Allergic contact dermatitis to substitute hair dyes in a patient allergic to para-phenylenediamine: Pure henna, black tea and indigo powder.

We report a case of a 50-year-old lady with allergic contact dermatitis to para-phenylenediamine, who in her quest to find a substitute hair dye, subsequently reacted to a number of plant-based hair dyes, including pure henna, black tea and indigo powder respectively. While these substances all contain tannins, testing to possible constituents tannic acid and gallic acid was negative.

Combination treatment of low-fluence Q-switched Nd:YAG laser and oral tranexamic acid for post-inflammatory hyperpigmentation due to allergic contact dermatitis to henna hair dye.

A 64-year-old female presented with facial hyperpigmentation. She had dyed her hair monthly with pure henna powder for the past seven months. After patch tests, the patient was diagnosed as post-inflammatory hyperpigmentastion due to allergic contact dermatitis to pure henna that has rarely been reported. The patient underwent Q-switched Nd:YAG laser treatment and was treated with oral tranexamic acid for 10 weeks. The hyperpigmentation on her forehead demonstrated substantial improvement.

Lifestyle factors and risk of leukemia and non-Hodgkin's lymphoma: a case-control study.

PURPOSE: Risk factors for leukemia and lymphomas in adults are largely unknown. This study was aimed at evaluating the association between lifestyle factors and the risk of hematological malignancies in an adult population. METHODS: Data were drawn from a population-based case-control study carried out in Italy and included 294 cases (199 lymphoid and 95 myeloid) and 279 controls. Analyses were performed using standard multivariable logistic regression. RESULTS: Hair dye use for at least 15 years was associated with a higher risk of lymphoid malignancies among females (OR 2.3, 95 % CI 1.0-4.9, p = 0.036, test for trend). Furthermore, a protective effect of a moderate to heavy tea consumption on the risk of myeloid malignancies was observed (OR 0.4, 95 % CI 0.2-0.9, p = 0.017). No association was found for the use of alcoholic beverages and tobacco smoking. CONCLUSIONS: Our results confirm the potential carcinogenic effect of prolonged hair dye use observed in previous investigations. The excess risk could be explained by exposure to a higher concentration of toxic compounds in hair products used in the past. The protective effect of regular tea consumption observed in an area with a very high prevalence of black tea consumers deserves further investigation.

Low-pulse energy Q-switched Nd:YAG laser treatment for hair-dye-induced Riehl's melanosis.

Riehl's melanosis, a form of dermatitis characterized by reticulate pigmentation, typically presents as a gray-brown to black hyperpigmentation on the face and neck. Among the various etiologic factors suggested, photoallergic reaction and pigmented contact dermatitis resulting from exposure to drugs, coal tar dyes, optical whitener, or other ingredients found in cosmetics are believed to be the major contributing factors in this disease. The histopathological features of Riehl's melanosis mainly consist of pigmentary incontinence along with infiltration of numerous dermal melanophages and lymphohistiocytes.1,2 Additionally, notable clinical improvements in the treatment of this condition have been reported for intense pulsed light (IPL) therapy, in comparison to long-term topical application of bleaching agents.2 Here, we report the cases of two Asian patients treated with a low-pulse energy 1,064-nm Q-switched (QS) Nd:YAG laser for hair dye-induced Riehl's melanosis on the face and neck. In conclusion, we observed that Riehl's melanosis on the face and neck was effectively and safely treated with a low-pulse energy 1,064-nm QS Nd:YAG laser. We suggest that this method can be used in Asian patients with Riehl's melanosis at risk of postinflammatory hyperpigmentation from excessive light or laser energy delivery.

Permanent hair dye-incorporated hyaluronic acid nanoparticles.

We prepared p-phenylenediamine (PDA)-incorporated nanoparticles using hyaluronic acid (HA). PDA-incorporated HA nanoparticles have spherical shapes and sizes were less than 300 nm. The results of FT-IR spectra indicated that PDA-incorporated HA nanoparticles were formed by ion-complex formation between amine group of PDA and carboxyl group of HA. Furthermore, powder-X-ray diffractogram (XRD) measurement showed that intrinsic crystalline peak of PDA disappeared by formation of nanoparticle with HA at XRD measurement. These results indicated that PDA-incorporated HA nanoparticles were formed by ion-complex formation. At drug release study, the higher PDA contents induced faster release rate from nanoparticles. PDA-incorporated nanoparticles showed reduced intrinsic toxicity against HaCaT human keratinocyte cells at MTT assay and apoptosis assay. We suggest that PDA-incorporated HA nanoparticles are promising candidates for novel permanent hair dye.

Synthesis of observational studies should consider credibility ceilings.

OBJECTIVE: Meta-analyses of observational studies often get spuriously precise results. We aimed to factor this skepticism in meta-analysis calculations. STUDY DESIGN AND SETTING: We developed a simple sensitivity analysis starting from the assumption that any single observational study cannot give us more than a maximum certainty c% (called credibility ceiling) that an effect is in a particular direction and not in the other. Each study included in meta-analysis is adjusted for different credibility ceilings c and the consistency of the conclusion examined. We applied the method in three meta-analyses of observational studies with nominally statistically significant summary effects (mortality with teaching versus nonteaching health care; risk of non-Hodgkin's lymphoma with hair dyes; mortality with omega-3 fatty acids). RESULTS: Between-study heterogeneity I(2) estimates dropped from 36%-72% without a ceiling effect to 0% with ceilings of 9%, 4%, and 4% in the three meta-analyses, respectively. Nominal statistical significance was lost with ceilings of 10%, 8%, and 11%, respectively. The likelihood ratios suggested that even with minimal ceiling effects, there was no strong support for the credibility of each of these three associations. CONCLUSIONS: Consideration of credibility ceilings allows conservative interpretation of observational evidence and can be applied routinely to meta-analyses of observational studies.

A clinical and patch test study of adult widespread eczema.

The purpose of this study was to investigate the role of contact hypersensitivity (CHS) in adult widespread eczema (WE) and to analyse the aetiology of WE. 108 consecutive adult WE patients were patch tested. 352 patients with suspected localized allergic contact dermatitis (ACD) tested in the same period served as a control. The average age of the patients with WE was significantly greater than the control group (47.6 +/- 15.0 v 39.2 +/- 14.9, p < 0.01, Student's t-test). More male patients were found in the WE group (42.6% vs 25.0%, p < 0.01, chi2-test). 71 (65.7%) of the WE patients were patch test positive. ACD was diagnosed in 29 out of 108 (26.9% of the WE patients and 40.8% of the PT positive patients) WE patients. ACD was also suspected in another 42 patients (39.8%), who had at least 1 positive PT result but the relevance of PT was hard to determine. In the remaining 37 patch test negative patients, 2 cases of food allergy were diagnosed by clinical findings and open food challenge test. 1 case of atopic dermatitis was diagnosed. 34 patients (31.5%) were diagnosed as unclassified endogenous eczema. Most of the WE patients with ACD (15/29, 51.7%) were ACD from widespread contact with hair dye during bathing. Most of the WE patients with hair dye ACD were male (male : female = 2.75). The total positive rates of PT in the WE group were no different to the control (65.7% vs 61.5%, p > 0.05, chi2-test). No significant difference was found for the positive rates of common contact allergens. The rate of atopy was no different between the 2 groups either (6.5% v 5.1%, p > 0.01, chi2-test). These results indicated that contact sensitization was very common in adult WE. Neglected widespread contact with contact allergens, especially hair dye, plays a very important role in our adult WE. The roles of age and sex in WE need to be studied further.

Diagnostic approach and management of occupational asthma by persulfate salts in a hairdresser.

An 18-year-old female hairdresser, nonsmoker and nonatopic, developed rhinoconjunctivitis followed by asthma after working for 18 months. The methods that were necessary to obtain a definitive diagnosis of occupational asthma are explained, as well as the medical management performed to improve her asthma over the next 12 months. Tryptase and eosinophil cationic protein (ECP) were determined before and after specific bronchial challenge. The application of these parameters as complementary diagnostic methods in some cases of occupational asthma is described. Clinical and functional control performed some months later demonstrated an increase in nonspecific bronchial responsiveness after avoidance, likely related to an upper respiratory infection.

Facial contact dermatitis. Pathogenetic factors in China.

In 107 cases of facial contact dermatitis, routine Finn chamber epicutaneous tests with TROLAB European Standard Allergens (ESAs) were performed. Sixty-one (57%) had positive reaction. The most frequent contact allergens were paraphenylenediamine dihydrochloride (16%), followed by fragrance mix (15%), and nickel sulfate (13%). The major sensitized contactants were rims of spectacles, hair dyes, cosmetic creams, and topical medications. Among the cases caused by cosmetic cream, the positive allergens were fragrance mix, formaldehyde, wood alcohols, and balsam of Peru. In ten season-incidence cases in which ESAs and cosmetic cream epicutaneous tests were negative, the chamber and scratch-chamber tests were performed using five kinds of pollen. The results show that all chamber tests were negative, but two cases with scratch-chamber tests were positive.

Medical and drug risk factors associated with neuroblastoma: a case-control study.

A matched case-control study of prenatal risk factors for neuroblastoma was conducted, including 104 cases diagnosed over the period 1970-79 in the Greater Delaware Valley. Significantly elevated odds ratios (ORs) were associated with maternal use of a neurally active drug during pregnancy (OR = 2.83), sex hormone exposure 3 months prior to or during pregnancy (OR = 2.25), frequent alcohol consumption during pregnancy (OR = 9.0), and maternal use of diuretic drugs during pregnancy (OR = 5.75). Significantly more case mothers than control mothers reported use of hair coloring products during pregnancy (OR = 3.0). No association was found between cigarette smoking, coffee consumption, or medical irradiation and case-control status.

Advances in the etiology of urothelial cancer.

Cigarette smoking has been shown to be the most important known preventable cause of bladder cancer. Occupations have continued to come under suspicion, although many of the newer findings are tentative. Neither coffee drinking nor use of artificial sweeteners appears to have been responsible for much, if any, human bladder cancer.

Studies on mutagenic and carcinogenic N-substituted aryl compounds: cosmetics and drugs.

We aimed our studies toward gaining an understanding of some of the reactions and pathways involved in the metabolism and activation of the aromatic diamines used in hair dyes and of phenacetin used in analgesic mixtures. Comparison of the data obtained from human and animal tissues established that animal tissues can serve as suitable models for evaluation of the activity of these compounds in humans.

Tobacco use, occupation, coffee, various nutrients, and bladder cancer.

In a Canadian population-based case-control study of 480 males and 152 female case-control pairs, the relative risk for development of bladder cancer for ever used versus never used cigarettes was 3.9 for males and 2.4 for females, with a dose-response relationship in both sexes. A reduced risk was associated with the use of filter cigarettes compared to nonfilter cigarettes. After control for cigarette usage, a significant risk was noted for male pipe smokers. For male ex-smokers the risk after 15 years of no smoking was less than one-half that of current male smokers. Bladder cancer risk was found for workers in the chemical, rubber, photographic, petroleum, medical, and food processing industries among males and for workers occupationally exposed to dust or fumes among both sexes. Bladder cancer risk was elevated for males consuming all types of coffee, regular coffee, and instant coffee and for females consuming instant coffee, but no dose-response relationship was found. Risk was found for males consuming water from nonpublic supples but not for females. No risk was observed in males or females consuming nitrate-containing foods, beverages other than coffee, or fiddlehead greens. Hair dye usage in females and phenacetin usage in males and females carried no risk. Divergent findings by area for aspirin suggested that an overall association was not causal. Reevaluation of the data on artificial sweeteners confirmed a significant bladder cancer risk in males and a dose-response relationship. The cumulated population attributable risk for bladder cancer was 90% for males from cigarette smoking, industrial exposure, and exposure to nonpublic water supplies and 29% for females from cigarette smoking, industrial exposure, and instant coffee consumption.

Mutagenicity of a new hair dye ingredient: 4-ethoxy-m-phenylenediamine.

An ingredient recently introduced in hair dyes, 4-ethoxy-m-phenylenediamine, is mutagenic in histidine-requiring strains of Salmonella typhimurium. Its mutagenic activity is similar to that of the hair dye ingredient is apparently replaced, 4-methoxy-m-phenylenediamine.