming medical care represented one of the most important exposure pathways to allergic contact dermatitis.
Transdermal oestrogen patches commonly used by transgender women contain acrylate adhesives and excipients such as propylene glycol, which are recognised contact allergens.
Reactions may present as sharply defined, itchy, or blistering eruptions confined to the patch site and can be mistaken for irritant dermatitis or cellulitis. In patients with confirmed allergy, Dr van Rooij suggested considering alternative hormone delivery methods, including injectable formulations or different adhesive systems.
For transgender men, topical testosterone gels and creams may also trigger allergic or irritant dermatitis because of ingredients such as propylene glycol or alcohol-based penetration enhancers.
Clinicians are encouraged to review the formulation of topical preparations when evaluating persistent, localised skin reactions.
The review also highlights postoperative exposures following gender-affirming surgery. Common surgical products including neomycin, bacitracin, chlorhexidine, and cyanoacrylate skin glues are recognised causes of allergic contact dermatitis, and early identification may prevent unnecessary antibiotic treatment and prolonged morbidity.
Cosmetics represent another significant source of allergen exposure. Long-wear foundations, primers, setting sprays, and other products frequently contain fragrance mixes, preservatives, and acrylate-based film formers.
The review also identified spirit gum and other prosthetic adhesives used in theatrical performance and drag as important sources of colophony sensitisation, while para-phenylenediamine (PPD) in permanent hair dyes remained one of the most potent contact allergens, particularly for people regularly colouring facial or scalp hair as part of gender affirmation.
Binders and tucking garments were also identified as under-recognised contributors to dermatitis.
Elastic fabrics may contain rubber accelerators and textile dyes, while metal fasteners can expose wearers to nickel. Prolonged compression, friction, and sweating further compromise the skin barrier, increasing allergen penetration, and the risk of chronic dermatitis affecting the chest, waist, or groin.
Dr van Rooij recommended considering textile dyes and rubber chemicals during patch testing when symptoms correspond with garment use.
Sexual health products warranted similar attention. Although latex-free condoms eliminate latex protein exposure, they may still contain rubber accelerators, adhesives, or other sensitising chemicals.
Lubricants, topical anaesthetics, and antiseptic products may also contain allergens including propylene glycol, parabens, chlorhexidine, and benzocaine.
Because reactions in the anogenital region can resemble infection or other inflammatory skin disorders, clinicians were encouraged to ask specifically about these products during consultations.
Tattoos and permanent makeup, increasingly used as part of gender expression, represented another potential source of allergic reactions.
The review highlighted red tattoo pigments, azo dyes, and metal salts including nickel, cobalt and chromium as common causes of delayed hypersensitivity.
Permanent eyebrow, lip and eyeliner pigments may also contain incompletely regulated ingredients, with reactions sometimes developing months or years after application.
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Dr van Rooij also emphasised psychosocial barriers to diagnosis.
“Psychosocial factors play a crucial role in the management of ACD among LGBTQI populations,” he wrote.
“Many SGM patients delay seeking care due to prior experiences of stigma, discrimination or misgendering in healthcare settings, which may result in chronic dermatitis, misdiagnosis and prolonged morbidity.
“Anxiety regarding disclosure of binding, tucking or gender-affirming medical practices can impede accurate exposure history collection.
“Additionally, clinicians often under-recognise the dermatologic impact of gender-affirming practices, which may lead to misattribution of dermatitis to atopic eczema, fungal infection or irritant reactions.
“Inclusive, SOGI-informed communication improves diagnostic accuracy and enhances patient trust, promoting timely intervention.
“Community-engaged research emphasises that patient-centred education, empathetic history-taking and collaborative care planning are key to minimising chronic morbidity and optimising allergen avoidance strategies.”
The review called for routine collection of sexual orientation and gender identity data in patch-testing registries, noting that the current lack of such information limits understanding of allergen prevalence and outcomes in LGBTIQA+ populations.
“Clinicians should adopt SOGI-informed, non-judgmental history-taking that explicitly addresses hormone delivery systems, adhesives and prosthetics, binders and tucking garments, cosmetics and performance products, sexual health products and tattoos or permanent makeup,” Dr van Rooij wrote.
“Patch-testing should be tailored to the patient’s exposures, incorporating acrylates and colophony for adhesive use, fragrance and preservative panels for cosmetic exposure, rubber accelerators for elasticised garments and textile dyes for clothing-related dermatitis.
“Management strategies include switching hormone delivery routes when excipient allergy is suspected, recommending medical-grade adhesives with transparent ingredient lists, using low-fragrance and preservative-limited cosmetics, limiting continuous binder wear and rotation and offering latex-free barrier alternatives.
“Documentation of clinically relevant patch-test results and education on safe product substitutions are essential for prompt symptom resolution while maintaining gender-affirming practices.”
