Contact dermatitis to hair dyes in a Danish adult population: an interview-based study

Patch Testing to Paraphenylenediamine: The North American Contact Dermatitis Group Experience (1994-2018)

Background/Objectives: Paraphenylenediamine (PPD) is an aromatic amine dye that may cause allergic contact dermatitis. This study examines the epidemiology of allergic patch test reactions to PPD. Methods: This retrospective analysis characterizes individuals tested to PPD (1% petrolatum) by the North American Contact Dermatitis Group (1994-2018). Demographics and dermatitis site(s) were compared between PPD-allergic and PPD-negative patients. PPD reactions were analyzed by reaction strength, clinical relevance, occupational relatedness, and source as well as coreactivity with structurally related compounds. Results: Of 54,917 patients tested to PPD, 3095 (5.6%) had an allergic patch test reaction. Compared with PPD-negative patients, PPD-allergic patients had significantly greater odds of age >40 years (odds ratio [OR] 1.55 [95% confidence interval; CI 1.43-1.69]) and female gender (OR 1.52 [95% CI 1.41-1.66]), but lower odds of being White (OR 0.66 [95% CI 0.60-0.71]). The most common primary anatomic sites of dermatitis were face (25.5%), hands (21.9%), and scattered/generalized pattern (15.5%). Over half (55.3%) of PPD reactions were ++ or +++ at the final reading and 60.9% were currently relevant. Common exposure sources included hair dye (73.5%) and clothing/shoes/apparel (3.9%). Occupationally related reactions occurred in 8.3%, most commonly in hairdressers/cosmetologists (72.8%). The most common coreactions were benzocaine (11.3%), N-isopropyl-N'-phenyl-p-phenylenediamine (6.7%), disperse dye mix (6.5%), and black rubber mix (5.1%). Conclusions: The 24-year percentage of allergic reactions to PPD was 5.6%. PPD allergy was associated with female gender and age >40 years. PPD allergic patients were less likely to be White. Allergic reactions were usually clinically relevant and hair dye was the most frequently identified source.

Association between gestational hair dye use and allergies at 3 years old: the Japan environment and Children's study

BACKGROUND

Hair dye use frequently induces allergic contact dermatitis, and on rare occasions induces immunoglobulin E-mediated immediate urticaria, anaphylaxis, and asthma. The effects of hair dye use during pregnancy on offspring have been studied for carcinogenicity, but not for development of allergies. This study aimed to assess the association between hair dye use during pregnancy and allergic disease in children at 3 years old.

METHODS

Data of 77,303 participants from the Japan Environment and Children's Study, which is a prospective birth cohort recruited from January 2011 to March 2014, were used. We examined the associations between using hair dye during pregnancy and allergic diseases (food allergy, asthma, atopic dermatitis and allergic rhinitis) in children after adjustment for covariates by multivariable logistic regression.

RESULTS

Among mothers who were exposed to hair dye during pregnancy, 50.0% were exposed in hair salons, 21.3% had home use, and 9.5% had occupational exposure. The percentages of doctor-diagnosed allergies at 3 years old were 6.3% for food allergies, 7.7% for asthma, 7.3% for atopic dermatitis, and 4.6% for allergic rhinitis. In univariable analyses, hair dye use at home and occupational exposure was significantly associated with asthma respectively (odds ratio [OR] 1.15, 95% CI 1.07-1.24 for at home; OR 1.18, 95% CI 1.08-1.28 for occupational exposure). Hair dye use at home were significantly associated with doctor-diagnosed allergic rhinitis at 3 years old (OR 1.12, 95% CI 1.02-1.22). After adjustment for covariates, these associations for asthma decreased and were no longer significant (aOR 1.06, 95% CI 0.98-1.14 for at home; aOR 1.09, 95% CI 1.00-1.20 for occupational exposure, p = 0.057), also for allergic rhinitis (aOR 1.07, 95% CI 0.97-1.19). Doctor-diagnosed allergic rhinitis at 3 years old was significantly associated with hair dye use at home in the most frequent use group (aOR for quite often versus never 1.78, 95% CI 1.22-2.60).

CONCLUSION

Both home and occupation use of hair dye during pregnancy showed a trend of increased odds of allergic rhinitis and asthma in offspring at 3 years. However, the only association that reached significance was in frequency of use analyses between the highest frequency of home hair dye users and allergic rhinitis.

Mimicking Natural Human Hair Pigmentation with Synthetic Melanin

Human hair is naturally colored by melanin pigments, which afford myriad colors from black, to brown, to red depending on the chemical structures and specific blends. In recent decades, synthetic efforts have centered on dopamine oxidation to polydopamine, an effective eumelanin similar to the one found in humans. To date, only a few attempts at polydopamine deposition on human hair have been reported, and their translation to widespread usage and potential commercialization is still hampered by the harsh conditions employed. We reasoned that novel, mild, biocompatible approaches could be developed to establish a metal-free route to tunable, nature-inspired, long-lasting coloration of human hair. Herein, we describe synthetic and formulation routes to achieving this goal and show efficacy on a variety of human hair samples via multiple spectroscopic and imaging techniques. Owing to the mild and inexpensive conditions employed, this novel approach has the potential to replace classical harsh hair dyeing conditions that have raised concerns for several decades due to their potential toxicity.

The rash that presents as a red swollen face

A red swollen face can be a skin sign of a potentially life-threatening condition. We present in detail the main clinical presentations, diagnostic tests, and management of some of the most severe conditions that can frequently present as a red and swollen face: acute or recurrent angioedema, mast cell-driven or bradykinin-mediated angioedema, nonhereditary and hereditary angioedema, allergic or photoallergic facial contact dermatitis, contact urticaria, severe adverse drug reactions (particularly drug reaction with eosinophilia and systemic symptoms [DRESS]), skin infections (erysipelas, cellulitis, necrotizing fasciitis), and autoimmune diseases (dermatomyositis). There are many other conditions that also have to be considered in the differential diagnosis of a red swollen face.

Non-oxidative hair dye products on the European market: What do they contain?

BACKGROUND

Hair dyeing is very common and may cause allergic contact dermatitis. Oxidative (often termed permanent or semi-permanent) hair dye products have constituted the focus of market surveys and toxicological risk assessments, while non-oxidative (semi-permanent, temporary or direct) products have not been assessed.

OBJECTIVES

To identify the hair dye substances presently used in non-oxidative hair dye products in Europe.

METHODS

Ingredient label data on eligible products in 5 European countries were collected, and 289 different non-oxidative hair dye products were included in this study.

RESULTS

Up to 9 hair dye substances were present in each product. Sixty-eight individual hair dye substances were identified on the 289 product labels, and their occurrence ranged from 0.3% to 34%. There were differences concerning substances used and their number per product between products of different consistency and colour.

CONCLUSIONS

The hair dye substances in non-oxidative hair dye products are different from those in oxidative hair dye products, and are currently not covered by patch test series. The toxicological and skin-sensitizing profile of the substances in non-oxidative hair dye products, as well as their concentrations, should be further investigated.

P-Phenylenediamine Hair Dye Allergy and Its Clinical Characteristics

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.

Factors associated with p-phenylenediamine sensitization: data from the Information Network of Departments of Dermatology, 2008-2013

BACKGROUND

Risk factors for p-phenylenediamine (PPD) sensitization include the use of hair dyes, the application of temporary black henna tattoos, working as a hairdresser, and, possibly, exposure to hair dye pretests.

OBJECTIVES

To quantify the impact of these (putative) risk factors on PPD sensitization.

METHODS

Six items related to PPD exposure were added to the routine Information Network of Departments of Dermatology questionnaire from 2008 to 2013. A retrospective analysis of data from 4314 patients tested with PPD 1% pet. was conducted.

RESULTS

Of the PPD-positive patients (n = 271), 80% had their hair dyed, and, of these, 57% subsequently developed scalp dermatitis, whereas only 11% had had a henna tattoo. The self-administrated pretest with hair dye was performed by only a few patients, precluding a more detailed analysis. Hair dyeing [odds ratio (OR) 6.0; 95% confidence interval (CI): 3.9-9.4], henna tattoos (OR 2.4; 95%CI: 1.5-3.7) and being a hairdresser (OR 2.1; 95%CI: 1.3-3.2) increased the risk of PPD sensitization. Neither dyeing of own hair nor application of a temporary henna tattoo seemed to affect PPD sensitization in hairdressers. p-Aminoaryl compounds more often gave positive reactions in patients with henna tattoo.

CONCLUSIONS

Hair dyeing is the major risk factor for PPD sensitization in this clinical setting, and application of a temporary black henna tattoo may also lead to (strong) PPD sensitization.

Contact sensitizers in commercial hair dye products sold in Thailand

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.

Prevalence of potent skin sensitizers in oxidative hair dye products in Korea

OBJECTIVES

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Patch test results in children and adolescents across Europe. Analysis of the ESSCA Network 2002-2010

BACKGROUND

Contact sensitization in children is more frequent than previously thought.

METHODS

The ESSCA collected patch test data from 11 European countries aggregated to 4 European regions.

RESULTS

Six thousand and eight patients aged 1-16 years old with suspected allergic contact dermatitis were analyzed during a period of 8 years (2002-2010). The overall prevalence of at least one positive reaction to a hapten was 36.9%. The 10 most frequent haptens were as follows: nickel sulfate, cobalt chloride and potassium dichromate, neomycin sulfate, Myroxylon pereirae resin (balsam of Peru), para-phenylenediamine, chloromethylisothiazolinone/methylisothiazolinone 3:1, fragrance mix, lanolin alcohols, and colophony. No difference was found in the prevalence of at least one positive reaction to at least one hapten between boys and girls and between children with atopic dermatitis and children without. Children without atopic dermatitis, when compared with those with, had a significantly higher prevalence of contact sensitization for nickel sulfate (20.91% vs 16.87%, respectively), 4-tert. butylphenol formaldehyde resin (1.61% vs. 0.7%), and para-phenylenediamine (2.49% vs. 1.3%).

LIMITATIONS OF THE STUDY

Chamber loading is not an exact science and variation may occur between staff and departments. Interinstitution variations in readings can occur. A possible geographic confounder is that the southern regions tested more children in the younger age group. Relevance was not addressed due to difficulties in the application of a set of uniform definitions.

CONCLUSIONS

Our study adds information on the most common contact allergens detected in children which could help to define a Standard European Pediatric Baseline Series.

Hair dye dermatitis and p-phenylenediamine contact sensitivity: A preliminary report

BACKGROUND

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).

OBJECTIVES

To study the clinical patterns and PPD contact sensitivity in patients with hair-dye dermatitis.

MATERIALS AND METHODS

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).

RESULTS

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.

CONCLUSIONS

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.

Analysis of the Results from the Patch Test to Para-Phenylenediamine in the TRUE Test in Patients with a Hair Dye Contact Allergy

Background

Para-phenylenediamine (PPD) is the primary patch test screening agent for hair dye contact allergy (HDCA). However, no recent studies have been published that describe the results of reactions to patch tests using PPD and hair dyes in Korea.

Objective

To analyze the results of the patch tests to PPD using the thin-layer rapid use epicutaneous (TRUE) Test system in patients with HDCA and to investigate patients' awareness that hair dyes contains allergens, which cause the development of HDCA.

Methods

Eighty-four patients with suspected HDCA (32 men and 52 women) underwent patch testing using the TRUE Test system and their own hair dyes. The patients' demographic data, behavior associated with hair dyeing, and clinical manifestations of HDCA were examined retrospectively.

Results

Positive patch-test reactions to hair dyes occurred in 53.6% of patients who used hair dyes, and they were diagnosed with HDCA. Although there was a significant correlation between HDCA and PPD sensitization (p=0.001), only 40% of the patients with HDCA showed positive reactions to PPD. Of the 45 patients diagnosed with HDCA, only 7 (15.6%) were aware that their hair dyes contained allergens that caused HDCA.

Conclusion

This study's findings show that PPD is an effective HDCA marker. However, we propose that investigations on hair dye components other than PPD should be conducted to develop and validate additional predictive HDCA markers.

A laboratory test based on determination of cytokine profiles: a promising assay to identify exposition to contact allergens and predict the clinical outcome in occupational allergic contact dermatitis

Background

Para-phenylenediamine (PPD) is the main allergen causing adverse reactions to hair dyes and a frequent cause of occupational-related skin sensitization among hairdressers and beauticians. The immunologic mechanism of the disease relies on the production of inflammatory cytokines by allergen-specific T cells, while regulatory T cells are thought to down-modulate the allergic response. This study was aimed at investigating the expression of effector or regulatory cytokines in exposed subjects in order to verify whether different cytokine profiles might predict distinct clinical outcomes. Peripheral blood mononuclear cells (PBMC) from 21 subjects occupationally exposed or not (10) to PPD were kept in short term cultures in the presence of optimized concentrations of NiSO4 × 6H2O or PPD. The production of IFN-γ and IL-10 elicited by antigens were analyzed by the ELISpot assay.

Results

The presence of IFN-γ responses toward PPD was significantly correlated with a positive patch test (P = 0.002) and allergic symptoms, while IL10 responses were invariably found in PPD-exposed but clinically asymptomatic subjects with negative patch testing. We found concordance between the different cytokine profiles and patch test results. No false-positive results were found for the different cytokine profiles induced by PPD, resulting in 100% specificity. The sensitivity of the test was 87.5% (95% CI 65.9-100.0) with an overall test accuracy of 93.3%. Although larger prospective-retrospective studies are necessary to validate the predictive potential of the test, the negative and positive predicted values for PPD in this study were NPV = 87.5% and PPV = 100%, respectively.

Conclusions

These data indicate that distinct cytokine profiles are associated with different clinical manifestations. The test, which is based on a simple and rapid profiling of cytokine responses by T lymphocytes against allergens, has proven to be a promising laboratory tool, useful for both the identification of previous contact with allergens and the etiologic diagnosis of contact allergies as well as capable of predicting the clinical outcome (development of an allergic or tolerant response).

p-Phenylenediamine and other allergens in hair dye products in the United States: a consumer exposure study

BACKGROUND

Hair dye products constitute an important source of allergen exposure, and contribute importantly to allergic contact dermatitis in consumers and hairdressers.

OBJECTIVES

To evaluate the presence of potent contact sensitizers in oxidative hair dye products intended for home use on the US market.

METHODS

Ingredient labels of 107 hair dyes from 10 major brands were examined and used to assess the prevalence of hair dye substances known to be potent contact sensitizers.

RESULTS

One hundred and six of 107 (99%) products contained at least one potent sensitizer, and the average product contained six (range 0-11). p-Phenylenediamine (PPD) was found in 83 products (78%), but resorcinol (89%), m-aminophenol (75%), p-aminophenol (60%) and toluene-2,5-diamine (21%) were also frequently identified.

CONCLUSIONS

Potent contact sensitizers were almost universally included in the hair dyes investigated in the United States. Although PPD is a common allergen, resorcinol and m-aminophenol were found more frequently. In total, 30 potent sensitizers were found. Clinicians should consider other allergens in addition to PPD when evaluating patients with suspected hair dye allergy.

Trends in use of hair dye: a cross-sectional study

Objective:

The objective of the following study was to assess the knowledge, practice, perception and adverse reactions among hair dye users.

Settings and Design:

A cross-sectional study was conducted on patients, their attenders and staff of SDUMC.

Materials and Methods:

A questionnaire (28) pertaining to use of hair dyes and reactions to them was administered randomly.

Statistical Analysis:

The demographic data are expressed as mean ± standard deviation, quantitative data expressed as percentages.

Results:

A total of 263 volunteers responded of which 52.5% and 47.5% were females and males respectively with mean age of 32.40 ± 6.01 years. The participants started using hair dye at an age of 27 (±3.63) years. Synthetic dyes were used by 91%. Frequency of use in a year was 2-5 times in 51%. Instruction of the package insert was followed by 63.5%. Skin test was never performed in 34% prior to their use. Nearly 96% expressed hair dyeing was unsafe during pregnancy, lactation and in children. Adverse reactions were reported by 42%, with headache (63%) and itching (38%) being the most common.

Conclusion:

Hair dyeing was started at very early age. Majority used semi-permanent dyes even though they perceived natural dyes were safe. They continued dyeing despite adverse reactions, which indicates cosmetic importance.

Side-effects of henna and semi-permanent 'black henna' tattoos: a full review

Henna, the dried and powdered leaf of Lawsonia inermis, is widely used as a dye for the skin, hair, and nails, and as an expression of body art, especially in Islamic and Hindu cultures. As it stains the skin reddish-brown, it is also called red henna. Black henna is the combination of red henna with p-phenylenediamine (PPD), and is used for temporary 'black henna tattoos'. This article provides a full review of the side-effects of topical application of red and black henna, both cutaneous (allergic and non-allergic) and systemic. Red henna appears to be generally safe, with rare instances of contact allergy and type I hypersensitivity reactions. In children with glucose-6-phosphate dehydrogenase deficiency, topical application of henna may cause life-threatening haemolysis. Black henna tattoos will induce contact allergy to its ingredient PPD at an estimated frequency of 2.5%. Once sensitized, the patients may experience allergic contact dermatitis from the use of hair dyes containing PPD. There are often cross-reactions to other hair dyes, dyes used in textiles, local anaesthetics, and rubber chemicals. The sensitization of children to PPD may have important consequences for health and later career prospects. Systemic toxicity of black henna has been reported in certain African countries.

The pattern of hair dyeing in koreans with gray hair

Background

Hair graying is considered as a part of normal ageing process. Nonetheless, this process raises a significant cosmetic concern, especially among ethnic Korean elderly whose baseline hair color is black. For this reason, Korean elderly dye their hair with frequency despite the risk of dermatologic problems such as allergic contact dermatitis.

Objective

In this study, the authors investigate the prevalence and pattern of hair dyeing and its relation with scalp diseases in Korea.

Methods

Six hundred twenty subjects (330 men and 290 women) with graying hair were given a questionnaire survery and underwent a physical examination.

Results

Of the 620 total, 272 subjects (43.9%) dyed their hair. Hair dyeing was significantly more frequent among women than among men (p<0.001). Subjects from 50 to 69 years of age showed higher prevalence of hair dyeing when compared to either younger or older groups. Subjective self-assessment of the extent of hair graying was associated with increased prevalence of hair dyeing, that is, individuals who feel graying has advanced by more than 20% of the overall hair were much more likely to dye their hair (p<0.001). Hair dyeing did not correlate with either alopecia or scalp disease.

Conclusion

Our survey has found that the prevalence of hair dyeing is higher among Korean women than men. People in their fifties and sixties and people with more than 20% extent of grayness were more likely to dye their hair than otherwise. Hair dyeing was not associated with any increase in the prevalence of scalp diseases.

Pattern of patch test reactivity among patients with clinical diagnosis of contact dermatitis: a hospital-based study

BACKGROUND AND OBJECTIVES

Contact allergy is associated with a significant morbidity all over the world. This study was performed to investigate the pattern of sensitization by contact allergens in the local population.

DESIGN AND SETTING

Retrospective study to investigate patch test reactivity among patients with clinical diagnosis of contact dermatitis who were referred to the allergy clinic at the King Khalid University Hospital, Riyadh, between April 2008 and March 2010.

PATIENTS AND METHODS

Of the 196 patients referred to the allergy clinic over the 2-year period, 91 (46.4%) patients reacted to one or more patch test allergens, and these patients were included in this study. The study group included 82 (91.1%) of Saudi nationality and 9 (8.9%) patients of other nationalities. The patch test was performed using the T.R.U.E TEST, containing 24 allergens/allergen mixes.

RESULTS

Of the 91 cases who reacted positively to one or more allergens, 67 (73.6%) were females with a mean age of 37 (8.3 years) and 24 (26.4%) were males with a mean age of 34 (11.6 years). Thirty-three (36.2%) patients reacted to nickel sulfate, 14 (15.3%) to p-phenylenediamine, 13 (14.2%) to p-tert-butylphenol-formaldehyde resin, 13 (14.2%) to thimerosal, and 9 (9.8%) to colophony. Reactivity against the rest of the allergens was not remarkable. A significantly higher percentage of females reacted to nickel sulfate (84.8% vs 15.2% in males;P=.0001), p-tert-butylphenol-formaldehyde resin (92.3% vs 7.7%; P=.0001), and thimerosal (76.9% vs 23.1%;P=.03).

CONCLUSIONS

Patch test reactivity to nickel sulfate was high. The pattern of contact allergy observed in this study indicates the need for large-scale investigations to identify local allergens responsible for contact allergy and for formulation of policies directed towards avoidance of exposure.

Local Side Effects Caused by Hair Dye Use in Females: Cross-sectional Survey

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.

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.

Severe allergic reactions to para-phenylenediamine in children and adolescents: should the patch test concentration of PPD be changed?

BACKGROUND

Semipermanent henna tattoos containing para-phenylenediamine (PPD) are a well-known cause of severe contact dermatitis, mainly in children. Another relevant exposure source to PPD are hair dyes, which are increasingly used by children and have also been reported to cause intense facial and scalp dermatitis. German patch test guidelines for children recommend that PPD should only be tested in patients who have had a henna tattoo, and then at a reduced concentration of PPD 0.5 % for 24 hours.

PATIENTS AND METHODS

We report on patch test results in four patients, three children and one adolescent, with a history of contact dermatitis to henna tattoos or hair dye. We used the recommended or even lower patch test concentrations of PPD with 24-hours exposure in all patients.

RESULTS AND CONCLUSION

All patients showed very strong patch test reactions to PPD and cross-reactions to related compounds even after dilution of PPD to as low as 0.05 %. Therefore, we suggest that in children with a history of allergic reactions to this compound, a titration test should be performed beginning at a concentration of maximal 0.05 %. This procedure has also been proposed previously based on a larger cases series in adults.

Exposures and reactions to allergens among hairdressing apprentices and matched controls

BACKGROUND

Early and extensive exposures to chemical substances such as are found in hair dyes, perfumes and nickel are known risk factors for allergic reactions. Hairdressing apprentices belong to a high-risk group, as they are exposed both occupationally and personally.

OBJECTIVES

To estimate the degree of exposure and adverse skin reactions to chemical substances in a cohort of hairdressing apprentices, at the start of their education, as compared with a matched sample from the general population.

MATERIALS

During their first 2 weeks of training, 382 hairdressing apprentices were enrolled in this study. All apprentices completed a self-administered questionnaire that included questions regarding, for example, exposures and skin reactions to hair dye, perfumed products, and piercings. For comparison, the questionnaire was sent to a control group from the general population, matched on age, sex, and postal code (n = 1870).

RESULTS

Within the previous year, 95.2% of hairdressing apprentices and 66.9% of the control group had dyed their hair (p < 0.001); the apprentices dyed their hair, on average, 6.6 times per year, as compared with 3.7 times per year in the control group (p < 0.001). The mean age of the first hair dying among the apprentices was 12.1 years, as compared with 13.3 years for the matched control group (p < 0.001). The hairdressing apprentices reported more eczematous reactions to hair dye (p = 0.002) than the controls. Semi-permanent so-called 'black henna tattoos' had been carried out in 48.1% of the apprentices, as compared with 31.0% of the controls (p < 0.001).

CONCLUSIONS

Both hairdressing apprentices and the matched control group of young people from the general population were highly exposed to potent allergens. The hairdressing apprentices were even more exposed to products containing hair dye substances and piercings, and reported more adverse reactions to hair dye products than their matched controls from the general population.

p-Phenylenediamine sensitization and occupation

BACKGROUND

p-Phenylenediamine (PPD) is an extreme delayed-type skin sensitizer, and is relevant in both occupational and non-occupational exposures.

OBJECTIVES

To estimate the prevalence of PPD sensitization in a population of consecutive patients with suspected allergic contact dermatitis who attended units of dermatology or occupational medicine in north-eastern Italy and to investigate the association between their PPD sensitization and occupation.

PATIENTS/MATERIALS/METHODS

A total of 14,464 patients (67.6% women and 32.4% men) with suspected allergic dermatitis underwent patch testing. The associations between patch test results and occupations were studied by multivariate logistic regression analysis.

RESULTS

In both sexes, PPD sensitization was significantly associated with hairdressing and beauty occupation [women, odds ratio (OR) 6.58, 95% confidence interval (CI) 3.76-11.50; men, OR 22.3, 95% CI 4.18-119]. In the female group, PPD sensitization was also significantly higher in professional drivers (OR 5.31, 95% CI 1.76-16.1), barmaids (OR 1.89, 95% CI 1.04-3.44), and cleaners (OR 1.82, 95% CI 1.24-2.68). In the male group, PPD sensitization was significantly higher in bakers and waiters (OR 13.0, 95% CI 1.38-123), household workers (OR 8.46, 95% CI 1.68-42.8), and printers (OR 5.68, 95% CI 1.50-21.5).

CONCLUSIONS

Our study showed that workers in several occupations may be at higher risk of developing sensitization to PPD. It is of importance to reduce possible exposure to PPD-crossreacting substances in these occupations.

Repeated exposure to hair dye induces regulatory T cells in mice

BACKGROUND

We have recently shown that commercial p-phenylenediamine (PPD)-containing hair dyes are potent immune activators that lead to severe contact hypersensitivity in an animal model. However, only a minority of people exposed to permanent hair dyes develops symptomatic contact hypersensitivity. This suggests that the majority of people exposed to hair dyes does not become sensitized or develop immunological tolerance.

OBJECTIVES

To study the immune response in mice repeatedly exposed to PPD-containing hair dye in a consumer-like manner.

METHODS

A commercial hair dye containing PPD was tested in C57BL/6 mice. The local immune response was measured by ear swelling and by histological examinations. The immune response in the draining lymph nodes was analysed by flow cytometry.

RESULTS

The hair dye induced local inflammation as seen by swelling and cell infiltration of the treated ears. In addition, exposure to hair dye caused T-cell activation as seen by T-cell proliferation and production of interferon-γ and interleukin (IL)-17 within the draining lymph nodes. The inflammatory response peaked at the fourth exposure to hair dye. From this point on, an upregulation of regulatory T cells and IL-10-producing cells was seen.

CONCLUSIONS

This study shows that PPD-containing hair dyes strongly affect the immune system. In addition to being potent skin sensitizers that activate inflammatory T cells, hair dyes also induce anti-inflammatory mechanisms. This might explain why many consumers can use hair dyes repeatedly without developing noticeable allergies, but it also raises the question whether the immune modulatory effects of hair dyes might influence the development of autoimmune diseases and cancers.