A primer on cosmetics. AAD Advisory Board, CTFA Task Force on Cosmetics

Quantification of p-Phenylenediamine in Hair Dyes and Health Risk Implications in the UAE: Describing Discordances Between Regulations and Real-Life Practices

Background

p-Phenylenediamine (PPD) has been used over the past five decades as a primary precursor in the production of oxidative hair dyes. Numerous health dangers are associated with the short- and long-term use of PPD, raising concerns about its safety. For instance, mounting data suggests that PPD is linked to dermatitis and allergy cases.

Objective

To quantify the PPD content in hair dyes by measuring the PPD concentration after mixing the ingredients of commercial hair dyes.

Methods

A total of 290 permanent hair dyes were tested. RP-HPLC-DAD analysis was performed to determine and quantify the PPD content.

Results

The estimated mean of the PPD limit was 0.89 (95% CI [0.81-0.96]). Of the 290 tested hair dyes, 7.2% (n = 21) exceeded the recommended PPD concentration after mixing. Significantly more hair dyes manufactured in India and China had a PPD content exceeding 2% after mixing compared to dyes from other regions (P = 0.001). Moreover, hair dyes manufactured in India and the UAE were more likely to have incomplete descriptions of the conditions of use and warnings on the label (P = 0.002).

Conclusion

The effectiveness of the current regulations relevant to these products should be reevaluated. Moreover, through the use of good manufacturing procedures (GMPs), research, and the reporting of adverse reactions, hair dyes should be subjected to better control and monitoring in terms of their safety and quality.

Patch testing in suspected allergic contact dermatitis to cosmetics

Background. Increasing use of cosmetics has contributed to a rise in the incidence of allergic contact dermatitis (ACD) to cosmetics. It is estimated that 1–5.4% of the population is sensitized to a cosmetic ingredient. Patch testing helps to confirm the presence of an allergy and to identify the actual allergens which are chemical mixtures of various ingredients. Objectives. The aims of this study are to perform patch testing in suspected ACD to cosmetics and to identify the most common allergen and cosmetic product causing dermatitis. Methods. Fifty patients with suspected ACD to cosmetics were patch-tested with 38 antigens of the Indian Cosmetic Series and 12 antigens of the Indian Standard Series. Results. The majority (58%) of patients belonged to the 21–40 years age group. The presence of ACD to cosmetics was confirmed in 38 (76%) patients. Face creams (20%), hair dyes (14%), and soaps (12%) were the most commonly implicated. The most common allergens identified were gallate mix (40%), cetrimide (28%), and thiomersal (20%). Out of a total of 2531 patches applied, positive reactions were obtained in 3.75%. Conclusion. Incidence of ACD to cosmetics was greater in females. Face creams and hair dyes were the most common cosmetic products implicated. The principal allergens were gallate mix, cetrimide, and thiomersal.

Contact Allergies to Cosmetics: Testing with 52 Cosmetic Ingredients and Personal Products

Fifty patients of both sexes with clinically suspected cosmetic dermatitis were subjected to patch testing with a cosmetic and fragrance series, approved by the Contact and Occupational Dermatosis Forum of India (CODFI), and with selected allergens from the Indian Standard Series (ISS). Most of these patients were young adults between 10-29 years; the mean age was 27.5 years. The majority of the patients had cosmetic dermatitis of <1 year duration (68%). The occupational profiles of the patients included students (46%), housewives (18%), teachers (10%) and laborers (4%). A miscellaneous group, comprised of tailors, farmers, staff nurses, beauticians, jewellers and engineers, accounted for the remaining 22%. The most commonly involved site was the face, followed by the forehead, neck and scalp. Patch testing of these patients revealed that, out of the 50 subjects tested, thirty-three (66%) reacted to one or more allergens. Fragrance components were the most common offending allergen (51.5%) followed by preservatives (39.3%), paraphenylenediamine (PPD) (21.2%), and cetrimide and tertiary butyl hydroquinone (12.1% each), in descending order of frequency. Hence, patch testing, with the standard series supplemented by personal cosmetics; should be considered for patients with cosmetic dermatitis to determine the offending allergen so as to avoid further contact with that allergen.

Knowledge and practices of, and attitudes towards, the use of hair dyes among females visiting a teaching hospital in Riyadh, Saudi Arabia

BACKGROUND AND OBJECTIVES

Use of hair dye is extremely common worldwide. However, our literature search failed to find studies concerning the knowledge and attitudes of the public with regard to hair dyes. We sought to explore the knowledge and practices of, and attitudes towards, the use of hair dye among females.

DESIGN AND SETTING

A cross-sectional survey conducted on females who attended various outpatient clinics at King Khalid University Hospital in Riyadh, Saudi Arabia, a tertiary referral hospital open to the general public.

PATIENTS AND METHODS

A self-administered questionnaire about the use of hair dyes was distributed randomly among females attending the outpatient clinics at a university hospital in 2008.

RESULTS

The response rate was 87.2%, with completion of 567 of the 650 distributed questionnaires. The mean (SD) age of respondents was 32.0 (10.2) years. Among respondents, 82.6% (464/562) had at some point dyed their hair. Furthermore, 69.3% (334/482) had dyed their hair in the past 12 months. The mean (SD) age of the participants when they first dyed their hair was 22.2 (7.1) years (range, 7-50). Of the participants, 76.8% (354/461) used permanent dyes, and about the same percentage of participants believed such dyes were the safest hair dye type. However, 52.4% (278/531) of the participants believed that hair dyes are harmful, and 36% (191/531) believed that hair dyes could cause cancer. Younger females tend to dye their hair less frequently (P<.001), whereas those with less education tend to dye their hair more frequently (P=.013).

CONCLUSION

Use of hair dye is very common among females. Because the practice starts at a very young age, we conclude that hair dyes are overused and misused. The public should be informed about the risks associated with excessive hair dye use.

Comparison of Marketed Cosmetic Products Constituents with the Antigens Included in Cosmetic-related Patch Test

BACKGROUND

Currently, cosmetic series (Chemotechnique Diagnostics, Sweden) is the most widely used cosmetic-related patch test in Korea. However, no studies have been conducted on how accurately it reflects the constituents of the cosmetics in Korea.

OBJECTIVE

We surveyed the constituents of various cosmetics and compare with the cosmetic series, to investigate whether it is accurate in determining allergic contact dermatitis caused by cosmetics sold in Korea.

METHODS

Cosmetics were classified into 11 categories and the survey was conducted on the constituents of 55 cosmetics, with 5 cosmetics in each category. The surveyed constituents were classified by chemical function and compared with the antigens of cosmetic series.

RESULTS

155 constituents were found in 55 cosmetics, and 74 (47.7%) of constituents were included as antigen. Among them, only 20 constituents (27.0%) were included in cosmetic series. A significant number of constituents, such as fragrance, vehicle and surfactant were not included. Only 41.7% of antigens in cosmetic series were found to be in the cosmetics sampled.

CONCLUSION

The constituents not included in the patch test but possess antigenicity are widely used in cosmetics. Therefore, the patch test should be modified to reflect ingredients in the marketed products that may stimulate allergies.

Allergic patch test reactions associated with cosmetics: retrospective analysis of cross-sectional data from the North American Contact Dermatitis Group, 2001-2004

BACKGROUND

Allergy to cosmetics is common.

OBJECTIVES

We sought to characterize patients with positive patch test reactions associated with a cosmetic source, to identify common allergens; and to explore gender and occupational associations.

METHODS

We performed a retrospective, cross-sectional analysis.

RESULTS

Of 6621 female and 3440 male patients, 1582 female (23.8%) and 611 of male (17.8%) patients had at least one allergic patch test reaction associated with a cosmetic source. Of "allergic" patients (>1 allergic reaction, n = 6815), females were 1.21 times more likely to have an allergic reaction associated with a cosmetic source than were male patients (p < .0001, 95% confidence interval [CI] 1.12-1.31). Within the "cosmetic allergic" group (n = 2243), head and neck involvement was significantly higher in female than in male patients (49.3% vs 23.7%, p < .0001). One hundred twenty-five patients had occupationally related allergic reactions associated with a cosmetic.

LIMITATIONS

This study is limited by its cross-sectional, retrospective design.

CONCLUSION

Of all patients studied, 21.8% had an allergic reaction associated with a cosmetic. Site of dermatitis, cosmetic categories, and specific allergens differed somewhat by gender.

Understanding the adverse effects of cosmetics: a pilot project in cosmetovigilance

Currently, cosmetics and toiletries are very popular and their use continues to increase because consumers consider physical appearance important and, at the same time, these products are considered to be safe. However, in spite of their safety and tolerability, during recent decades, we have become aware that adverse effects can occur. The number of adverse effects known so far is very low indeed. This is partly because such adverse effects are underestimated as a result of self-diagnosis and self-medication, which are common behaviours in the presence of mild-to-moderate reactions, as in the case of cosmetics. Moreover, such effects are underestimated because of the absence of formal and reliable monitoring systems ('cosmetovigilance'). This requires the creation of a standard reporting form, as well as resolution concerning professional categories authorized to report and the subsequent validation/evaluation of the collected forms. All these items are of great importance, not only to investigate but also to prevent risks caused by cosmetic use. A pilot project was undertaken to test the effectiveness of a notification system by the validation of either a reporting form or the role of dermatologists and community pharmacists as reporting categories. Collection of reporting forms began in July 2006 and it is still in progress; the preliminary data reported here refer to the period July 2006-June 2007 and mainly concern the recording and validation of the collected reporting forms. During this period, we have received 40 reporting forms (32 by dermatologists and 8 by pharmacists). The validation process of the recorded forms revealed several drawbacks, such as incompleteness (19 forms), inadequacy of the description of the suspected undesirable effect and its location (2), illegible handwriting (6) and mistaken statements (3). Six forms reported a misuse of a cosmetic product: four of these were related to the site of application while two were related to time. In one case, instructions for use were not followed. In conclusion, our experience regarding the notification of adverse effects of cosmetics, although limited to a restricted geographical area, suggests that for an efficient and reliable monitoring system to be in place, which includes all the necessary measures to protect public health, an education and training programme for all stakeholders (health professionals, consumers and appropriate authorities) is required.

Allergic Contact Dermatitis to Cosmetics

Cosmetics are used to enhance one's appearance and are used by women worldwide. This article reviews the epidemiology, clinical features, and management of cosmetic allergic contact dermatitis. Additionally, several important cosmetic-related allergens are discussed.

Cosmetics in the treatment of acne vulgaris

This article describes scenarios of patients who have acne vulgaris have tried over-the-counter products and cosmetics and are disheartened by the persistence of their disease and the resulting scars. They may have seen an aesthetician, plastic surgeon, or even a general practitioner before seeing a well-informed skin specialist. Patients perceive the dermatologist to be the skin care expert and seek guidance to obtain otherwise unobtainable results. Therefore, practicing dermatologists should take advantage of the available tools to treat patients aggressively and completely. Appropriately applied cosmetics can play a role in achieving this goal. This article describes scenarios that integrate cosmetics into an anti-acne treatment regimen that is effective and safe for all ethnic groups and is well tolerated by both male and female patients.

Cosmetic dermatitis - current perspectives

BACKGROUND

Increasing use of cosmetics by modern society has contributed alarming to an rise in the incidence of cosmetic dermatitis (CD). The causative agents are skin, hair, nail and eye cosmetics. Reported cases of cosmetic dermatitis represent only the tip of the iceberg, as most patients who experience an adverse reaction to cosmetics do not consult a physician but discontinue using the suspected items.

METHODS

A comprehensive history followed by adequate clinical examination and patch test is important to diagnose reaction to cosmetics. In addition other tests like Repeated Open Application Test (ROAT), usage test, elimination test and safety test are important, as many cosmetics and their ingredients are either weak allergens or irritants.

RESULTS

A wide variety of adverse reactions to cosmetics are seen which are of both irritant and allergic type. Pattern of CD varies in different parts of the world depending upon the type and frequency of different cosmetics used. Reactions are more commonly seen in females of younger age and the face is the most common site.

CONCLUSIONS

Though prevention is better than cure, but cosmetics have definitely infiltrated into our life style. We cannot prevent use of cosmetics but can only limit their use by educating their users and helping them in judicious selection of the required cosmetics.

An ultrastuctural study of hair fiber damage and restoration following treatment with permanent hair dye

INTRODUCTION

Hair fibers are comprised of non-nucleated keratinocytes and are biologically dead. Clinical damage to the hair shaft occurs with the application of hair dye. Whether this damage can be repaired and the time frame involved is of interest and may help to determine the optimal interval between repeat applications.

AIMS AND METHODS

Ultrastructural changes of hair shafts after application of permanent hair dye were observed sequentially in a 26-year-old woman. The dye contained p-phenylenediamine, m-aminophenol, resorcin and hydrogen peroxide as an oxidizer. Scanning and transmission electron microscopy was performed immediately before application of the hair dye and again at 30 min, 1 h, 3 h, 6 h, 1 day, 3 days, 1 week, 2 weeks, 4 weeks, 6 weeks and 8 weeks.

RESULTS

The hair showed cuticular swelling with focal degeneration. In some places there was exposure of the hair cortex due to extensive cuticular detachment. There were many holes of various size in the endocuticle, small focal lacunae along the intercellular space and an ill-defined A-layer especially beneath the area of cuticular detachment. The exocuticle appeared normal. The findings were most dramatic in the 6 h and 1 day specimens and tended to improve gradually thereafter. The 8 week specimen showed near complete restoration of the hair cuticle and return to the precoloring state.

CONCLUSION

Hair returns to its precoloring state and this requires 8 weeks.

Adverse reactions to cosmetic ingredients

Numerous cosmetics are used on a daily basis by men, women, and children. Despite a few adverse reactions, cosmetics are a remarkably safe group of products.

Natural ingredients based cosmetics. Content of selected fragrance sensitizers

In the present study, we have investigated 42 cosmetic products based on natural ingredients for content of 11 fragrance substances: geraniol, hydroxycitronellal, eugenol, isoeugenol, cinnamic aldehyde, cinnamic alcohol, alpha-amylcinnamic aldehyde, citral, coumarin, dihydrocoumarin and alpha-hexylcinnamic aldehyde. The study revealed that the 91% (20/22) of the natural ingredients based perfumes contained 0.027%-7.706% of 1 to 7 of the target fragrances. Between 1 and 5 of the chemically defined synthetic constituents of fragrance mix were found in 82% (18/22) of the perfumes. 35% (7/20) of the other cosmetic products (shampoos, creams, tonics, etc) were found to contain 0.0003-0.0820% of 1 to 3 of the target fragrances. Relatively high concentrations of hydroxycitronellal, coumarin, cinnamic alcohol and alpha-amyl cinnamic aldehyde were found in some of the investigated products. The detection of hydroxycitronellal and alpha-hexylcinnamic aldehyde in some of the products demonstrates that artificial fragrances, i.e., compounds not yet regarded as natural substances, may be present in products claimed to be based on natural ingredients.

Exposure to selected fragrance materials. A case study of fragrance-mix-positive eczema patients

The aim of the present study was to assess exposure to constituents of the fragrance mix from cosmetic products used by fragrance-mix-positive eczema patients. 23 products, which had either given a positive patch and/or use test in a total of 11 fragrance-mix-positive patients, were analyzed. In all cases, the use of these cosmetics completely or partly explained present or past episodes of eczema. Between 1 to 6 constituents of the fragrance mix were found in 22 out of 23 products. The cosmetics of all the patients sensitive to hydroxycitronellal, eugenol, cinnamic alcohol and alpha-amylcinnamic aldehyde were found to contain the respective substances. Exposure concentrations were seen to cover a large range. The content of hydroxycitronellal was, on average, 5 x higher in cosmetics from hydroxycitronellal-sensitive patients, compared to cosmetics from hydroxycitronellal-negative patients. It is concluded that exposure to constituents of the fragrance mix is common in fragrance-allergic patients with cosmetic eczema, and that the fragrance mix is a good reflection of actual exposure.

1992 AAD Award for Excellence in Education: The Integrated Basic and Clinical Science Conference Series at the University of Texas Southwestern Medical Center

This article was written to share information concerning the establishment and implementation of a successful, integrated basic and clinical science conference series for resident trainees in dermatology. We discuss the underlying philosophy and describe the concepts employed in, and the dynamics that have resulted from, this educational experiment. Finally, we include the schedule and references for the 1993-1994 academic year.