What scented alternatives do you recommend patients with fragrance allergies try to replace perfumes/colognes?

My approach is to initially advise for the first 3 months a strict personal care “product elimination diet” free of fragrances, botanicals, and essential oils for patients who test positive to fragrance-related allergens. “Product elimination diet” is a term coined by expert Canadian dermatologist Sandy Skotnicki, MD. I tend to be more cautious on a long-term basis if a patient has a positive patch test to fragrance mix I, fragrance mix II, or Balsam of Peru. I am inclined to be less restrictive...

I agree with Dr. @Dr. First Last - I try to get patients to avoid all fragrances for at least 3 months, then if they clear I tell them it is up to them if they want to try reintroducing fragranced products one at time, one a month.

What I wanted to add was that I have had MANY patients who were patch test positive to fragrance who have continued to have dermatitis on and off despite giving a history of good avoidance. I never knew if it was that there were hidden exposures or if it was that the ...

Agree with Dr. @Dr. First Last. Some patients with Th2 skewed allergic contact dermatitis who do not improve with topical avoidance of fragrances will respond to dietary avoidance of related flavorants. These patients will also respond to dupilumab, but they should be informed there is an alternative to lifelong use of this expensive medication.

Of course, as Dr. @Dr. First Last points out, dupilumab is also useful for eczematous dermatosis of aging and eczematous bullous pemphigoid, both of whi...