Article

55 Cases of allergic reactions to hair dye: A descriptive, consumer complaint-based study

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Severe facial and scalp dermatitis following the use of permanent hair dyes has been reported in several cases. Para-phenylenediamine (PPD) is known as a potent contact allergen, and PPD is allowed in hair dye at a concentration of 6%. Hair dye reactions are usually diagnosed by the patients themselves, and adverse reactions to hair dye may not necessarily be recorded by the health care system, unless the reactions are especially severe. Based on this assumption, we suspected that hair dye dermatitis was occurring more frequently than reported in the literature. Consumer complaint-based data were obtained by advertising for persons with adverse reactions to hair dye. Among those responding to the advertisement, 55 cases of severe, acute allergic contact dermatitis were identified. The main symptoms were severe oedema of the face, scalp and ears, and clinically this was often mistaken for angio-oedema. The 55 cases comprised a total of 75 visits to the health service and 5 admissions to hospital. 18 persons had sick leave, which supports the impression of very severe dermatitis reactions. 60% were treated with antihistamine, while 52% were treated with corticosteroids. 29% of the cases were patch tested and all were found positive to PPD. Our data presented here clearly show that PPD and its derivatives in hair dye at the present concentrations presents a significant health risk for the population. Furthermore, the severe acute allergic skin reactions are often misdiagnosed in the health care system. The frequency of allergic contact dermatitis resulting from hair dye is likely to be underestimated. New methods to survey the frequency of adverse reactions should be considered.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... According to the European figure, PPD is considered the fifth most allergen [9]. Contact allergy to PPD can be tested by doing a patch test before using the hair dye [10]. Severe facial and scalp dermatitis due to permanent hair dyes has been reported, with symptoms including severe oedema of the face, scalp, and ears [10]. ...
... Contact allergy to PPD can be tested by doing a patch test before using the hair dye [10]. Severe facial and scalp dermatitis due to permanent hair dyes has been reported, with symptoms including severe oedema of the face, scalp, and ears [10]. If not identified early, it can lead to permanent blindness or death as there is no antidote for PPD poisoning [11]. ...
... Countries like Germany, France, and Sweden have banned the use of PPD in hair dye due to severe allergic reactions. The European Union legislation requires PPD in hair dye to comprise up to 6 % of the dye's content but reduced to 3 % when added to the oxidizing solution required for color growth [10]. ...
Article
Currently, the use of henna-based herbal black hair dyes is widespread in the community. However, it is important to note that these dyes cannot be classified as completely natural due to the addition of various in�gredients to enhance their effectiveness. Most black hair dyes use paraphenylenediamine (PPD) to get a black hue, however, PPD is widely recognized as a contact sensitizer. The toxicity of heavy metals is also prevalent in the cosmetics sector. These metallic elements can permeate the skin and provide widespread exposure throughout the body. Hair dye requires an alkaline pH value because of reactions that occur during the dyeing process, which is incompatible with scalp pH. The varying concentrations of these chemicals and their frequency of usage can result in diverse health issues. The present research implemented High-Performance Liquid Chro�matography and Atomic Absorption Spectrometry to quantify the concentrations of PPD and heavy metals (Pb, Cd, and Fe) in seven frequently used brands in Sri Lanka. The lead content in the examined samples exhibited variability, ranging from 0.04 ± 0.01 ppm to 0.28 ± 0.14 ppm. However, all the samples remained below the allowed level of 2 ppm according to the BVL standard. Regarding Cd, certain examined materials surpassed the acceptable thresholds, while others did not and varied between 0 ppm and 2.33 ± 1.92 ppm. Iron was found at a significantly higher concentration compared to the other two heavy metals. A significant quantity of PPD was detected, exceeding the allowable threshold of 6 % according to the European Union legislation. All the samples that were analyzed had a pH value within the alkaline range. The study indicates that herbal dyes generated from natural materials may contain harmful compounds, such as a high concentration of PPD in herbal black hair color potentially inducing sensitization.
... Some adverse skin reactions are attributed to hair dyes, especially allergic contact dermatitis which may be severe and require a physician consultation. Mild skin reactions to hair dyes are usually identified by the users themselves due to the relative short timeframe between exposure and the development of skin reactions in the exposed region [14]. Corbett indicated that some colorants contained in hair dye give rise to skin problems including sensitization or irritation [15]. ...
... It allows us to highlight that some types of hair dye as well as the place of use influence sensitivity to a varying degree. Owing to the fact that reactions to hair dye are identified by the users due to their rapid onset [14], and that mainly of the symptoms are subjective, the implementation of an epidemiological study is appropriate to assess facial skin and scalp sensitivity [1]. Furthermore, this kind of study based on subjects' declarations by means of self-questionnaires on web is relevant because the subjects can easily identify sensitive skin symptoms and thus do not necessary require a dermatological consultation [23]. ...
Article
Hair dyes are more and more used and the role of the exposure to these products in the development of skin reactions in the exposed region is suspected. The aim of this study is to assess the effects of hair dyes on facial skin and scalp sensitivity by performing a Computer Assisted Web Interview on 1257 women older than 15 years old. Differences were observed in the scores evaluating facial skin and scalp sensitivity according to different parameters. Women aged between 15 and 24 years old suffered more from skin and scalp sensitivity both for hair dye users and for non-users. The results obtained according to hair dye usage patterns indicated the highest sensitivity of the scalp and facial skin when the hair dyeing process was performed at home with professional products, or when the type of product used was bleach alone or bleach followed by another dyeing product. The severity of facial skin and scalp sensitivity depends on different factors and seems to be potentially exacerbated by the hair dyeing process.
... Instead, symptoms involving hair thinning, hair loss, burning sensations, and unrelenting pruritus are often associated with scalp ACD, especially in patients with repeated allergenic exposures. 8,24 Although erythematous lesions are uncommon on the scalp, they may appear on anatomical regions where scalp products run off (periauricular areas, hairline, face, and neck). Figure 1 adopted from Rozas-Muñoz et al. 5 highlights the clinical distribution of affected neighboring regions from scalp ACD. ...
Article
Full-text available
Background It is hypothesized that scalp allergic contact dermatitis (ACD) in women is commonly mistaken for other disorders due to overlapping symptoms and unique clinical presentations. Objective This study reviews the potential underdiagnosis and misdiagnosis of scalp ACD and explores ways to improve diagnostic accuracy. Methods This study conducted an extensive literature review to identify diagnostic challenges, common misdiagnoses, and diagnostic approaches for scalp ACD, focusing on standard versus targeted patch testing techniques. Results Scalp ACD, often misdiagnosed as seborrheic dermatitis due to similar symptoms, has atypical presentations such as hair thinning, hair loss, and erythematous lesions affecting neighboring regions. Trichoscopy can help distinguish scalp ACD, identifying its patchy distribution of thin white scales, in contrast to the yellow scaling of seborrheic dermatitis. Standardized patch testing further contributes to diagnostic errors, with a study reporting 83% of patients who tested negative with standardized patch tests were positive when using their personal products. Individualized patch testing is more effective in identifying causative allergens and accurately diagnosing scalp ACD. Limitations It is a retrospective review. Conclusion Several factors contribute to scalp ACD’s misdiagnosis for conditions such as seborrheic dermatitis. The significant discrepancy in ACD detection rates between personalized and standardized patch tests in women emphasizes the importance of using patient-specific products in diagnostic testing. Incorporating scalp ACD more readily into one’s differential, employing individualized patch testing with trichoscopy, and accounting for neighboring symptomatic areas are all crucial elements in improving diagnostic accuracy for scalp ACD in women.
... According to the International Agency for Research on Cancer (IARC) (Rollison et al., 2006), hair dyes (HD) have mutagenic and carcinogenic properties. Ingredients of hair dyes are 4-aminobiphenyl and 4-phenylenediamine, which are potent cancer-causing agents leading to contact allergens and dermatitis (Søsted et al., 2002). Their direct discharge of hair dye into the water streams by domestic end users leads to an adverse effect on aquatic animals and human health. ...
... 7 The signs observed include erythematous macules, patches, papules, plaques, vesicles, oozing, crusting, fissuring, lichenification, oedema, swelling, suppuration and ulceration at the affected sites. 23,29 Hair dye use can also produce split ends in hair dryness, lustreless hair, hair loss, paradoxical excessive greying and slowing of hair growth. 30 Oxidative hair dyes sometimes induce painful sensory irritation of the scalp. ...
Article
Full-text available
Hair dyeing is a popular practice dating back to ancient Egyptian times. Initially, hair dye use was restricted to concealing grey and white hairs of the elderly population. However, in recent times, its use is common among the younger generation as a fashion statement. Hair dye contact dermatitis is a common dermatological condition encountered by dermatologists. It is a delayed type of hypersensitivity reaction that commonly affects the scalp and the vicinity of hair line and neck. Para-phenylenediamine (PPD), a synthetic aromatic amine is the most common allergen specifically implicated in hair dye contact dermatitis. Para-phenylenediamine was announced as the allergen of the year in 2006 by the American Contact Dermatitis Society. Contact allergy to para-phenylenediamine can occur in 0.1–2.3% of the general population. Epicutaneous patch testing is the gold standard test for the diagnosis of hair dye contact dermatitis. However, para-phenylenediamine carries a risk of cross-sensitivity and co-sensitization to other allergens. Apart from contact dermatitis, hair dye use is also associated with various other cutaneous adverse effects such as pigmentary changes, hair loss, skin malignancies and autoimmune disorders. Due to the various adverse effects associated with hair dye use, it is prudent to look for safer alternatives to allergenic hair dyes. In this article, we review the epidemiology, cutaneous and systemic adverse effects associated with hair dye use, patch testing, preventive strategies to minimize the risk of hair dye contact dermatitis, and treatment aspects.
... Hair dyeing-induced contact allergies occur frequently, which may further lead to the occurrence of ACD and urticarial contact (Table 3). 37−40 ACD commonly occurs on the scalp, face, and hands of hair dye users, manifesting as redness of the skin with vesiculation or scaling (Table 3), 41,42 which reduces quality of life in the affected individuals and can have negative socioeconomic impacts. The presence of contact allergies is closely attributed to the potent skin sensitizers contained in hair dyes, such as aromatic amines including PPD, a prevalent hair dye ingredient. ...
Article
Full-text available
Given the worldwide popularity of hair dyeing, there is an urgent need to understand the toxicities and risks associated with exposure to chemicals found in hair dye formulations. Hair dyes are categorized as oxidative and nonoxidative in terms of their chemical composition and ingredients. For several decades, the expert panel's Cosmetic Ingredient Review (CIR) has assessed the safety of many of the chemicals used in hair dyes; however, a comprehensive review of hair dye ingredients and the risk of exposure to hair dyeing has not been documented. Herein, we review the safety of the various chemicals in oxidative and nonoxidative hair dyes, toxicities associated with hair dyeing, and the carcinogenic risks related to hair dyeing. While many compounds are considered safe for users at the concentrations in hair dyes, there are conflicting data about a large number of hair dye formulations. The CIR expert panel has ratified a number of coloring ingredients for hair dyes and banned a series of chemicals as carcinogenic to animals and unsafe for this application. The use of these chemicals as raw materials for producing hair dyes may result in the synthesis of other contaminants with potential toxicities and increased risk of carcinogenesis. It is an open question whether personal or occupational hair dyeing increases the risk of cancer; however, in specific subpopulations, a positive association between hair dye use and cancer occurrence has been reported. To address this question, a better understanding of the chemical and mechanistic basis of the reported toxicities of hair dye mixtures and individual hair dye ingredients is needed. It is anticipated that in-depth chemical and systems toxicology studies harnessing modern and emerging techniques can shed light on this public health concern in the future.
... Solar irradiation intensifies the damages to hair cuticle, for instance, peeling of the cuticle layers and the complete cuticle removal, thus contributing significantly to hair fragility and opacity [20]. Permanent hair dyes often inflict a harmful action on cells and organisms that expressed in hypersensitivity reactions [21], cytotoxic and genotoxic effects in the cells [22]. ...
Article
Full-text available
In this review article, the recent approaches to nanoarchitectonics on hair are briefly overviewed. Different types of nanomodifications can be used for the cosmetic and medical applications to provide the aesthetic improvement or treatment of hair and scalp diseases. This article will discuss in detail the various aspects of nanostructures using to enhance the effect of daily care products, to increase the efficiency of penetration of active substances into the hair structures responsible for their regeneration. In general, nanocoatings are promising in the field of application for improving the structure and aesthetics of the hair shaft, as well as for imparting various beneficial properties to hair or for protection from harmful environmental factors. Finally, the approaches of nanoarchitectonics and regenerative medicine will be overviewed from the point of effective methodology for the regeneration of hair follicles creation.
... Angioedema-like periorbital edema as an often-misdiagnosed specific pattern of ACD from PPD/hair dyes was present in a higher percentage (20%) of patients than was previously reported. 33,41 Rubber glove and thiuram were the least common occupational allergens for hairdressers in the present and some other studies. 42,43 This might be because some of the hairdressers do not wear gloves, or only wear gloves for a short period of time, and that they usually prefer cheap polyethylene film gloves, or less frequently the black nitrile gloves. ...
Article
Background Limited data exists on occupational allergic contact dermatitis (OACD) in Turkey. Objectives To investigate the epidemiologic profile of OACD in Turkey. Methods A retrospective cohort study on 294 patients with OACD among 2801 consecutively patch-tested patients in the allergy unit of the dermatology department of İstanbul Faculty of Medicine between 1996–2019. Results The overall prevalence of OACD was 10.5%, showing a male predominance. OACD was most frequently seen in construction workers (45.2%), followed by hairdressers, metalworkers, healthcare workers, and miscellaneous. The main relevant allergens were chromium in cement, thiurams in rubber gloves, hairdressing chemicals, resins/glues/plastics, metals, isothiazolinones, and fragrances. Hands were the mainly involved site (95.6%). Airborne eczema was observed in 21.4%. Hand&foot eczema and co-sensitizations to chrome&thiuram and chrome&cobalt were significantly associated with being a construction worker. Sensitizations to isothiazolinones in house painters, ammonium persulfate and p-phenylenediamine in hairdressers, and colophonium increased after 2010. Conclusion These were the largest data on OACD from Turkey, reflecting the importance of rubber glove allergy in all occupations and the striking increase in ammonium persulfate allergy among hairdressers. Chrome and cobalt were still the main cement allergens in Turkey, where the cement directive is not yet in force. This article is protected by copyright. All rights reserved.
... Toxic effects of hair dye reactions cannot be diagnosed by the person using it unless it is visibly apparent on the skin of the applicant. The incidence or quantum of dermatitis caused by hair dye use is much more than reported in the literature [28]. The main symptoms of hair-dye-induced toxicity may include severe edema of the face, scalp, and ears. ...
Article
Full-text available
Cosmetics, commonly known as ‘makeup’ are products that can enhance the appearance of the human body. Cosmetic products include hair dyes, shampoos, skincare, sunscreens, kajal, and other makeup products. Cosmetics are generally applied throughout the face and over the neck region. Sunlight has different wavelengths of light, which include UV-A, UV-B, UV-C, and other radiations. Most cosmetic products have absorption maxima (λmax) in the range of visible light and UV-R. The effect of light-induced photosensitization of cosmetic products, which results in the production of free radicals through type-I and type-II photosensitization mechanisms. Free-radicals-mediated DNA damage and oxidative stress are common consequences of cosmetic phototoxicity. Cosmetic phototoxicity may include percutaneous absorption, skin irritation, eye irritation, photosensitization, mutagenicity, and genotoxicity. Oxidative stress induces membrane lipid peroxidation, glycoxidation, and protein covalent modifications, resulting in their dysfunction. Natural antioxidants inhibit oxidative-stress-induced cosmetic toxicity. Sunlight-induced photodegradation and accumulation of cosmetic photoproducts are also a matter of serious concern. India has tropical weather conditions throughout the year and generally, a majority of human activities such as commerce, agriculture, sports, etc. are performed under bright sunlight conditions. Thus, more focused and dedicated research is warranted to explore the effects of cosmetics on oxidative stress, glycoxidation of biomolecules, and photoproducts accumulation for its total human safety.
... [100][101][102] It can also induce immediate-type reactions going from local urticaria to fatal systemic reactions and anaphylactic shock. [103][104][105] Other chemical compounds of LMW reported as inducing ICoU are aliphatic polyamides, methyl ethyl ketone, widely used as solvent in plastic manufacture, and monoamylamine, a vehicle ingredient of topical medicaments. Also, benzonitrile, a useful solvent and versatile precursor to many derivatives, carbamate-constituting groups of polyureythanes and diethyl fumarate. ...
... Hair colouration has usually been done by the use of oxidation dyes. However, the components such as aromatic amines, i.e. p-phenylenediamine, cause very occasionally contact dermatitis to hairdressers and people who dyes hair themselves [3,4]. ...
Article
Full-text available
The hair dyeing using green tea extracts containing high amount of catechins in combination with chemical oxidants such as O2, H2O2 and NaIO4 was attempted in order to establish a novel hair dyeing technique without using aromatic amines contained in commercial oxidation dye products. The new hair dyeing technique consists of a twostep colouration system. The first step is treatment of hair with tea extract solution and the second one is oxidation treatment. Three kinds of oxidation methods such as (1) treating hair with basic dyeing solution (pH = 11.5) supplied with large amount of O2 gas (O2 method), (2) treating hair with H2O2 solution (pH = 9.5) (H2O2 method), (3) treating hair with NaIO4 solution (pH = 7) (NaIO4 method) were attempted as the second oxidation treatment. The results show that once dyed hair is discoloured by H2O2 in the oxidation process and white hair is hardly coloured by the method. In contrast, white hair is dyed brown by the O2 or NaIO4 method, and the dyeability increases with increasing temperature of the first tea extract treatment. This may be due to the increase in the amount of dye precursors adsorbed onto hair by heating. Colour fastness of the hair samples dyed by the O2 and NaIO4 method to washing is almost same level as that by the commercial oxidation dyes. The NaIO4 method is more useful than the O2 method because the supply of O2 gas is unnecessary for the NaIO4 one and it uses the neutral solution.
... In our study, 68 people (64.8%) had HDCA only on the direct contact area, while 37 people (35.2%) showed skin lesions on both the direct and indirect areas. Similar to our study, other studies have reported that the forehead was the most common location showing an allergic reaction to PPD, followed by the eyes, ears, and then scalp; these direct contact areas also showed more severe presentation 9,17,21,29 . Allergy contact dermatitis from PPD derivatives also seems to be related to lichen planus or lichenoid eruptions 6,30-32 . ...
Article
Full-text available
Background P-phenylenediamine (PPD) has been identified as the most frequent contact sensitizer of hair dye and the clinical characteristics of hair dye contact allergy (HDCA) are diverse. Objective The purpose of this study was to identify the clinical characteristics of HDCA and to assess the relationships between HDCA, exposure time to PPD and PPD positivity. Methods We analyzed 105 patients with patch test-confirmed hair dye allergy who presented between July 2009 and March 2015. Clinical symptoms, signs, associated skin diseases, involved ACD area, and patterns of hair dye use were obtained by reviewing medical records and by interview. Results HDCA was more common in women and in individuals aged more than 50 years. Pruritus was the most common symptom; erythematous macules and patches were the most frequently observed clinical signs. The most common site of HDCA was the face and non-specific eczema and urticaria were frequently observed with HDCA. Exposure time to hair dye, represented as frequency and duration, showed a positive correlation with the area affected by hair dye allergy (p<0.001). Hair dye allergy was identified in most patients (80%) before diagnosis by patch test. However, only 28.6% of all patients stopped using hair dye, even after the diagnosis was confirmed. Conclusion The extent of hair dye allergy involvement was related to exposure time to hair dye. For effective treatment of HDCA, it is important to properly educate patients with HDCA about the clinical manifestations of HDCA and to keep away from allergens.
... Many of these molecular ingredients are toxic, and some are even carcinogenic. 3 If they are absorbed through the skin or inhaled, they could cause allergic reactions [4][5][6] or even more severe consequences. [7][8][9][10][11][12] Treating hair with a weaker alkaline base or at near neutral pH avoids the opening of the cuticles and is less likely to inflict permanent hair damage. ...
Article
Graphene-based sheets are found to be excellent hair dyes. Graphene oxide (GO) and its reduced form r-GO can be used to create water-based formulations to form smooth and continuous coatings on hair. This not only avoids the use of toxic, small molecular ingredients in common hair dyes but also renders new properties of hair for enhanced comfort, such as greatly improved antistatic performance and heat dissipation. After drying, the graphene hair dyes can form a strongly adhering coating on hair surfaces, which can resist repetitive washing with shampoo, and thus reach the performance requirement of permanent hair dyes. The color of the GO coating can be gradually darkened or patterned to create the effect of gradient dyeing, and the lightness of the resulting r-GOcoating can be adjusted through the loading level to produce different shades.
... Along with hair dyes, PPD is also present in textile dyes, leather dyes, fur dyes, photocopiers and black rubbers. Hair dye dermatitis can present as irritant dermatitis, allergic contact dermatitis or photocontact dermatitis [4]. Other common presentations include airborne contact dermatitis, photocontact dermatitis, periorbital eczema, hand eczema, lichenoid lesions and lichen planus pigmentosus like pigmentary changes. ...
Article
Full-text available
Erythema multiforme (EM) is an acute, self limited skin disease characterized by the sudden eruption of symmetrical lesions in typical targetoid fashion usually confined to face and extremities. The most commonly implicated factors include infections like herpes simplex, mycoplasma, drugs like antibiotics and anticonvulsants and vaccinations. Contact dermatitis induced EM is a rarely reported entity. Herein we present a case of a 40 year old female who presented with EM due to contact sensitivity to p-Paraphenylenediamine (PPD), a common coloring agent in hair-dyes and a potent sensitizer. Till date, there have been only a few case reports of PPD induced EM.
... 16 Permanent hair dye compounds such as aromatic amines may cause contact allergy to self-hair dye users, hairdressers, and their clients. 17,18 Hairdressers are usually exposed to both skin irritants and sensitizers; so, they are at a higher risk of occupational skin diseases. 19 ...
Article
Full-text available
Para-phenylenediamine (PPD) is the commonest and most well-known component of hair dyes. Oxidative hair dyes and dark henna temporary tattoos contain PPD. Individuals may be sensitized to PPD by temporary henna tattooing in addition to dyeing their hair. PPD allergy can cause severe reactions and may result in complications. In recent years, frequency of positive patch test reactions to PPD has been increasing. Cross-sensitization to other contact allergens may occur, in particular to other hair dye components. Hairdressers are at a high risk for PPD allergy and require counseling regarding techniques to minimize exposure and protective measures while handling hair dye. We focus this review on the current perspectives of diagnosis and management of PPD allergy.
... In consumers, allergic contact dermatitis caused by PPD can be severe [306], with edema of the face, scalp, and ears that may be clinically mistaken for angioedema [307]. Although its use is illegal in Europe, active sensitization to PPD has been increasingly observed from its use as a skin paint in so-called temporary tattoos when black henna is used [308,309]. ...
Article
Full-text available
The distinction between allergic and irritant contact dermatitis is usually made by patch testing. This test procedure is indicated in the investigation of longstanding cases of contact dermatitis and should also be used to exclude contact allergy as a complicating factor in stubborn cases of other eczematous diseases such as atopic dermatitis, stasis eczema, seborrhoeic dermatitis and vesicular hand eczema. A patch test is the cutaneous application of a small amount of the suspected allergen in a suitable concentration and vehicle. The test site, usually the back, is covered with an occlusive dressing for 2 days. The skin condition, vehicle and concentration and volume of the test substance, test site, application time, and the number of readings influence the result, and frequent errors are possible [l–3] (see Sect. 10.1). The proper performance and interpretation of this bioassay require considerable training and experience.
... Mild to moderate contact reactions such as erythema, oozing, and ulceration typically at the scalp margin, and on the ears and neck are common as a result of direct contact. [21,22] Ho et al. [23] observed that hair dye dermatitis primarily involved the face and neck (28%), and hands (25%), whereas widespread dermatitis occurred in 17% of patients. Airborne contact dermatitis, irritant contact dermatitis, photocontact dermatitis, periorbital eczema, hand eczema, lichenoid lesions, and lichen planus pigmentosus-like pigmentary changes were the commonly observed clinical patterns of hair dye dermatitis, whereas contact leukcoderma, contact urticaria, lymphomatoid papulosis, erythema multiforme-like or prurigo nodularis-like lesions, and anaphylaxis have occurred atypically with PPD. ...
Article
Full-text available
The contact allergic reactions from p-phenylenediamine (PPD) in hair dyes vary from mild contact dermatitis to severe life- threatening events (angioedema, bronchospasm, asthma, renal impairment). To study the clinical patterns and PPD contact sensitivity in patients with hair-dye dermatitis. Eighty (M:F 47:33) consecutive patients aged between 18 and 74 years suspected to have contact allergy from hair dye were studied by patch testing with Indian Standard Series including p-phenylenediamine (PPD, 1.0% pet). 54 Fifty-four (M:F 21:33) patients showed positive patch tests from PPD. Eight of these patients also showed positive patch test reaction from fragrance mix, thiuram mix, paraben mix, or colophony. Fifty-seven (71%) patients affected were aged older than 40 years. The duration of dermatitis varied from < 1 month to > 1 year with exacerbation following hair coloring. Forty-nine patients had dermatitis of scalp and/or scalp margins and 23 patients had face and neck dermatitis. Periorbital dermatitis, chronic actinic dermatitis, and erythema multiforme-like lesions were seen in 4, 2, and 1 patients, respectively. Hair dyes and PPD constitute a significant cause of contact dermatitis. There is an urgent need for creating consumer awareness regarding hair-dyes contact sensitivity and the significance of performing sensitivity testing prior to actual use.
Chapter
Hair dyeing has a rich history, dating back to ancient times when dyes were derived from plants such as henna, indigo, turmeric, and amla. Synthetic dyes began in the 1860s with the discovery of paraphenylenediamine’s reactivity. Eugène Schueller created the first synthetic hair dye in 1907 the first launch of a home color product was “Poly Color,” in 1947 (Pointer 2005). Today, hair dyeing is a thriving multibillion-dollar industry, utilizing both plant-derived and synthetic dyes. Throughout history, people have altered their hair color for personal adornment and social status. Ancient Egyptians used henna and dried cow’s blood to create red and black shades, while Greeks rinsed their hair with potassium solutions and sun-exposed ointments for lighter hues. In the sixteenth century, Venetian women bleached their hair in the sun. In 1907, Eugène Schueller developed the first synthetic hair colorant, leading to the rise of permanent hair coloring in the 1920s (Pointer 2005). Despite risks like irritant dermatitis and potential carcinogens, hair coloring gained popularity with the introduction of home application products. Over time, hair coloring evolved with changing trends. In the Middle Ages, blonde and red were fashionable, while the Renaissance popularized strawberry blonde. Wigs powdered white were chic in the nineteenth century. The twentieth century saw the advent of chemical coloring treatments, becoming widely popular in the 1920s. Today, hair coloring is a common salon treatment and offers diverse options, reflecting a preference for variety. The future of hair coloring holds continued innovation and alternative options for consumers. Plant-based dyes offer a natural alternative for coloring hair. Henna, derived from the Lawsonia inermis plant, is known for its orange hue. Its active component, lawsone, binds to keratin, making it semi-permanent to permanent, depending on hair type. Over time, henna builds up from orange to red and then auburn. Indigo, sourced from plants like Indigofera tinctoria, can be combined with henna to create brown to black shades. However, some commercial henna products contain metallic salts that may react unpredictably with hydrogen peroxide used in perms or synthetic hair dyes, leading to unwanted tones and skin irritation. Pure plant-based options are available to avoid such issues. Additionally, in 2018, a sustainable method utilizing blackcurrant fruit skin waste to extract anthocyanin pigments for semi-permanent hair dyes was developed, offering intense blue color with high build-up and stability through multiple washes (Rose et al. 2018).
Article
Background Hair dyes are widely used in daily life. However, data on self‐reported adverse skin reactions are scarce. Objectives To estimate the proportion of lifetime hair dye use and self‐reported adverse skin reactions in the Dutch general population, and to investigate the association between (adverse skin reactions to) hair dye use and contact allergy‐related factors. Methods This cross‐sectional study collected questionnaire‐derived data from the Lifelines cohort. Logistic regression analyses were conducted between (adverse skin reactions to) hair dye use and black henna tattoo use, reactions to henna tattoos, patch testing, hand eczema and an occupation as hairdresser or beautician. Results The proportion of hair dye use was 63.1% of 70 987 participants, of which 6.8% experienced adverse skin reactions, mostly mild (77.7%). Hair dye users and those with skin reactions were both positively associated ( p < 0.05) with female sex, middle‐age, (positive) patch test results and hairdresser or beautician occupations. Hair dye users were more likely to have had henna tattoos, and those with reactions to hair dye were more likely to have had reactions to henna tattoos. Conclusions Hair dye use is prevalent among the Dutch general population and frequently causes adverse skin reactions, especially in females who had black henna tattoos.
Article
Os produtos cosméticos são definidos como preparações constituídas por substâncias naturais ou sintéticas, de uso externo nas diversas partes do corpo humano, que têm o objetivo principal de limpar, perfumar, alterar e/ou corrigir odores corporais e manter o corpo em bom estado. Por ter essas funções, esses produtos são utilizados diariamente por milhões de pessoas – e, por isso, é fundamental efetuar a vigilância da qualidade desses produtos. Neste trabalho, foi examinada a documentação de 133 produtos cosméticos que foram recebidos e analisados no Instituto Nacional de Controle da Qualidade (INCQS) no período de 2005 a 2009. Desvios referentes aos parâmetros físico-químico, microbiológico e toxicológico foram encontrados. O dado mais surpreendente foi referente à rotulagem desses produtos, visto que 94% dos produtos avaliados apresentaram o rótulo em desacordo com a legislação brasileira vigente.
Article
Background: This study investigated cases diagnosed as allergic contact dermatitis (ACD) in emergency departments (EDs) and management. Methods: A multi-site retrospective study of patients attending EDs in metropolitan Melbourne between July 2017 and June 2018 was performed. Using International Statistical Classification of Disease-10 (ICD-10) codes, the Victorian Agency for Health Information generated a list of cases of contact dermatitis (CD). Demographic and clinical data were analysed. Results: 228 patients from 14 different sites were diagnosed with ACD. Hair dyes caused the most cases, and one such case was admitted to hospital. It was apparent from the specified causes that cases of irritant CD were misdiagnosed as ACD. There were significant differences in management with dermatology input, with dermatologists more often advising oral corticosteroids (33.3% vs 14.5%, p= 0.004) topical corticosteroids (92.9% vs 38.7% p <0.01), emollients (38.1% vs 20.4%, p = 0.01) and less often advising antihistamines (16.7% vs 44.6%, p <0.001). With dermatology input, potent or very potent steroids were more likely to be prescribed (69.3% vs 11.1%, p < 0.001); without, a mild potency steroid was more likely to be prescribed (63.9% vs 4%, p=0.01). Conclusion: Improved understanding, diagnosis and management of CD is needed in EDs. This article is protected by copyright. All rights reserved.
Article
Full-text available
In this study, the authors investigated hair colouring by utilising chemical oxidation of biocatechols, which are obtained from organisms and have catechol (o-dihydroxybenzenes) groups such as (+)-catechin (Cat), (-)-epicatechin (EC), L-3,4-dihydroxyphenylalanine (DOPA), hematoxyline (HX), braziline (BZ), rosmarinic acid (RA), caffeic acid (CA) and chlorogenic acid (ChA). The three types of dyeing methods for the chemically decolourised white human hair were tried as follows: the dyeing by using the solution of the oxidised bio-catechols at 30 °C and pH = 7 (redissolution dyeing), the dyeing by using the oxidation solution of bio-catechol reacting at 30 °C and pH = 10.8 with the introduction of O2 gas continuously (simultaneous oxidation dyeing) and the oxidation by O2 at 30 °C and pH = 11.6 after the treatment of hair with the bio-catechol solution at 30 °C (post-oxidation dyeing). The order of the hair dyeability of the methods using Cat as the bio-catechol was found to be post-oxidation>redissolution>simultaneous oxidation dyeing. Moreover, the resulting colour of hair dyed with Cat by post-oxidation dyeing was reddish brown. The results demonstrate that EC, HX and BZ are also available for hair dyeing by using post-oxidation dyeing and the colours of the dyed hair are yellowish brown, deep brown and reddish brown, respectively. It was found that the bio-catechols having a chroman (3,4-dihydro-2H-1-benzopyran) structure with the catechol part work effectively as dye precursors for colouring hair by the post-oxidation dyeing technique.
Article
Hair products are commonly used to maintain hair health or cosmesis. Products applied to the scalp and hair contain multiple active and inactive ingredients that can potentially cause irritant and/or allergic contact dermatitis. The objectives of this study were to identify and to discuss the most common allergens in scalp and hair applied products causing scalp allergic contact dermatitis (ACD). A PubMed search identified 99 studies, with 3185 patients and 31 categories of scalp products. Hair products reportedly associated with scalp ACD were hair dyes (41%), shampoos (28%), and conditioners (22%). The most commonly reported patch test-positive allergens were p-phenylenediamine (23%), nickel (15%), fragrance mix (13%), balsam of Peru (10%), cocamidopropyl betaine/3-dimethylaminopropylamine (7%), and methylchloroisothiazolinone/methylisothiazolinone (6%). Common symptoms and signs include eczematous lesions, pruritus, and a burning sensation. Medical practitioners should be aware of causative agents to provide appropriate patient education, counseling, and/or treatment.
Chapter
Clinical features of contact dermatitis include the symptoms: pruritus, stinging, smarting, and pain. The typical clinical finding is dermatitis at the site of contact with the causative substance. Physical findings can vary from faint erythema to severe, widespread dermatitis and erythema multiforme-like eruptions. There are significant differences in the exposures of contact allergens and irritants to different areas of the body. It is not possible on clinical grounds alone to distinguish between irritant and allergic contact dermatitis. Allergy testing, primarily patch testing, is necessary to confirm a diagnosis of allergic contact dermatitis and to support a diagnosis of irritant contact dermatitis.
Article
Background Oxidative hair dyes are an important source of chemical exposure and a major risk factor for the development of occupational and non‐occupational allergic contact dermatitis (ACD) worldwide. Objectives To identify the frequency of common allergens associated with occupational and non‐occupational ACD to hair dyes, during the last 10 years, in Greece. Methods We retrospectively reviewed the medical records of patients with suspected ACD to hair dyes from 2010 to 2019. All patients with patch test‐confirmed ACD to hair dyes were evaluated. Results Out of 501 patients with suspected ACD to hair dyes, 362 had at least one positive reaction to hair dye allergens. 62.4% were customers and 37.6% were hairdressers. The mean age of customers was 43.8 and of hairdressers 30.8 years. 58.9% of customers were exposed to dyes for >10 years and 61% of hairdressers for <5 years. The most common site of ACD among customers was the scalp (85%), and among hairdressers the hands (90%). p‐Phenylenediamine (PPD) (52.2%) was the most common contact allergen, followed by toluene‐2,5‐diamine, p‐aminophenol, m‐aminophenol, and ammonium persulfate. Conclusions Sensitization prevalences for PPD and cross‐reacting allergens in Greece have increased during the last decade, regardless of occupational or non‐occupational exposure to hair dyes. This article is protected by copyright. All rights reserved.
Article
Hair colouring by using dyestuffs formed by the oxidation of (+)-catechin (Cat.) under light irradiation was studied and the oxidation system was combined with photosensitisers which absorb visible light and generate oxidants. Rose bengal (RB) and Methylene Blue (MB) were used as the visible light photosensitiser. Hair was treated with the solutions containing them and was irradiated with artificial sunbeam in dry condition or in Cat. aqueous solution. It was found that hair is not coloured when it is pretreated with the aqueous solutions containing Cat., RB and MB, and irradiated with the light in the dry condition (dry system). In contrast, hair is coloured most when it is pretreated with the solutions containing RB and MB, and then irradiated with the light in Cat. aqueous solution (wet system). The RB and MB in hair may promote the oxidation of Cat. and production of colourants to give better colouration results, when the treated hair is irradiated with visible light in the solution condition.
Chapter
An ever-expanding list of causes has been reported for immediate skin contact reactions, of which most are proteins (molecular weight 10,000 to several hundred thousand daltons), but also chemical compounds of low molecular weight (less than 1,000 Da). Low molecular weight chemical agents can be indeed responsible for immediate contact skin symptoms in the differently defined categories of contact urticaria. The most important chemicals responsible for nonimmunological and immunological contact urticaria are described in this chapter. For purposes of simplification and comprehension, these have been classified into the major families of products that include fragrances and cosmetic ingredients, biocides and preservatives, and drugs, together with other categories.
Article
Background Despite its association with a number of side effects, hair dye use is common worldwide. Objective To explore the local side effects of hair dye use and to relate these effects to features of hair dyeing. Methods A questionnaire about hair dye use was distributed to a random sample of 650 female patients at various outpatient clinics in 2008. Results A total of 567 females returned the questionnaire (87.2% response rate). Of these respondents, 82.6% (464 of 562) had used hair dye products in the past. The mean age at first use was 22.23 ± 7.05 years, and the median time between two consecutive dyes was 6 months. Of these respondents, 76.8% (354 of 461) used permanent dyes. Participants reported that they suffered skin redness caused by hair dyes (15.1%, 65 of 431), had scaling (14.4%, 60 of 417), or had itchiness (31.3%, 134 of 428). In addition, 74% (262 of 354) of the participants reported that they had issues with the texture or condition of hair following hair dye use; 77.7% (314 of 404) reported split ends, whereas 69.6% (273 of 392) reported hair dryness, 69.4% (256 of 369) lusterless hair, 77.2% (308 of 399) excessive hair loss, and 53.6% (210 of 392) excessive hair graying. Furthermore, 55.1% (196 of 356) of the participants reported a slowing of hair growth. The total number of hair dyeing events was associated with increased hair loss (p = .04) and excessive graying (p < .001) after controlling for all relevant variables. Conclusion Hair dye is associated with local side effects to the skin and hair. Increased public awareness of these risks could help inform consumer choices and reduce excessive use.
Article
Background: Occupational skin disease is common in healthcare workers. If the healthcare worker develops moderate to severe dermatitis, return to work (RTW) may be challenging. Objectives: The study objectives were to review the impact of an RTW program on the work status of nurses with occupational hand dermatitis and to identify successful intervention methods and strategies. Methods: Nurses who received RTW services at a tertiary occupational medicine clinic were identified, and information related to their diagnosis and RTW was abstracted from their charts. Results: Eighteen nurses with irritant hand dermatitis who received RTW services were identified. Twelve nurses (67%) were performing administrative duties because of their skin condition when admitted to the RTW program, and others were performing patient care with modifications. A graduated RTW trial was commonly implemented with optimized skin care management and monitoring by physicians and the RTW coordinator. Upon discharge, 14 nurses (78%) had returned to their nursing roles with direct patient care, 3 (17%) were working as nurses in non-patient care roles, and 1 (6%) was on permanent disability. Conclusions: A graduated RTW trial to reduce cumulative irritant exposure is a crucial strategy to facilitate nurses' transition back to work and to maintain direct patient care nursing roles.
Article
Background: para-Phenylenediamine (PPD) is a potent allergen with frequent exposure through use of hair dyes or henna tattoos. Objectives: We wished to determine if prevalence of PPD sensitivity is changing through time as trends in its use change. Patients: A total of 3631 patients were patch tested consecutively with the environmental standard series between 2007 and 2014 to map the prevalence of PPD sensitivity and its distribution according to age, sex, and diagnosis. Results: Two hundred nine patients (5.75%) were proven to be PPD sensitive. Most PPD-sensitive patients were approximately in their 60s in 2007, whereas in 2014, they were in their 20s and 30s. In 2014, 61.1% of the patients were younger than 35 years and 50% were younger than 25 years. Of 209 PPD-sensitive patients, 32.5% had present relevance related to hair dyeing and eyebrow or eyelash coloring procedures. All affected male patients were hairdressers. Adverse reaction to henna was detected in only 1 case after henna hair dye use. Conclusions: The 5.75% prevalence of PPD sensitization in our study was higher compared with that in the European data. It is alarming that PPD hypersensitivity occurred even among teenagers. This may be mainly explained by hair dyeing at an early age.
Article
Full-text available
The enzymatic oxidation of (+)-catechin (Cat) with copper-containing oxidase, tyrosinase, was applied to hair colouring in the study. The Cat is oxidised to be o-benzoquinone form, the catechinone, which works as the hair dyestuff. Four kinds of hair colouring techniques using Cat were examined and each of their dyeability was compared in order to improve it. The first dyeing method is dyeing hair by the redissolved catechinone, which is preliminarily obtained by the oxidation of Cat (Redissolution Dyeing Method). The second one is dyeing hair in the dye solution just after the dye being formed by the enzymatic reaction (Sequential Dyeing Method). The third one is dyeing hair in solution containing Cat and the dyeing process is accompanied by the oxidation of Cat (Simultaneous Oxidation Dyeing Method). The fourth one is two-step dyeing that the hair immersed in Cat solution at the first step and then it is oxidised enzymatically to colour at the second step (Post-Oxidation Dyeing Method). The hair is dyed pale yellow by Redissolution Method, deeper yellowish brown by Sequential and Simultaneous Oxidation Dyeing Method and slightly reddish brown by Post-Oxidation Method with Cat. The order of their dyeability is the Simultaneous Oxidation ≈ Post-Oxidation > Sequential > Redissolution Dyeing Method at 30°C. The dyeability of Redissolution Method increases with an increase in dyeing temperature (T) between 20°C - 60°C. In Simultaneous Oxidation Method, the T increment also provides higher dyeability, and the colour of dyed hair becomes duller over 50°C. The Post-Oxidation Method shows higher dyeability at the lower oxidation temperature (20 °C - 40°C).
Chapter
The range of physical and chemical treatments used on hair is now very large and new treatments are continually being introduced. Nater and de Groot (1) list seven categories of hair product that may cause adverse effects on the skin (Table 1).
Article
Background: Hair dyes are known to contain potent contact allergens for which sensitization rates have increased over the last decade. Objective: To examine the type and frequency of potent contact sensitizers labelled on hair dyes sold in metropolitan Bangkok, Thailand. Methods: During the 2013-2014 study period, labelled ingredient information from home use and professional hair dye products was collected. Results: Two hundred and fifty-two hair dye products were evaluated. One hundred and forty-nine products from 48 brands were domestically produced in Thailand, and 103 products were from 23 multinational brands produced in countries other than Thailand. Two hundred and fourteen of 252 (84.9%) hair dye products were found to contain strong skin sensitizers, with 118 (46.8%) being found in domestically produced products, and 96 (38.1%) being found in multinational brand products. Thirty-eight hair dye products (15.1%) were free of potent skin sensitizers. The number of domestically produced products (31, 20.8%) that were free of potent skin sensitizers was significantly higher (p = 0.002) than the number of multinational brand products (7, 6.8%). Conclusions: p-Phenylenediamine was the most prevalent potent sensitizer found among domestically produced hair dyes available on the market. Our findings indicate regional differences in hair dye allergen exposure.
Chapter
The viscosity is responsible for a covering effect which makes the simple passive washing more difficult, because the product sticks to the contact area (Fig. 4.1). A corrosive has, most often, a hydrophilic character. Mechanical washing can more or less remove hydrophilic viscous products, depending on their properties. However, viscous substances may also be hydrophobic and therefore more difficult to wash after a skin splash because of their low water solubility. In some cases, for highly viscous products, it may even be useful to remove mechanically the major part of the product by wiping the surface of the skin before decontamination. An experiment has been designed to compare the efficacy of the mechanical water washing between viscous and fluid compound (Fig. 4.2). © Springer-Verlag Berlin Heidelberg 2014. All rights are reserved.
Article
Objective: P-Phenylenediamine (PPD) is a possible contact sensitizer in skin tissues; however, data are lacking regarding its specific effects on nitric oxide synthase (NOS) expression during the sensitization phase. The purpose of this study was to investigate nNOS and iNOS expression in the skin tissue of PPD-treated mice. Methods: BALB/c mice were dermally exposed to PPD, at a dose of 10 or 50 mg/kg, on three occasions. The ear and dorsal skin tissues were then isolated from PPD-treated mice and vehicle-treated controls. Western blot analyses were performed on samples derived from the skin tissues. Results: The dorsal skin tissues of PPD-treated BALB/c mice showed significantly increased levels of iNOS. However, nNOS expression in dorsal skin, and nNOS and iNOS expression in the ear, was not significantly altered in PPD-treated skin tissues compared to controls. Conclusion: Because enhanced expression of iNOS may contribute to inflammation in allergic contact dermatitis, our data suggest that increased levels of iNOS may be involved in early immunological responses to PPD-induced pathogenesis in dorsal skin. © 2015, International Journal of Pharmacy and Pharmaceutical Sciences. All rights reserved.
Article
The objective of the present study was to elucidate the prevalence of potent skin sensitizers in oxidative hair dye products manufactured by Korean domestic companies. A database on hair dye products made by domestic companies and selling in the Korean market in 2013 was used to obtain information on company name, brand name, quantity of production, and ingredients. The prevalence of substances categorized as potent skin sensitizers was calculated using the hair dye ingredient database, and the pattern of concomitant presence of hair dye ingredients was analyzed using network analysis software. A total of 19 potent skin sensitizers were identified from a database that included 99 hair dye products manufactured by Korean domestic companies. Among 19 potent skin sensitizers, the four most frequent were resorcinol, m-aminophenol, p-phenylenediamine (PPD), and p-aminophenol; these four skin-sensitizing ingredients were found in more than 50% of the products studied. Network analysis showed that resorcinol, m-aminophenol, and PPD existed together in many hair dye products. In 99 products examined, the average product contained 4.4 potent sensitizers, and 82% of the products contained four or more skin sensitizers. The present results demonstrate that oxidative hair dye products made by Korean domestic manufacturers contain various numbers and types of potent skin sensitizers. Furthermore, these results suggest that some hair dye products should be used with caution to prevent adverse effects on the skin, including allergic contact dermatitis.
Article
Full-text available
A population-based case-control study was conducted in Los Angeles, California, which involved 1,514 incident cases of bladder cancer and an equal number of age-, sex- and ethnicity-matched controls. Information on personal use of hair dyes was obtained from 897 cases and their matched controls. After adjustment for cigarette smoking, a major risk factor for bladder cancer, women who used permanent hair dyes at least once a month experienced a 2.1-fold risk of bladder cancer relative to non-users (p for trend = 0.04). Risk increased to 3.3 (95% CI = 1.3–8.4) among regular (at least monthly) users of 15 or more years. Occupational exposure to hair dyes was associated with an increased risk of bladder cancer in this study. Subjects who worked for 10 or more years as hairdressers or barbers experienced a 5-fold (95% CI = 1.3–19.2) increase in risk compared to individuals not exposed. © 2001 Wiley-Liss, Inc.
Article
Full-text available
A population-based case-control study was conducted in Los Angeles, California, which involved 1,514 incident cases of bladder cancer and an equal number of age-, sex- and ethnicity-matched controls. Information on personal use of hair dyes was obtained from 897 cases and their matched controls. After adjustment for cigarette smoking, a major risk factor for bladder cancer, women who used permanent hair dyes at least once a month experienced a 2.1-fold risk of bladder cancer relative to non-users (p for trend = 0.04). Risk increased to 3.3 (95% CI = 1.3-8.4) among regular (at least monthly) users of 15 or more years. Occupational exposure to hair dyes was associated with an increased risk of bladder cancer in this study. Subjects who worked for 10 or more years as hairdressers or barbers experienced a 5-fold (95% CI = 1.3-19.2) increase in risk compared to individuals not exposed.
Article
Full-text available
In 1990 and 1998 15-41-year-old people were patch-tested in 2 cross-sectional studies of random samples of the population in the western part of Copenhagen County, Denmark. In 1990, 290 subjects and in 1998, 469 subjects were patch-tested. The participation rates were 69% and 51%, respectively. Contact sensitivity to one or more haptens was found in 15.9% and 18.6% in 1990 and 1998, respectively. Nickel sensitivity is still the most common contact sensitivity. The risk of contact sensitivity to the cosmetic-related haptens included in the series (formaldehyde was not included) increased significantly from 2.4% in 1990 to 5.8% in 1998 (odds ratio 2.44, 95% confidence interval 1.04-5.73). The prevalence of contact sensitivity to cosmetic-related allergens has been doubled between 1990 and 1998.
Article
Para-phenylenediamine (PPDA) and toluene-2-5-diamine have been prohibited in hair dyes in Sweden from 1943 to 1992 and from 1943 to 1964, respectively. It was anticipated that the reintroduction of PPDA in Sweden (concentration limit 6 %) according to the EEC Cosmetics Directive would cause an increase in the number of cases of contact allergy to PPDA. Patch test results for the time period from 1993 to 2000 - after the reintroduction - were analyzed and the figures compared with data obtained 1980-1984 and 1989-1992. During 1993-2000 a total of 21 840 dermatitis patients were tested at seven clinics and 358 (1.6 %) were positive to PPDA. 20 (5.6 %) patients were hairdressers. No definite increase or trend could be seen after the reintroduction of PPDA-containing hair dyes in comparison with figures from the 1980s. Some cases of PPDA sensitivity were reported to have appeared after home treatment with hair dyes. A survey among suppliers showed that of 37 hair care products for occupational use 30 % contained paraphenylenediamines and 78 % toluene-diamines. An alarming observation was the relatively large numbers of cases related to the use of black henna containing PPDA.
Article
200 patients (122 male, 78 female) with suspected allergic contact dermatitis were patch tested with the European standard series (ESS) and the results compared with other Asian centres. 131 (65.5%) patients showed 1 or more patch test positives to the ESS. Patch tests were positive to all allergens except primin. Potassium dichromate was the most common allergen (20.5%) followed by nickel sulfate (16.5%), SQL mix (14%), PPD (11.5%), cobalt (8%), fragrance mix (7.5%), formaldehyde (6.5%), colophony (5.5%), neomycin sulfate and mercapto mix (5% each). In women, nickel sulfate was the commonest allergen (30.8%) followed by SQL mix (16.7%) and potassium dichromate (15.4%). In men, potassium dichromate was the commonest sensitizer (23.8%) followed by SQL mix and PPD (12.3% each). Our results are at variance with other centres in Asia. SQL mix was able to detect less than 1/2 (42.2%) of patients allergic to ethanolic dilutions of ether extracts of parthenium. We conclude that the European standard series, with exclusion of primin, is suitable for detection of allergic contact dermatitis in India. However, SQL mix is not a adequate screen for parthenium sensitivity and patch testing with extracts of the plant should be continued, wherever indicated.
Article
Human subjects were used to evaluate the skin sensitization potential of several substances used in marketed drugs and cosmetics, as well as other chemical agents. The results show that a modified Draize test is a useful, predictive patch-test procedure. Potentially strong sensitizers show a dose-response relationship when a range of concentrations of test material are used (at induction), whereas weak sensitizers may not; thus a range of concentrations of test materials may be used as a means of disclosing the potential of these compounds to produce delayed skin hypersensitivity.
Article
We present the first reported case of fatal anaphylaxis resulting from the application of hair dye. A 68-year-old woman had a history of anaphylactic reaction to hair dye 2 years before her death. After using a different hair dye preparation, the patient experienced shortness of breath, collapsed, and died. Autopsy findings were consistent with anaphylaxis. Pathogenic mechanisms are reviewed.
Article
Sensitization rates to contact allergens vary between centers and are influenced by sex and age. Eliminating the latter 2 factors by standardization of data by age and sex, the present analysis addresses possible differences between centers remaining after elimination of these confounders, and analyzes other factors which might influence rates, e.g., the MOAHL index. Overall standardized rates were well within the range reported in previous studies and may be regarded as representing the rates of the "patch test population" in Central Europe (e.g., nickel sulfate 12.9%, fragrance mix 10.5%, balsam of Peru 7.3%, thimerosal 5.6%). For this analysis, data of those departments which contributed more than 2000 patients, or of those with extreme proportions concerning sex, age and occupational cases were selected. Patients from these 10 departments differed considerably with regard to the items of the MOAHL index and with regard to standardized rates. The items of the MOAHL index proved to be suitable for describing different patch test populations and for explaining some differences between centers. Only 'atopic dermatitis' seems to have little influence on (standardized) rates. Face dermatitis is not yet represented in the MOAHL index, but should be included, together with age > 40 years, in an extended index (acronym: MOAHLFA). Regional allergen exposure (with striking differences between East Germany, West Germany and, to a lesser extent, Austria) seems to have a great influence on the sensitization pattern observed in a department. In addition, sociological factors may influence sensitization rates, which is exemplified by high rates of nickel allergy in a socially defined subgroup. Future studies should focus on these factors, as well as on factors concerning patch test practices and quality control.
Article
Occupational contact dermatitis (OCD) is a very important skin disease both for its high frequency and for its social and economic implications. The aim of our work is to evaluate the epidemiology of occupational contact dermatitis in a north-Italian population and the possibility of a correct etiological diagnosis using the patch test standard series of GIRDCA (Italian Group of Resarch on Contact Dermatitis). We patch tested 1,565 out-patients affected by dermatitis with standard series GIRDCA and with other specific professional haptens. The manifestations were suspected of being of occupational origin by a dermatologist on the basis of clinical and anamnestic data. Of all the recorded professions we have considered only the more numerically significant: food industry, building industry, textile industry, employees, cleaners, hospital personnel, hairdressers, housewives, mechanics and metallurgists. Sixty-nine percent of contact dermatitis was found in women, the hairdressers had the greatest number of patients in the younger group (68.7% in the 11-20 years age group) and the textile industry workers in older group (100% in the 41-50 years age group). A positive allergological anamnesis emerged in 32.3% of allergic contact dermatitis. Irritant contact dermatitis (10.6%) was more frequent than allergic contact dermatitis (8.4%). The hands are the most common localization (94. 4%). The allergen with the highest frequency of positive reactions is p-phenylenediamine (25.3%). We discuss the frequency of positives to various groups of allergens in each profession and the principal means of contact. Because of the frequency of this type of occupational skin disease, we stress the importance of prevention. The standard series GIRDCA was found to be adequate for recognizing occupational contact dermatitis in most of our patients (74%).
Article
Skin painting (pseudotattooing) with henna is traditionally performed mainly in Muslim or Hindu persons. Recently, transient artists have begun using black henna mixtures to temporarily paint the skin. Emergence of allergic contact dermatitis after application indicates the presence of a skin sensitizer in such preparations and poses future risks. Four patients developed allergic contact dermatitis after skin painting with black henna performed in France, Egypt, and the United States. The delay of symptoms suggested previous sensitization in 1 patient and active sensitization in 3 patients. Of 3 patients who underwent patch testing, the results were positive for p-phenylenediamine in 3 patients and for p-toluylenediamine in 1 patient. These sensitizers are found in hair dye preparations. The mixtures used by the artists possibly contained natural henna, a rare and weak skin sensitizer, and likely contained chemical coloring agents, diaminobenzenes, such as p-phenylenediamine and/or diaminotoluenes. The long duration of skin contact, the high concentrations of sensitizing materials, and the lack of a neutralizing agent dramatically increase the risk of skin sensitization, which is why such substances are prohibited for direct skin application. Because of the worldwide vogue of skin painting, future cases of sensitization to p-phenylenediamine and diaminobenzenes or diaminotoluenes are expected.
Article
After observing 2 cases of acute telogen effluvium induced by allergic contact dermatitis to hair dyes, we decided to evaluate the effects of acute contact dermatitis of the scalp on the hair cycle. Single-center, 6-month study of consecutive patients affected by acute scalp dermatitis. Department of Dermatology, University of Bologna, Bologna, Italy. Diagnosis of allergic contact dermatitis of the scalp was confirmed by patch testing. Eight women presenting with acute contact dermatitis of the scalp entered the study. Hair shedding was evaluated monthly for 6 months by pull test and wash test. Increased hair loss was detected in 4 of the 7 patients who completed the study. Hair loss was mild to moderate and appeared 2 to 4 months after the episode of scalp dermatitis. A scalp biopsy specimen from 2 patients confirmed the diagnosis of telogen effluvium. Allergic contact dermatitis of the scalp should be included among the possible causes of telogen effluvium. The pathogenesis of telogen effluvium caused by contact dermatitis is unknown but may be related to cytokine release during the inflammatory process.
Article
Effective toxicologic evaluation of skin sensitization requires that potential contact allergens are identified and that the likely risks of sensitization among exposed populations are assessed. By definition, chemicals that are classified as contact sensitizers have the capacity to cause allergic contact dermatitis (ACD) in humans. However, this hazard is not an all-or-nothing phenomenon; clear dose-response relationships can be discerned and thresholds identified for both the induction of sensitization and the elicitation of ACD. Commonly, these parameters are grouped under the heading of potency, the determination of which is vital for risk assessment. Preclinical testing for sensitization potential is critically important for hazard assessment before human exposure. The murine local lymph node assay (LLNA) is the most recently accepted test method for sensitization hazard assessment. The aim was to compare potency estimations derived from LLNA data with clinical determinations of relative potency based on human data. No-effect levels (NOELs) for a range of 21 chemicals were determined from nondiagnostic human repeat patch test studies as reported in the literature. These levels were compared with LLNA EC(3) values, the estimated concentration required to produce a 3-fold increase (positive response) in draining lymph node cell (LNC) proliferative activity. Using available human repeat patch test data, together with expert judgment, the compounds were classified as strong, moderate, weak, extremely weak, or nonsensitizing. Additionally, the potency of each chemical was classified independently based on its LLNA EC(3) value. The results show clearly that LLNA EC(3) values are very comparable with the NOELs calculated from the literature. Moreover, the potency rankings based upon LLNA EC(3) data support their human classification. The present investigations show that the LLNA can be used to provide quantitative estimates of relative skin sensitizing potency EC(3) values that correlate closely with NOELs established from human repeat patch testing and from our clinical experience.
Article
We aimed to determine the prevalence of contact sensitization in the general population and to investigate associations with important sociodemographic and medical characteristics. Within a population-based nested, case-control study in Germany, we performed patch tests with 25 standard allergens in 1141 adults (50.4% female, age median 50 years). Additional information was obtained by a dermatologic examination, a standardized interview, and blood analysis. At least one positive reaction was exhibited by 40.0% of the subjects, with reactions most frequently observed to fragrance mix (15.9%), nickel (13.1%), thimerosal (4.7%), and balsam of Peru (3.8%). Women were sensitized more often than men (50.2% vs 29.9%, OR 2.36, CI 1.84-3.03), and this was also significant for fragrance mix, nickel, turpentine, cobalt chloride, and thimerosal. Contact sensitization was more frequent in subjects who reported adverse skin reactions (53.8% vs. 32.6%; OR 2.41, CI 1.85-3.14), and this was particularly true for sensitization to nickel (45.5% vs 8.8%, OR 8.64, CI 5.67-13.17) and fragrance mix (29.0% vs 14.0%, OR 2.51, CI 1.60-3.91) and the corresponding intolerance of fashion jewelry and fragrances. Contact sensitization decreased with increasing degree of occupational training (unskilled 45.9%, apprenticeship 40.1%, technical college 40.4%, and school of engineering 12.5%; P=0.023; trend test P=0.042). Significant associations of contact sensitization and presence of allergen-specific IgE antibodies, atopic eczema, or psoriasis were not observed. Frequency estimates for the general adult population based on these findings were 28.0% for overall contact sensitization and 11.4% for fragrance mix, 9.9% for nickel, and 3.2% for thimerosal. It is concluded that contact allergy is influenced by sociodemographic parameters and plays an important role in the general population.
Article
Recently, temporary paint-on tattoos have become increasingly popular as a safe alternative to permanent tattoos in Asia and other regions. The most common dye for such temporary tattoos is henna, a vegetable dye. Henna is considered to possess low allergenicity because the incidence of allergic contact dermatitis to henna has rarely been reported. However, recently, allergic reactions to henna used in temporary tattoos have been reported frequently. Ten patients developed inflamed skin eruptions after receiving temporary paint-on tattoos in either Thailand or Indonesia. The 6 patients who were patch tested all exhibited moderate to strong positive reactions to p-phenylenediamine (1% in petrolatum). Four of the 6 patients were then tested with commercial black henna obtained from Thailand, and all 4 had strong positive reactions. A skin biopsy specimen showed lichenoid dermatitis. Mass spectrometry analysis of commercial black henna for molecular weight revealed a major peak at the mass-charge ratio of 108.1, which corresponds to the molecular weight of p-phenylenediamine. The most likely causative agent for the lichenoid reaction associated with use of commercial black henna for temporary tattooing, currently popular in Southeast Asia, is p-phenylenediamine. With the increased popularity of temporary paint-on tattoos, clinicians should be aware of the possible associated complications.
Article
Temporary black henna tattoos are very popular as body adornment. Although contact allergy to natural henna is unusual, the inclusion of hair dye, p-phenylenediamine (PPD), increases the risk of contact sensitization. This study was performed to identify the presence and concentration of PPD in a black henna tattoo mixture to which our patient developed contact allergy. The presence of PPD in a black henna tattoo mixture, various samples of commercially available henna powders, and several hair dye products was qualitatively and quantitatively detected using high performance liquid chromatography (HPLC). This study demonstrated that PPD was present in the black henna tattoo mixture at a concentration of 15.7%, which is significantly higher than commercial hair dye preparations. The presence of PPD in black henna tattoo mixtures in high concentration poses a health hazard and a risk of allergic contact sensitization with potential long-term consequences.
Contact allergy to PPD in Sweden
  • Wahlberg J
Wahlberg J, Tammela M, Anderson C et al. Contact allergy to PPD in Sweden. Dermatol Beruf Umwelt 2002: 50: 51–
Use of permanent hair dyes. and bladder cancer risk Address: Torkil Menné Department of Dermatology Amtssygehuset i Gentofte DK-2900
  • M Gago-Dominguez
  • J E Castelao
  • J-M Yuan
  • Yumc
  • R Ross
Gago-Dominguez M, Castelao J E, Yuan J-M YuMC, Ross R K. Use of permanent hair dyes. and bladder cancer risk. Int J Cancer 2001: 91: 575–579. Address: Torkil Menné Department of Dermatology Amtssygehuset i Gentofte DK-2900 Hellerup Denmark Tel: π 45 39773200
Identification and quantification of PPD in a temporary tattoo
  • R R Brancaccio
  • Brown Lh
  • Y T Chang
  • J P Fogelman
  • E A Mafong
  • Cohen
  • De
Brancaccio R R, Brown Lh, Chang Y T, Fogelman J P, Mafong E A. Cohen DE. Identification and quantification of PPD in a temporary tattoo. Am J Contact Dermatitis 2002: 13: 15–18.
on the approximation of the laws of the member States relating to cosmetic products, Annex III (amended) European Communities off
Council Directive 76/768/EEC of 27 July 1976 on the approximation of the laws of the member States relating to cosmetic products, Annex III (amended). European Communities off. J. L262 27.09.1976.
Cohen DE. Identification and quantification of PPD in a temporary tattoo
  • Brancaccio
Common contact sensitizers in Chandigarh, India
  • Sharma