ArticlePDF Available

Severe allergic hair dye reactions in 8 children

Authors:

Abstract and Figures

Serious adverse skin reactions to permanent hair dyes and temporary black tattoos have been reported. As temporary tattoos have become fashionable among adolescents, the risk profile for p-phenylenediamine (PPD) sensitization of the population has changed simultaneously with an increasing use of hair dyes in this age group. This investigation reports PPD sensitization in children with regard to cause of sensitization, clinical presentation and consequences. Clinical history and patch test results for consecutive children below 16 years of age with suspected hair dye allergic reactions and positive patch tests to PPD were collected over 2 years in 2 Danish dermatology clinics. 8 children aged 12-15 years were collected, and they all reacted to several hair dye ingredients. 5 of the patients were hospitalized, 1 in the intensive care unit. 6 of the patients gave a history of prior reaction to temporary black tattoos. These children showed simultaneous positive patch reactions to N-isopropyl-N-phenyl-p-phenylenediamine and local anaesthetics, while such reaction patterns were not seen in children with hair dye reactions only. The clinical consequences of these reactions are unknown. A re-evaluation of the risk assessment/risk management for hair dyes is required.
Content may be subject to copyright.
Severe allergic hair dye reactions in 8 children
HEIDI SOSTED
1
,JEANNE DUUS JOHANSEN
1
,KLAUS EJNER ANDERSEN
2
AND TORKIL MENNE
´
1
1
National Allergy Research Centre, Department of Dermatology, Gentofte Hospital, University of Copenhagen, and
2
Department of Dermatology, Odense University Hospital, University of Southern Denmark, Denmark
Serious adverse skin reactions to permanent hair dyes and temporary black tattoos have been reported.
As temporary tattoos have become fashionable among adolescents, the risk profile for p-phenylenedia-
mine (PPD) sensitization of the population has changed simultaneously with an increasing use of hair
dyes in this age group. This investigation reports PPD sensitization in children with regard to cause
of sensitization, clinical presentation and consequences. Clinical history and patch test results for
consecutive children below 16 years of age with suspected hair dye allergic reactions and positive
patch tests to PPD were collected over 2 years in 2 Danish dermatology clinics. 8 children aged 12–15
years were collected, and they all reacted to several hair dye ingredients. 5 of the patients were
hospitalized, 1 in the intensive care unit. 6 of the patients gave a history of prior reaction to temporary
black tattoos. These children showed simultaneous positive patch reactions to N-isopropyl-N-phenyl-p-
phenylenediamine and local anaesthetics, while such reaction patterns were not seen in children with
hair dye reactions only. The clinical consequences of these reactions are unknown. A re-evaluation of
the risk assessment/risk management for hair dyes is required.
Key words: 4-amino-m-cresol; allergic contact dermatitis; benzocaine; black henna tattoo; children;
cosmetics; Disperse orange 3; hair colouring; hair dyes; Hydroquinone; IPPD; m-aminophenol; N-p-
phenylenediamine; p-amino-m-cresol; p-aminophenol; patch test; p-phenylenediamine; semiperma-
nent tattoo; toluene-2, 5-diamine; youngsters. #Blackwell Munksgaard, 2006.
Accepted for publication 8 September 2005
The median age of first hair dying in a Danish
Population is 16 years for both men and women
(1). Permanent hair dyes contain strong contact
allergens, such as p-phenylenediamine (PPD) and
related substances (2, 3), but other groups of hair
dye ingredients also have a significant potential to
cause allergic reactions (4). Severe allergic reactions
to hair dyes have been reported by 1.4% of women
and 1.3% of men dying their hair (1). In some cases,
the patient develops severe angioedema-like reac-
tions necessitating intensive care treatment (5).
PPD is also used on an illegal basis in semiper-
manent tattoos, also called black henna tattoos, in
order to obtain a darker colour and a faster drying
time than natural henna can provide. The content
of PPD in semipermanent tattoo ink has been
reported to vary between 0.43 and 15.7% (6–8).
This form of exposure also causes allergic reac-
tions, which are usually localized (9), but puts the
individual at risk of adverse reactions if hair dying
with PPD and related substances later.
This investigation reports PPD-sensitization in
children below 16 years of age with regard to
cause of sensitization, clinical presentation and
consequences.
Materials and Methods
Children aged 16 years or younger seen at 2
dermatological departments associated with the
National Allergy Research Centre in 2003 and
2004 and showing a positive patch tests to PPD
were included. The medical history (Table 1) as
well as patch test results with European Standard
Series and additional dye-related ingredients were
recorded. Details of the patch test materials are
in Table 2. In one case, testing was performed
with 4-amino-m-cresol 1% supplied from the
hair dye producer (KPSS Gmbh, Darmstadt
Germany); the purity of it is unknown.
The patch tests were performed according to
the International Contact Dermatitis Research
Group recommendations at the upper back,
occlusion time was 2 days, and readings were
performed at D3/4 and D7 (10).
Results
8 children aged between 12 years and 15 years
were referred to the clinics because of a suspected
allergic reaction to a hair dye product. 5 of them
had been admitted to hospital, and all had
Contact Dermatitis 2006: 54: 87–91 Copyright #Blackwell Munksgaard 2006
Printed in Singapore. All rights reserved CONTACT DERMATITIS
Table 1. Hair dye dermatitis and temporary black tattoo dermatitis in children: sex, age, exposure, symptoms and medication
No. Sex/age Hair dye exposure
Symptom description and onset
after exposure to hair dye
Previous reaction to
temporary tattoo Admission to hospital and medication
1 M/12 LIVE, permanent black colour,
Schwartzkopf. Home colouring
D1: oedema of ears, eczema. D2–4: facial
oedema. Severe symptoms lasted for 1 week
Temporary black tattoo in the past
with subsequent skin reaction
Admission to hospital for 2 days.
Topical and systemic corticosteroids
2 F/14 Red dark color at a hairdresser D2: oedema of the forehead. Still eczema on
D10
When 11 years old, temporary
black tattoo in Thailand with
subsequent skin reaction
Topical corticosteroids and antibiotic
3 F/15 Evolution 564 R. Alfa-Parf Srl,
Milano. Coloured at a hairdresser
D1: eczema, oedema of forehead, eyes and face.
Symptoms lasted for 2 weeks
When 13 years old, temporary
black tattoo in Thailand with
subsequent skin reaction
Admitted to hospital. Systemic
anti-histamine and corticosteroids
4 M/14 Garnier, Nutrisse, Natea,
(2.10 Bilberry)
LO
´real. Home colouring
D3: severe facial and neck oedema. Symptoms
lasted for 1 week
When 13 years old, temporary
black tattoo in Egypt with
subsequent skin reaction
Acute admission to hospital, intensive
care unit. Corticosteroids and anti-histamine
5 M/12 Garnier, Nutrisse, Natea,
(2.10 Bilberry)
LO
´real. Home colouring
D2: eczema and severe oedema in face. 13 days
after application: symptoms lasted for 2 weeks.
None Topical corticosteroids
6 M/15 Garnier Nutrisse Natea (Blue black)
LO
`real. Home colouring
D1: fainting. Severe oedema of the face and
eyes completely closed
When 11 years old, temporary
black tattoo in Turkey with
subsequent skin reaction
D3. Admission to hospital for 4 days.
Systemic and local corticosteroids.
Systemic antibiotic.
7 F/14 LO
´real New Casting 37
Mangue. Home colouring
D2: oedema of forehead and face. Oozing
scalp dermatitis, and she cut off all her hair.
When 8 years old, temporary
black tattoo in Thailand with
subsequent skin reaction
Systemic corticosteroids
8 F/15 Wella Koleston Perfect and Wella
Magma Lightning Colour.
Coloured at a hairdresser.
D1: redness and scaling. D10: oedema and
oozing dermatitis on scalp and ears. D18:
depigmentation on truncus and
infiltrated eczema on the scalp
None Admission to hospital for 5 days. Systemic
antibiotic. Topical corticosteroids
88 SOSTED ET AL. Contact Dermatitis 2006: 54: 87–91
received medical treatment. In 5 cases, home col-
ouring was performed, and in 3 cases, hair dying
was performed by a hairdresser. The brand and
colour of the product used was available in 7 of 8
cases. (Table 1). 6 of the youngsters had a history
of a skin reaction to a temporary tattoo, while 2
had reactions to hair dyes only.
At patch testing, almost all of the children gave
a reaction to PPD as well as the hair dye ingredi-
ents toluene-2,5-diamine, m-aminophenol or p-
aminophenol. 5 of the 6 children with previous
reactions to temporary tattoos had reactions to
the black rubber chemical N-isopropyl-N-phenyl-
p-phenylenediamine (IPPD) and 3 children to
local anaesthetics (Fig. 1, Tables 1 and 2), without
any history of prior exposure to these chemicals.
The 2 children (no. 5 and no. 8) with no prior
temporary tattooing only gave allergic reaction to
hair dye ingredients and did not react allergic to
IPPD or local anaesthetics. In 1 patient (no 1), the
hair dye ingredient p-amino-m-cresol was tested,
as it was contained in the hair dye causing the
reaction, and it gave a strong-positive reaction.
Contact allergy to this substance to our knowledge
have never been reported before.
Discussion
The 8 children with severe allergic reactions to
hair dyes diagnosed within 2 years in 2 hospital
clinics that on a yearly basis see about 5% of the
suspected contact dermatitis patients in Denmark
suggest that this problem of PPD allergy among
children is more frequent than reflected by the
actual number of cases.
Furthermore, it is estimated that only 10% to
30% of those with a severe reaction to cosmetics
such as hair dyes will be seen by a doctor and
even fewer by a dermatologist (1, 11, 12). On a
European level, this suggests that severe allergic
reactions to hair dyes in children may be a con-
siderable problem.
6 of the 8 children had a history of prior reac-
tions to a temporary tattoo, which probably con-
tained the black dye PPD. Temporary tattoos
have become fashionable (13) as also is dying
hair at an increasingly younger age (1, 14). This
means that the risk profile of the population
using hair dyes is changing, and producers of
legal consumer products, such as hair dyes, will
have to take this into consideration. While the
primary reaction to temporary tattoos is a minor
event in the medical context, these children may
become severely ill from dying their hair.
However, severe allergic reactions to hair dyes is
seen also in children without any prior history of
temporary tattoo use.
The current cases of contact allergy in children
to hair dyes were selected based on patch test
reactions to PPD. PPD is described as cross-
reacting to the hair dyes toluene-2,5-diamine,
p-aminophenol, 2-nitro-PPD (15) and to disperse
orange 3 (16). The severe clinical reactions
may be caused by the multiple PPD-related
Table 2. Hair dye and black henna temporary tattoo dermatitis in children. Maximum patch test reaction from D3/4 and D5–7
Patient no. PPD DO3 TDA pAP Hydro-quinone Black rubber mAP N-PPD Caine
1
b
+++ +++ +++ ++ + ++ ++ ++ ++
2
f
++ ++ ++ ++ ++ ++ ++ ++ +
3
e
+++ NT ++ ++ ++ + + ++ +
4
c
+++ +++ +++ +++ +++ ++ Neg. ++ Neg.
5++
a
+++ ++
a
++ ++ Neg. ++ +?
a
Neg.
6
d
++
a
+++ ++
a
+?
a
Neg. ++ +?
a
Neg.
a
+?
7++
g
NT Neg. ++ Neg. Neg. ++ Neg. +?
8 ++ + + +? Neg. Neg. +? Neg. Neg.
Neg., negative; NT, not tested; +?, doubtful positive reaction.
p-phenylenediamine (PPD); Disperse Orange 3 (DO3); toluene-2, 5-diamine (TDA); p-aminophenol (pAP); m-aminophenol (mAP);
N-p-phenylenediamine (N-PPD).
All the substances were 1% in petrolatum (pet.). Black rubber is N-isopropyl-N-phenyl-p-phenylenediamine 0.1% pet. from Hermal
or black rubber-mix from TRUE
1
TEST. Caine is Caine mix from TRUE test or benzocaine 5% from Hermal. 4-amino-m-cresol
1% was supplied from the hair dye producer KPSS Gmbh, Darmstadt, Germany, the purity is not known.
The patch test materials were from Hermal, Germany; Chemotecnique Diagnostics AB, Sweden or TRUE
1
TEST, Mekos,
Denmark.
The patch test reading followed the ICDRG recommendations.
a
30 min open application.
b
+Sesquiterpenelactone-mix 1%, ++pyrogallol 1%, +++p-aminoazobenzene 0.25%, ++4-amino-m-cresol.
c
Fragrance mix positive in TRUE test negative in Finn chamber
1
.p-aminoazobenzene 0.25% +++, pyrogallol positive.
d
+++aminoazobenzene 0.25%.
e
+Thiuram mix 1%, doubtful to resorcinol.
f
+Thiuram mix 1%, ++Disperse blue 124, hydrogen peroxide ++, pyrogallol ++,++aminoazobenzene, ++hydrogen peroxide
3% aq.
g
0.1% PPD.
Contact Dermatitis 2006: 54: 87–91 SEVERE ALLERGIC HAIR DYE REACTION 89
cross-reacting allergens present in commercial
dyes. As many of these chemicals are potent aller-
gens, synergistic immunological reactions may be
the result (17) and unpredictable severe clinical
reactions among the consumers the consequence.
PPD has also been described to cross-react
with the black rubber chemical family, including
IPPD (18). As regard to local anaesthetics, little
evidence is published of cross-sensitization; how-
ever, this seem to occur, as 5 of our 6 children,
who had had a temporary tattoo, gave positive or
doubtful reactions to TRUE
1
test caine mix or
benzocaine. Contamination of the tattoo ink with
other chemicals cannot be ruled out, but it is
unlikely, because the tattoos were performed at
resorts in different parts of the world. The ten-
dency to react to other chemically related sub-
stances may also reflect the degree of sensitivity
of the individual. The practical consequences of
the individual as regard to use of local anaes-
thetics in the future is unknown.
Exposure to semipermanent tattoos containing
PPD mimics, an experimental model, showing
the effect of continuous exposure to PPD in rela-
tively high concentrations. In hair dying, the
maximum allowed quantity of PPD is 6% before
oxidation (19). The producers recommend that
the hair dye is applied to the skin for 24–48 hr
as a pretest before hair dying in order to identify
the already sensitized consumer (20). This may be
comparable to semipermanent tattooing. Under
the hair dying process, the exposure to the che-
micals is short, around 30–45 min, but repeated
exposures have in some contexts been shown to
be of equal or greater significance than just dura-
tion of exposure (21, 22).
One can only speculate on the future conse-
quences of these excessive exposures to potent
allergens starting at an early age and continuing
in many cases intermittently for life. A re-evalua-
tion of the risk assessment and risk management
before marketing of hair dyes is required.
References
1. Sosted H, Hesse U, Menne T, Andersen K E, Johansen J D.
Contact dermatitis to hair dyes in an adult Danish popula-
tion – an interview based study. Br J Dermatol 2005: 153:
132–135.
2. Marzulli F N, Maibach H I. The use of graded concentra-
tions in studying skin sensitizers: experimental contact sen-
sitization in man. Food Cosmet Toxicol 1974: 12: 219–227.
3. Sosted H, Rastogi S C, Andersen K E, Johansen J D,
Menne T. Hair dye contact allergy: quantitative exposure
assessment of selected products and clinical cases. Contact
Dermatitis 2004: 50: 344–348.
4. Sosted H, Basketter DA, Estrada E, Johansen JD,
Patlewicz GY. Ranking of hair dye substances according
to predicted sensitization potency – quantitative structure-
activity relationships. Contact Dermatitis 2004: 51: 241–254.
5. Jasim Z F, Darling J R, Handley J M. Severe allergic
contact dermatitis to paraphenylene diamine in hair dye
following sensitization to black henna tattoos. Contact
Dermatitis 2005: 52: 116–117.
6. Avnstorp C, Rastogi S C, Menne T. Acute fingertip derma-
titis from temporary tattoo and quantitative chemical ana-
lysis of the product. Contact Dermatitis 2002: 47: 119–120.
7. Brancaccio R R, Brown L H, Chang Y T, Fogelman J P,
Mafong E A, Cohen DE. Identification and quantification
of para-phenylenediamine in a temporary black henna tat-
too. Am J Contact Dermat 2002: 13: 15–18.
8. Wakelin S H, Creamer D, Rycroft R J, White I R,
McFadden J P. Contact dermatitis from paraphenylenedia-
mine used as a skin paint. Contact Dermatitis 1998: 39: 92–
93.
9. Marcoux D, Couture-Trudel P M, Riboulet-Delmas G,
Sasseville D. Sensitization to para-phenylenediamine from
a streetside temporary tattoo. Pediatr Dermatol 2002: 19:
498–502.
10. Wilkinson D S, Fregert S, Magnusson B et al. Terminology
of contact dermatitis. Acta Derm Venereol 1970: 50: 287–
292.
11. de Groot A C. Adverse reactions to cosmetics. Thesis, The
Netherlands, State University of Groningen, 1988.
12. Sosted H, Agner T, Andersen K E, Menne T. 55 cases of
allergic reactions to hair dye: a descriptive, consumer com-
plaint-based study. Contact Dermatitis 2002: 47: 299–303.
13. Downs A M, Kirkup M. Minerva-photofinish. BMJ 1997:
315: 1722.
14. The European Cosmetic Toiletry and Perfumery
Association (Colipa). The European cosmetic, toiletry &
perfumery Market, 2003. The European cosmetic, toiletry
& perfumery Association (Colipa) 2004: 1–26.
15. Fautz R, Fuchs A, van der Walle H B, Henny V, Smits L.
Hair dye-sensitized hairdressers: the cross-reaction pattern
with new generation hair dyes. Contact Dermatitis 2002: 46:
319–324.
16. Goon A T, Gilmour N J, Basketter D A, White I R,
Rycroft R J, McFadden J P. High frequency of simulta-
neous sensitivity to Disperse Orange 3 in patients with
positive patch tests to para-phenylenediamine. Contact
Dermatitis 2003: 48: 248–250.
17. Johansen J D, Skov L, Volund A, Andersen K, Menne T.
Allergens in combination have a synergistic effect on the
elicitation response: a study of fragrance-sensitized indivi-
duals. Br J Dermatol 1998: 139: 264–270.
18. Herve-Bazin B, Gradiski D, Duprat P, Marignac B,
Foussereau J, Cavelier C, Bieber P. Occupational eczema
from N-isopropyl-N´-phenylparaphenylenediamine (IPPD)
Caine mix
Black rubber mix
Reading D3
Toluenediamine
30 min occlusion
PPD 30 min
occlusion
Fig. 1. p-phenylenediamine (PPD) allergic patient with
cross-reactivity to caine mix and black rubber mix (with
kind permission of Frosch, P. Textbook of Contact
Dermatitis, 4th edition 2006, #Springer-Verlag, Berlin,
Heidelberg).
90 SOSTED ET AL. Contact Dermatitis 2006: 54: 87–91
and N-dimethy-1,3 butyl-N´-phenylparaphenylenediamine
(DMPPD) in tyres. Contact Dermatitis 1977: 3: 1–15.
19. 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 2004: L262 (27.9 1976).
20. Krasteva M, Cottin M, Cristaudo A et al. Sensitivity and
specificity of the consumer open skin allergy test as a
method of prediction of contact dermatitis to hair dyes.
Eur J Dermatol 2005: 15: 18–25.
21. Hextall J M, Alagaratnam N J, Glendinning A K,
Holloway D B, Blaikie L, Basketter DA, McFadden JP.
Dose-time relationships for elicitation of contact allergy
to para-phenylenediamine. Contact Dermatitis 2002: 47:
96–99.
22. McFadden J P, Wakelin Sh, Holloway D B, Basketter DA.
The effect of patch duration on the elicitation of
para-phenylenediamine contact allergy. Contact Dermatitis
1998: 39: 79–81.
Address:
Heidi Sosted
National Allergy Research Centre
Department of Dermatology
Gentopte Hospital
University of Copenhagen
2900 Helleup
Denmark
Tel: + 45 39 77 7303
Fax: + 45 39 77 7118
e-mail: hesos@gentoftehosp.kbhamt.dk
Contact Dermatitis 2006: 54: 87–91 SEVERE ALLERGIC HAIR DYE REACTION 91
... In 2003, the same year as our study ran, the Norwegian consumer research institute found that 89% of women and 30% of men (N=1126) had colored or bleached their hair at some point in their life [24] (Berg L.et. al. 2004). Our data showed that the mean age of dyeing the hair for the first time was 24 years and other studies have shown that both adults and children are exposed to the same products [25] containing same allergens [26]. The sex and age distribution among the responders was equal except for female responders in the age group 40-55 being overrepresented. ...
... The most common serious health consequence of black henna tattoos is sensitization to PPD dye, the allergic reaction can be life-threatening and necessitate hospitalization (Sosted et al., 2006). ...
... However, this may also be due to the nature of spontaneous reporting. The first period (2003)(2004)(2005)(2006) coincided with an accumulation of serious allergic contact dermatitis reactions to hair-colouring products in young individuals sensitized to black henna tattoos [17,18]. These reactions were often misdiagnosed as life-threatening Quincke's oedema and necessitated hospitalization and systemic treatment. ...
Article
Full-text available
Background: A previous analysis of undesirable events (UEvs), reported to four major companies following the use of hair-colouring products in Europe, showed that the reporting rates were stable for both oxidative and direct hair-colouring products over the period 2003-2006. Objectives: In order to verify the impact of risk management measures implemented since 2006, as well as the impact of a new Commission Regulation (No 1223/2009), the same four companies analysed cosmetovigilance data collected over an additional four-year period (2014-2017). The objective was to determine whether there was any time effect, country effect, or product type effect, as well as identify risk factors. Materials and methods: Each company collected reports of alleged UEvs, undesirable effects (UEfs) and serious undesirable effects (SUEs) for their products in their key European markets, and calculated the respective reporting rates (number of events/million units sold). A detailed analysis was performed on allergic contact dermatitis-type events. Results: The reporting rates for alleged UEvs and allergic-type UEfs associated with hair-colouring products remained stable over the four-year period, although a statistically significant decrease was observed for some companies. No time effect on SUEs was observed for three companies but a statistically significant decrease in SUEs was observed for one company. Black henna tattoos remained a major risk factor regarding SUEs due to hair dyes. Conclusion: The reporting rates of undesirable events, including contact allergy-type events, were stable over time. This was true for oxidative and direct hair dyes, for both home use and professional exposure scenarios.
Article
A chromogenic and fluorogenic active coumarin-based chemodosimeter (DP21) has been synthesized. The probe shows remarkable fluorescent intensity with phenylenediamine isomers (PDA) such as ortho-phenylenediamine (OPD) and para-phenylenediamine (PPD) in the presence of competitive species. The probe changes from light yellow to reddish brown and dark yellow with OPD and PPD, respectively, through naked eye. The interaction of lone pair electrons in carbonyl group present in DP21 with amino group of OPD and PPD shows the intermolecular hydrogen bonding. The PDA isomers can be detected selectively in the presence of other interfering organic and inorganic amines by the DP21. It shows excellent low detection limit (LOD) for OPD and PPD is 0.19 nM and 0.4 nM respectively.Graphical abstract
Article
Background: Allergic contact dermatitis (ACD) can exist in the setting of other dermatologic conditions. It is known that the treatment of these conditions can cause ACD, increasing both diagnostic and treatment difficulty. Objective: The aim of this study was to determine the frequency of common dermatologic conditions in the setting of ACD and in specific patient populations. Methods: A retrospective database study was completed using Truven Health to collect information on patch-tested ACD patients. Demographics and diagnostic information were retrieved. Of those with ACD, the presence of 15 dermatologic diagnoses was investigated. Subanalyses were conducted for each condition, including International Classification of Diseases, 10th Revision code specificity, demographics, and diagnostic information. Results: A total of 6380 patients (76.83% female) were given a diagnosis of ACD via patch testing. Of those with concomitant disease, those most common include atopic dermatitis (23.98%), urticaria (16.69%), and acne (11.51%). Eight of the concomitant conditions were found to have statistical significance in comparing the average age of ACD diagnosis with the selected diagnoses (α = 0.05). Conclusions: Common dermatologic diseases can exist concomitantly with ACD, many of which can be treated by compounds that precipitate or worsen preexisting ACD. The average age of the diagnosis varies from concomitant diagnoses, which can contribute to difficulty in ACD diagnosis and treatment.
Article
Full-text available
Allergies to cosmetic products are frequent. They are most often manifested in the form of contact eczema. An in-depth interrogation detailing the nature of all the cosmetic products used, as well as a meticulous clinical examination in search of signs in favor of contact eczemas and the carrying out of patch tests or epicutaneous tests are all necessary elements to retain the diagnosis. Besides the elimination of the responsible allergen (s), the treatment is based on dermocorticoids. We report the observation of a 16-year-old girl already sensitized to paraphenylenediamine following a hair dye, which presented contact eczema 3 hours after the application of a tinge of eyebrows containing paraphenylenediamine (PPD).
Article
Zusammenfassung Bei einer Patientin traten nach der Färbung der Augenbrauen mit einem vermutlich Paraphenylendiamin-haltigen Produkt eine großflächige Gesichtsrötung und eine periorbitale Schwellung auf. Bei der Vorstellung in der interdisziplinären Notaufnahme eines nahegelegenen Klinikums wurde auf eine Therapie verzichtet und die Patientin an einen niedergelassenen Dermatologen verwiesen. Erst mit Verzögerung und nach weiterer Verschlechterung des Hautbefundes wurde in einem anderen von der Patientin konsultierten Klinikum eine allergologische Notfalltherapie mit einem systemischen Glukokortikosteroid und einem Antihistaminikum eingeleitet. Die Schlichtungsstelle beurteilte die Unterlassung der Notfalltherapie als einen ärztlichen Behandlungsfehler. Bei Einbezug der Kenntnis der zeitlichen Entwicklung der Erkrankung durch eine allergische Verursachung, die dem Dienstarzt bekannt war, wäre bei Einsatz einer Kortikoidtherapie das Krankheitsgeschehen wesentlich zu beeinflussen und eine deutliche Verkürzung des Krankheitsverlaufs zu erwarten gewesen. Klinisch schwere akute allergische Kontaktekzeme bedürfen einer medizinischen Notfalltherapie, wozu neben einer Entfernung und Meidung möglicherweise auslösender Allergene auch eine topische und ggf. systemische antiinflammatorische Therapie gehört. Die Unterlassung dieser Notfalltherapie kann eine ärztliche Sorgfaltspflichtverletzung und damit einen Behandlungsfehler darstellen. Die Versorgung dermatologischer Notfälle durch Nichtdermatologen entbindet diese nicht von der Pflicht zu einer Notfallbehandlung, wie sie unabhängig von der Spezialisierung von jedem Arzt erwartet werden muss. Interdisziplinäre Notfallambulanzen sollten Möglichkeiten der konsiliarischen Unterstützung durch Dermatologen vorsehen.
Article
Forty-two cases of contact sensitivity to N-isopropyl-N'-phenylparaphenylenediamine (IPPD), an amine antiozonant used in rubber manufacture, were collated from several firms and plants dealing with tyres. Ten motor car tyres manufactured by eight different firms all induce sensitivity reactions in seven subjects allergic to IPPD. Clinical cross-reaction tests show that 100% of the subjects sensitive to IPPD are also sensitive to N-phenyl-N'-cyclohexy-paraphenylenediamine (CPPD), another amine antiozonant, and 37% to paraphenylenediamine (PPD). The various types of tyres were analyzed by gas chromatography and then by infra-red and thin-layer chromatography where necessary. None of the 12 tyres examined was found to be free from aromatic amines. Test reactions carried out with various automobile accessories on subjects allergic to IPPD in tyres gave positive results precisely in those cases where the articles contained IPPD. The authors then studied occupational sensitivity to N-dimethyl-1,3 butyl-N'-phenylparaphenylenediamine (DMPPD), a rubber antiozonant purported to be non-sensitizing and marketed in the United States. The The DMPPD tests were positive for all the IPPD-allergic patients tested; there is no doubt as to the allergenic nature of DMPPD. The irritant and sensitizing potentials of the four amines in question were tested in laboratory animals: PPD proved to be the most allergenic product, IPPD the least allergenic, and DMPPD and CPPD seem to give identical results. All these products produce positive cross-reactions in varying degrees of severity.
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
To study the length of exposure time required to elicit para-phenylenediamine (PPD) allergic reactions, patients known to be allergic to PPD were recruited and patch tested. A group of 7 patients were patch tested with 1% PPD in pet. for 15 min, 30 min and for 120 min. The remaining 9 patients were patch tested with 1%, 0.3%, 0.1% and 0.01% PPD for 15 min, 30 min and for 120 min each. With exposure for 120 min, 11 of 16 subjects reacted to 1% PPD and 2 of 9 reacted to 0.01%. With exposure of 15 min, 6 of 16 reacted to 1% PPD and 0 of 9 reacted to 0.01% PPD. This study showed marked inter-individual variability in eliciting a reaction to the PPD molecule on patch testing, with regard to both the exposure time and the concentration required.
Article
Perfume ingredients were chosen as model substances to study the effect of allergens in combination on the elicitation response. Two groups of eczema patients were studied. One consisted of 18 subjects with a contact allergy to two fragrance substances and the other was a control group of 15 subjects allergic to only one of the same two fragrance substances. The test and matched control subject were patch tested in exactly the same way with two allergens applied in serial dilution in separate chambers on one side and combined in one chamber on the other side of the upper back. The assessment of reactions was carried out on day 3 by clinical grading and laser Doppler flowmetry, and the extent of the reaction was measured in millimetres. The data were analysed by logistic dose-response models. It was found that the combination of two allergens in individuals allergic to both substances had a synergistic effect on the elicitation response evaluated by all three methods. The 1 : 1 mixtures of the two allergens elicited responses as if the doses were three to four times higher than those actually used, which is significantly more than expected if an additive effect had been present. In the control group, no increased response was seen to the combined allergens compared with the allergens tested separately. The synergistic effect demonstrated is likely to apply to other contact allergens as well and should be taken into account in designing diagnostic tests and performing safety assessments.
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.
Article
Hair dye allergies are a frequent cause of occupational skin disease among hairdressers. Conventional hair dyes contain 4-phenylenediamine (PPD), 2, 5-diaminotoluene sulfate (DTS) and 2-nitro-4-phenylenediamine (ONPPD) as allergens. In new generation hair dyes, FD & C and D & C dyes are used in the hair dye formulations. This study investigated the cross-reaction pattern of new generation hair dyes among hairdressers (n = 40) with a known allergy to PPD and/or DTS and/or ONPPD. In the 40 hairdressers no positive reactions were observed to the single FD & C and D & C dyes. In two hairdressers, doubtful reactions were observed to one or more of the hair dye formulations. The data from this study suggest that for hairdressers sensitized to PPD and/or DTS and/or ONPPD this new generation of hair dyes is a safe alternative for use in their salons.
Article
Skin-sensitizing chemicals exhibit dose-response relationships for the elicitation of contact dermatitis. Previously, considerable work has been carried out in which the elicitation of allergic skin reaction has been examined as a function of the applied concentration. However, the relationship between exposure time, dose and response has not been explored in any depth. The present work has extended our initial assessment of the relationship between both exposure time and concentration for para-phenylenediamine (PPD) in a group of 19 PPD-allergic volunteers. The results clearly demonstrate that a relationship exists between both exposure time and concentration. Positive responses to PPD were directly proportional to exposure time: at 5 min 16% responded; at 15 min, 38%; at 30 min, 50%; and at 120 min, 69%. A similar direct relationship was found between concentration of PPD and response: after 120 min, 22% of patients had responded to 0.01%, and 69% to 1% PPD. All exposures for 1 and 2 min were negative. Subsequent evaluation using repeated 5 min open application testing demonstrated a cumulative effect, as after 8 days 39% of the panel reacted, more than double the number that reacted to a single occluded 5-min treatment. It was noted that there was marked subject variability in exposure time and dose required to elicit an allergic response. These results are of relevance for the general interpretation of patch test data, especially with regard to risk assessment.
Article
"Temporary" henna tattoos (skin painting or pseudotattooing) are in vogue among American and European youngsters, particularly when vacationing. A 17-year-old girl presented with a severe contact dermatitis of her scalp and face after having dyed her hair with a permanent oxidative hair dye. She denied previous use of oxidative hair dye. Eight months earlier she had a "temporary" henna tattoo applied on her shoulder by a transient artist in downtown Montreal and developed an acute, erythematous, edematous eruption that resolved with residual, prolonged hyperpigmentation. As henna tattooing is a lengthy and tedious procedure, para-phenylenediamine (PPD) may be added to the mixture to accelerate the process, to darken, and to give more precision to the design. This short-lived fad can have longer-term sequelae then expected, ranging from postinflammatory hyperpigmentation of the tattoo site to permanent sensitization to PPD and related compounds.