P-Phenylenediamine Hair Dye Allergy and Its Clinical Characteristics

Clinical Patterns and Risk Factors of Occupational Contact Dermatitis in Hairdressers: A Questionnaire-based Cross-sectional Study

BACKGROUND

Occupational contact dermatitis (OCD) is prevalent among hairdressers due to frequent exposure to chemicals like hair dyes and bleaching agents. Despite the risks, awareness among hairdressers remains low, leading to underreporting and inadequate preventive measures.

OBJECTIVE

This study evaluated hairdressers' awareness of harmful hair dye ingredients, their experiences with OCD, and the association with product usage patterns.

METHODS

A cross-sectional study involving 100 hairdressers in Korea examined the relationship between work experience, product usage, and OCD. Chi-square tests and multivariate regression identified significant correlations.

RESULTS

Among the participants, 51% reported experiencing adverse skin reactions, with the hands being the most commonly affected area. Longer work experience as a hairdresser was significantly associated with the occurrence of adverse effects (p=0.046). Notably, shampoo was identified as a suspected causative material significantly more often by the severe group compared to the non-severe group (28.0% vs. 3.8%, p=0.04).

CONCLUSION

Chemical exposure and frequent wet work contribute to high rates of OCD among hairdressers. Poor glove usage, especially during shampooing due to inconvenience, is a major risk factor. Raising awareness, promoting proper glove use, and improving workplace safety training are essential for reducing these skin conditions.

General dermatology and dermatology in primary healthcare

A 14-year-old girl presented with a 4-day history of an intensely pruritic and burning rash on her bilateral forearms, appearing 10 days after a black henna tattoo application. This case explores the approach to paraphenylenediamine contact dermatitis and differential diagnoses.

Ecotoxicity, Health Risks and Contact Allergy Due to p-Phenylenediamine in Hair Dyes and Tattoos: Female Students' Perspectives

While the financial advantages of hair coloring and tattooing are widely acknowledged, environmental hazards and health risks linked to this trend due to their p-phenylenediamine (PPD) content have received less attention. Health education on hair-dying products is warranted to enhance the public's awareness of hair-dying ingredients and their side effects.  A cross-sectional study was therefore conducted with 319 students to assess knowledge of ecotoxicity, health risks, and practices of hair dyeing and tattooing among undergraduate students. A random sample of 59 students was checked for any allergic morphology in the scalp and exposed areas of skin near the neck, ears, palms, and nails. Responses collected were used for data analyses using IBM SPSS Statistics for Windows, Version 17 (Released 2008; IBM Corp., Armonk, New York, United States). Use of hair dye was significantly high among study participants 58.5% (n=187; p<0.05). However, their knowledge regarding the presence of PPD in hair dyes and associated environmental toxicity (37.8%, n=121) was very limited. The majority of participants did not do any allergy tests before applying hair dye (88.9%, n=283). The study revealed that the main reason for hair coloring was as a fashion statement (93.7%, n=299). Regarding tattooing practices, 96.9% (n=309) of study participants had never practiced tattoos, and hence, the prevalence of tattooing was 3.9% (n=12). These data confirmed that the practice of hair dyeing as a style statement was high among students. However, the majority were unaware of their PPD contents and their potential ecotoxicity and health risks.

Hair Product Allergy: A Review of Epidemiology and Management

Allergy to hair products is an increasingly common issue among people given the exposure to these products on a daily basis. Allergic reactions could be in the form of delayed-type contact dermatitis or the form of immediate-type hypersensitivity reactions. Hair products contain many ingredients and chemicals that patients may have allergies to, but common allergens are hair dyes, fragrances, persulfate salts, ammonium thioglycolate, coconut fatty acid derivatives, and acrylates. Allergy to hair dye is the most common followed by other allergens such as fragrances and persulfate salts. We discussed testing for hair dye allergy along with suggestions for alternative hair dyes that patients may use. Allergy to topical scalp medications is also seen in patients using those products. Allergy to topical minoxidil is seen more often due to the increased use of minoxidil sprays and foams among patients to increase hair growth. We will discuss in this review the diagnosis and alternatives for patients with minoxidil allergy. Hairdressers are at higher risk of allergy to hair products compared to the general population due to prolonged exposure to allergens and specific measures should be implemented to minimize the hazards of exposure.

Pigmented contact dermatitis and hair dyes: A retrospective case-control multicentre study in Korea

BACKGROUND

Pigmented contact dermatitis (PCD), a rare variant of non-eczematous contact dermatitis, is clinically characterized by sudden-onset brown or grey pigmentation on the face and neck. It is hypothesized to be caused by repeated contact with low levels of allergens.

OBJECTIVES

This study evaluated the risk of using hair dyes in patients with PCD in Korea.

METHODS

A total of 1033 PCD patients and 1366 controls from 31 university hospitals were retrospectively recruited. We collected and analysed the data from the patient group, diagnosed through typical clinical findings of PCD and the control group, which comprised age/sex-matched patients who visited the participating hospitals with pre-existing skin diseases other than current allergic disease or PCD.

RESULTS

Melasma and photosensitivity were significantly more common in the control group, and a history of contact dermatitis was more common in the PCD group. There were significantly more Fitzpatrick skin type V participants in the PCD group than in the control group. There was no significant difference in sunscreen use between the groups. Using dermatologic medical history, Fitzpatrick skin type and sunscreen use as covariates, we showed that hair dye use carried a higher PCD risk (odds ratio [OR] before adjustment: 2.06, confidence interval [CI]: 1.60-2.65; OR after adjustment: 2.74, CI: 1.88-4.00). Moreover, henna users had a higher risk of PCD (OR before adjustment: 5.51, CI: 4.07-7.47; OR after adjustment: 7.02, CI: 4.59-10.74), indicating a significant increase in the risk of PCD with henna dye use. Contact dermatitis history was more prevalent in henna users than in those using other hair dyes in the PCD group (17.23% vs. 11.55%).

CONCLUSION

Hair dye use is a risk factor for PCD. The risk significantly increased when henna hair dye was used by those with a history of contact dermatitis.

Dermatological adverse effects of hair dye use: A narrative review

Hair dyeing is a popular practice dating back to ancient Egyptian times. Initially, hair dye use was restricted to concealing grey and white hairs of the elderly population. However, in recent times, its use is common among the younger generation as a fashion statement. Hair dye contact dermatitis is a common dermatological condition encountered by dermatologists. It is a delayed type of hypersensitivity reaction that commonly affects the scalp and the vicinity of hair line and neck. Para-phenylenediamine (PPD), a synthetic aromatic amine is the most common allergen specifically implicated in hair dye contact dermatitis. Para-phenylenediamine was announced as the allergen of the year in 2006 by the American Contact Dermatitis Society. Contact allergy to para-phenylenediamine can occur in 0.1-2.3% of the general population. Epicutaneous patch testing is the gold standard test for the diagnosis of hair dye contact dermatitis. However, para-phenylenediamine carries a risk of cross-sensitivity and co-sensitization to other allergens. Apart from contact dermatitis, hair dye use is also associated with various other cutaneous adverse effects such as pigmentary changes, hair loss, skin malignancies and autoimmune disorders. Due to the various adverse effects associated with hair dye use, it is prudent to look for safer alternatives to allergenic hair dyes. In this article, we review the epidemiology, cutaneous and systemic adverse effects associated with hair dye use, patch testing, preventive strategies to minimize the risk of hair dye contact dermatitis, and treatment aspects.

HAIR DYE-INDUCED RETINOPATHY MIMICKING MEK-INHIBITOR RETINOPATHY

PURPOSE

To report a new toxic retinopathy related to the use of hair dye.

METHODS

Case reports of three patients with follow-up after exposure and until resolution.

RESULTS

There were three middle-aged women (32-66 year old) all of whom had bilateral moderate to severe vision loss and normal slit-lamp examination at presentation. Fundus examination showed bilateral multiple serous retinal detachments predominantly located in the posterior pole, with some pigment epithelial hypertrophy in chronic cases. Optical coherence tomography showed similar features as in MEK-inhibitor retinopathy. Electrooculogram performed in one patient showed abnormal Arden ratio. During follow-up, visual acuity improved with regression of the serous retinal detachments. The speed of resolution was proportional to the acuteness of the exposure to aromatic amines.

CONCLUSION

Hair dyes containing aromatic amines can be responsible for bilateral toxic retinopathy mimicking MEK-inhibitor retinopathy.

Contact Dermatitis: Classifications and Management

Contact dermatitis (CD) is a common inflammatory skin disease caused by exposure to contact allergens and irritants. It is also the most common reason of occupational dermatitis and contributes greatly to hand dermatitis and facial dermatitis. Besides the two major forms of contact dermatitis: allergic contact dermatitis and irritant contact dermatitis, other subtypes of CD have been recognized including immediate skin reactions, photoinduced contact dermatitis, systemic contact dermatitis, and non-eczematous contact dermatitis. CD is a great imitator which can mimic many kinds of skin diseases, such as atopic dermatitis, lichen planus, and angioedema. For the diagnosis of CD, a complete medical history, including occupational history, is very important. It can give a clue of CD and provide a list of suspected substances. Besides the well-known diagnostic test, patch testing, there are many other diagnostic tests can be used to help diagnosis of CD and identify the causative allergens, including photopatch test, skin tests for detecting of immediate contact reactions, serum allergen-specific IgE test, and qualitative and quantitative testing of allergen in the suspected materials patients exposed to and challenge test. Before the treatment, the suspected irritants or allergens should be avoided completely. This includes both the removal of the patient from the environment that contains those substances and the promotion of the metabolism and expulsion of the allergens that have been absorbed by the body. In addition, it is also important to restore the skin barrier and reduce skin inflammation through multiple treatments, such as emollients, topical corticosteroids, and antihistamines, as well as systemic corticosteroids and immunosuppressants. Early and appropriate treatments are important to prevent further deterioration and persistence of the skin condition.

Bioinspired polymeric pigments to mimic natural hair coloring

Due to an increasingly aging population, hair dyeing has become more necessary in daily life; however synthetic hair dyes often have the disadvantages of harsh dyeing conditions, a slow dyeing process and biological toxicity. Herein, we developed a bioinspired approach to mimic the natural hair dyeing process under mild conditions. Compared to the existing polydopamine deposition approach with harsh conditions, mild conditions and effective deposition were achieved here. First, in the presence of tyrosine hydroxylase and metal ions, dopamine could be oxidized into polydopamine, a mimic of human eumelanin, and then self-assembled into nanometer-scale pigments. Through optimizing the experimental parameters, various colors and the desired darkness could be achieved within less than 1 minute. In addition, significant durability was observed after continuous washing with polydopamine assemblies as hair dyes. Morphological analysis was applied to verify the deposition of polydopamine assemblies onto the hair surface, which induces the hair color change. Also, animal studies were conducted to evaluate the efficiency and biological toxicity of this approach. Overall, this bioinspired approach could provide a new avenue for biocompatible and effective nanomaterial-based hair dyes for at-home use.

Face and Neck Pigmentary Alterations in Hair Dye Users: A Cross-sectional Study from South India

Background:

Hair dyes are commonly used for the concealment of grey hair in India. The pigmentary alterations produced by hair dyes on the face and neck have not received sufficient attention.

Aims:

To study the pigmentary alterations on the face and neck in hair dye users, and identify possible risk factors associated with the face and neck hyperpigmentation.

Methods:

A hospital-based descriptive cross-sectional study was done on consecutive hair dye users. A detailed history was taken, and a clinical examination was done to record the pigmentary alterations. The patterns, areas affected, the intensity of hyperpigmentation, percentage of the area involved and risk factors were noted.

Results:

One hundred and twenty patients were included in the study. Around 118 (98.3%) patients had hyperpigmentation over face and/or neck: 16 (13.3%) barely perceivable, 40 (33.3%) mild, 44 (36.7%) moderate, and 18 (15%) severe pigmentation. The lateral forehead (106, 88.3%), the helix of the ear (106, 88.3%), central forehead (97, 80.8%), and zygomatic area (92, 76.7%) were the most frequently affected areas in our study. Fourteen patients (11.7%) had depigmented macules on the scalp and/or lips.

Conclusion:

Pigmentary alterations, particularly hyperpigmentation over the upper face and ears are common with the use of hair dyes. The skin type may play a role in the intensity of hyperpigmentation.

Dendritic Epidermal T Cells in Allergic Contact Dermatitis

Allergic contact dermatitis (ACD) is a common inflammatory skin disease with a prevalence of approximately 20% in the European population. ACD is caused by contact allergens that are reactive chemicals able to modify non-immunogenic self-proteins to become immunogenic proteins. The most frequent contact allergens are metals, fragrances, and preservatives. ACD clinically manifests as pruritic eczematous lesions, erythema, local papules, and oedema. ACD is a T cell-mediated disease, involving both CD4⁺ and CD8⁺ T cells. In addition, γδ T cells appear to play an important role in the immune response to contact allergens. However, it is debated whether γδ T cells act in a pro- or anti-inflammatory manner. A special subset of γδ T cells, named dendritic epidermal T cells (DETC), is found in the epidermis of mice and it plays an important role in immunosurveillance of the skin. DETC are essential in sensing the contact allergen-induced stressed environment. Thus, allergen-induced activation of DETC is partly mediated by numerous allergen-induced stress proteins expressed on the keratinocytes (KC). Several stress proteins, like mouse UL-16-binding protein-like transcript 1 (Mult-1), histocompatibility 60 (H60) and retinoic acid early inducible-1 (Rae-1) α-ε family in mice and major histocompatibility complex (MHC) class I-chain-related A (MICA) in humans, are upregulated on allergen-exposed KC. Allergen-induced stress proteins expressed on the KC are consequently recognized by NKG2D receptor on DETC. This review focuses on the role of γδ T cells in ACD, with DETC in the spotlight, and on the role of stress proteins in contact allergen-induced activation of DETC.