A systematic review of association between use of hair products and benign and malignant gynecological conditions.

Hair products often contain chemicals like para-phenylenediamine (PPD) and endocrine-disrupting chemicals (EDCs); giving rise to concerns about the possible adverse effects such as hormonal disturbances and carcinogenicity. The objective of this systematic review was to evaluate the association between the use of different hair products and benign and malignant gynecological conditions. Studies were identified from three databases including PubMed, Embase, and Scopus, and evaluated in accordance with PRISMA guidelines. The risk of bias was assessed using the Newcastle-Ottawa Scale. A total of 17 English-language studies met the inclusion criteria. Associations of hair relaxer or hair dye use with breast and ovarian cancer were observed in at least one well-designed study, but these findings were not consistent across studies. Further sub-analysis showed 1.08 times (95 % CI: 1.01-1.15) increased risk of breast cancer in females with permanent hair dye use. Chang et al. reported strong association between uterine cancer risk and hair relaxer use (HR 1.8, 95 % CI: 1.12-2.88), with no observed association with hair dye use. Studies conducted by Wise et al. and James-Todd et al. for benign gynecological conditions; including uterine leiomyoma (IRR 1.17, 95 % CI: 1.06-1.30), early onset of menarche (RR 1.4, 95 % CI: 1.1-1.9), and decreased fecundability (FR 0.89, 95 % CI: 0.81-0.98) revealed positive associations with hair relaxer use, but these findings were based on small sample sizes. In summary, the available evidence regarding personal use of hair products and gynecological conditions is insufficient to determine whether a positive association exists.

Regulation of immune response genes in the skin of allergic and clinically tolerant individuals exposed to p-phenylenediamine.

BACKGROUND: p-Phenylenediamine (PPD) is a potent contact allergen found in many hair colour products. However, not all individuals develop allergic contact dermatitis (ACD) although they are regularly exposed to PPD. It is unclear whether these asymptomatic individuals are true non-responders to PPD or whether they mount a response to PPD without showing any symptoms. METHODS: Skin biopsies were collected from 11 asymptomatic hairdressers regularly exposed to PPD and from 10 individuals with known ACD on day 4 after patch testing with 1% PPD in petrolatum and petrolatum exclusively as control. RNA sequencing and confocal microscopy were performed. RESULTS: T cell activation, inflammation and apoptosis pathways were up-regulated by PPD in both asymptomatic and allergic individuals. Compared to asymptomatic individuals with a negative patch test, individuals with a strong reaction to PPD strongly up-regulated both pro- and anti-inflammatory cytokines genes. Interestingly, PPD treatment induced significant up-regulation of several genes for chemokines, classical type 2 dendritic cell markers and regulatory T cell markers in both asymptomatic and allergic individuals. In addition, apoptosis signalling pathway was activated in both non-responders and allergic individuals. CONCLUSION: This study demonstrates that there are no true non-responders to PPD but that the immune response elicited by PPD differs between individuals and can lead to either tolerance, subclinical inflammation or allergy.

Early presentation of allergic contact dermatitis due to paraphenylenediamine.

Allergic contact dermatitis (ACD) is a more frequent pathology in adults than in children, because, in most cases, allergic sensitization requires a prolonged exposure time to the allergen, mostly months or years. In fact, the actual incidence and prevalence of ACD in children and adolescents is unknown. However, there is a hypothesis that ACD is increasing in the pediatric population. Among the allergens involved in ACD, the frequency of paraphenylenediamine (PPDA) is increasing. PPDA is one of the five most common contact allergens in the general population and one of the 10 most common contact allergens in children. The most relevant sources today are henna tattoos and hair dyes. Currently, European Union legislation limits the use of PPDA in hair dyes and prohibits its use in henna tattoos. Despite this legislation, the use of henna tattoos with PPDA is becoming more frequent in younger ages. We report an early presentation of ACD by PPDA, with a permanent hypopigmented skin area as an aftermath, in a 7-year-old male child. We believe that health authorities should advise against making these tattoos in children.

Hair Dyes Sensitization and Cross-Reactions: Challenges and Solutions: A Systematic Review of Hair Dye Allergens' Prevalence.

Widespread use of oxidative hair dyes during the past decades has raised questions on the potential allergy reactions and their management, as well as prevention measures for both professionals and consumers. Allergic contact dermatitis can be elicited by various hair dye-related allergens, though the main problem remains with p-phenylenediamine and related aromatic amines. If allergy is suspected, patch testing identifies the responsible hapten. Individuals sensitized to specific permanent hair dyes substances should avoid the exposure to these chemicals, but also be aware of possible cross-sensitization to other similar compounds. Cross-reactions detected in patch-tested populations indicate that one cannot safely use alternatives, although cross-reactivity is not always clinically relevant. An open application hair dye allergy self-test is recommended by manufacturers for early detection of allergy predisposition in consumers, although the lack of standardized conditions makes the efficacy of this process doubtful. Appropriate use of hand gloves, especially nitrile, is the most efficient prevention measure for professional hand eczema. In this systematic review, we focus on cross-reactions among hair dye-related allergens and make an attempt to answer some, frequently encountered by physicians, questions, while presenting the prevalence of the hair dye-related allergens.

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.

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.

Contact allergy to ingredients of hair cosmetics in female hairdressers and female consumers-An update based on IVDK data 2013-2020.

BACKGROUND: Hair cosmetic products contain several, partly potent contact allergens, including excipients like preservatives. Hand dermatitis in hairdressers is common, scalp and face dermatitis in clients or self-users (summarised here as 'consumers') may be severe. OBJECTIVE: To compare frequencies of sensitization to hair cosmetic ingredients and other selected allergens between female patch tested patients working as hairdressers and consumers without professional background, respectively, who were tested for suspected allergic contact dermatitis to such products. METHODS: Patch test and clinical data collected by the IVDK (https://www.ivdk.org) between 01/2013 and 12/2020 were descriptively analysed, focusing on age-adjusted sensitization prevalences in the two subgroups. RESULTS: Amongst the 920 hairdressers (median age: 28 years, 84% hand dermatitis) and 2321 consumers (median age: 49 years, 71.8% head/face dermatitis), sensitization to p-phenylenediamine (age-standardised prevalence: 19.7% and 31.6%, respectively) and toluene-2,5-diamine (20 and 30.8%) were most common. Contact allergy to other oxidative hair dye ingredients was also more commonly diagnosed in consumers, whereas ammonium persulphate (14.4% vs. 2.3%) and glyceryl thioglycolate (3.9 vs. 1.2%) as well as most notably methylisothiazolinone (10.5% vs. 3.1%) were more frequent allergens in hairdressers. CONCLUSIONS: Hair dyes were the most frequent sensitizers both in hairdressers and in consumers; however, as indication for patch testing may differ, prevalences cannot directly be compared. The importance of hair dye allergy is evident, often with marked coupled reactivity. Workplace and product safety need to be further improved.

Contact sensitizers in commercial hair dye products in the Indian market: A consumer exposure study.

BACKGROUND: Hair dye is a concoction of various ingredients that can result in allergic contact dermatitis (ACD) which is a common problem encountered by dermatologists. OBJECTIVES: To find out the presence of potent contact sensitizers in commercially available hair dyes in Puducherry, a union territory in South India, and to compare the findings with similar studies conducted in different countries. METHODS: Ingredients labels of 159 hair dye products from 30 brands that were manufactured and marketed in India screened for the presence of contact sensitizers. RESULTS: A total of 25 potent contact sensitizers were found in 159 hair dye products. p-Phenylenediamine and resorcinol were the most frequent contact sensitizer found in the study. The mean contact sensitizer concentration in a single hair dye product is 3.72 ± 1.81. The number of potent contact sensitizers in individual hair dye products ranged from 1 to 10. CONCLUSION: We observed that most of the consumer-available hair dyes contain multiple contact sensitizers. Also, an inadequacy in mentioning the p-Phenylenediamine content, and appropriate warning contents regarding hair dye use were not mentioned in the cartons.

Diagnostics and Prevention of Occupational Allergy in Hairdressers.

PURPOSE OF REVIEW: This study aims to provide an overview on current knowledge on occupational allergic diseases in hairdressers and up-to-date perspectives of prevention. RECENT FINDINGS: Hand eczema (dermatitis) is common in hairdressers, often caused by contact allergy to one or multiple small molecules (haptens) used, e.g., for dyeing, bleaching, and waving/relaxing or by ancillary substances such as preservatives. Hairdressers, compared to other patch-tested patients, have an up to fivefold increased risk to be found sensitized, e.g., against p-phenylenediamine, ammonium persulfate, and glyceryl thioglycolate. Some of these small molecules may induce respiratory sensitization causing allergic rhinitis and/or asthma, notably persulfate salts. Occupational hazards in hairdressing are well described. This knowledge needs to be put into use for risk reduction, mainly by substitution of allergenic ingredients by less allergenic ones, education, and use of ventilation and suitable single-use gloves.

Association of p-phenylenediamine exposure with alterations of pulmonary function, pruritus and health-related quality of life in hair dye factory workers: a cross-sectional study.

P-Phenylenediamine (PPD) is a common component of hair dye, which can cause skin contact allergy and asthma with impaired pulmonary function. However, the adverse effects of occupational exposure to different dose PPD was rarely mentioned. We recruited 124 workers from a hair dye factory to explore the association of occupational PPD exposure on pulmonary function, pruritus and health related quality of life (HRQL). We categorized exposure to PPD into 3 levels: lower exposure group (< 0.00001 mg/m3); middle exposure group (0.00001-0.00033 mg/m3); higher exposure group (0.00033-0.047 mg/m3). The HRQL and subjective pruritus of the workers were assessed by the short form 36 health survey (SF-36) and Visual analogue scale (VAS) of pruritus, respectively. In the high PPD-exposed group, the percentage of FEV1 (FEV1%) was lower in higher exposure group compared with lower exposure group. The FEV1/FVC was also lower in comparison to the higher exposure and middle exposure groups (p < 0.05). PPD levels were negatively correlated with vitality and mental health (p < 0.01). The structural equation model showed the positive effects of PPD on VAS level (ß = 0.213, p < 0.001), and indicated partly negtive effects of PPD on total score of SF-36 (ß = - 0.465, p = 0.002), respectively. Our results indicate that occupational exposure to PPD might be associated with pulmonary function impairment, poor HRQL, and subjective pruritus of the workers.

Systematic review on skin adverse effects of important hazardous hair cosmetic ingredients with a focus on hairdressers.

BACKGROUND: The burden of occupational hand eczema in hairdressers is high, and (partly strong) allergens abound in the hair cosmetic products they use. OBJECTIVES: To systematically review published evidence concerning contact allergy to an indicative list of active ingredients of hair cosmetics, namely, p-phenylenediamine (PPD), toluene-2,5-diamine (PTD), persulfates, mostly ammonium persulfate (APS), glyceryl thioglycolate (GMTG), and ammonium thioglycolate (ATG), concerning the prevalence of sensitization, particularly in terms of a comparison (relative risk; RR) between hairdressers and non-hairdressers. METHODS: Following a PROSPERO-registered and published protocol, eligible literature published from 2000 to February 2021 was identified, yielding 322 publications, and extracted in standardized publication record forms, also considering risk of bias. RESULTS: Based on 141 publications, the contact allergy prevalence to PPD was 4.3% (95% CI: 3.8-4.9%) in consecutively patch tested patients. Other ingredients were mostly tested in an aimed fashion, yielding variable, and partly high contact allergy prevalences. Where possible, the RR was calculated, yielding an average increased sensitization risk in hairdressers of between 5.4 (PPD) and 3.4 (ATG). Additional evidence related to immediate-type hypersensitivity, experimental results, exposures, and information from case reports was qualitatively synthesized. CONCLUSIONS: An excess risk of contact allergy is clearly evident from the pooled published evidence from the last 20 years. This should prompt an improvement in working conditions and product safety.

Association between hair dye use and cancer in women: a systematic review and meta-analysis of case-control studies.

Background: The use of hair dye for cosmetic purposes appears to be increasing worldwide. As 50-80% of women use hair dye throughout their lifetimes, the possible association between hair dye use and cancer is a public health concern. Method: This systematic review was performed by retrieving studies from PubMed, Scopus, WOS, and ProQuest databases. The inclusion criteria were case-control studies evaluating the association between hair dye use and cancer in women. Women with cancer who have used any hair dye were the focus of our study. Results: The present study combined 28 studies, to assess the association between hair dye use and cancer. The pooled odds ratio (OR) of hematopoietic system cancers among those who have generally ever used any type of hair dyes was 1.10 (95% CI:1.01-1.20) in 17 studies. In 11 studies investigating hair dye made before and after 1980 as a risk factor for cancer, the pooled OR for cancer was 1.31(95% CI:1.08-1.59). Likewise, in the 13 studies that evaluated the association of light and dark hair dye with cancer, the risk among those using dark hair dye increased by 9%, compared to non-users (OR=1.09; 95% CI:0.95-1.25). Conclusion: The present study suggests that, although the use of hair dye may increase the risk of cancer among users, a more detailed evaluation is required to assess the type of hair dye use in terms of guidelines and metrics.

A clinical evaluation of a permanent hair dye designed to reduce allergic contact dermatitis and hair damage.

BACKGROUND: Permanent hair dye is the most commonly used anti-aging procedure used by both men and women. However, permanent hair dye can cause irritant contact dermatitis due to ammonia and allergic contact dermatitis due to paraphylenediamine (PPD). METHODS: This research examined an ammonia-free and PPD-free permanent hair dye in 50 ethnically diverse females 21-91 years of age who were current users of permanent hair dyes. Subjects were patch tested prior to dyeing. Two dye sessions were undertaken at baseline and 2-6 weeks post-baseline depending on the dyeing habits of the subject. RESULTS: 50/50 subjects successfully completed the study with no incidence of allergic or irritant contact dermatitis. After 2 dyeing procedures, the dermatologists rated an 87% improvement in hair shine, 90% improvement in hair color, 88% improvement in hair moisturization, 87% improvement in hair porosity, and 88% improvement in hair combability. CONCLUSIONS: A MEA-based ammonia-free cream hair color without PPD or resorcinol was safe for use on the hair and scalp of females with diverse hair types and textures.

The 2-Methoxymethyl Modification of p -Phenylenediamine Reduces the Sensitization Risk for Hairdressers to Hair Dyes-An Occupational Hand Exposure-Based Risk Assessment.

BACKGROUND: Allergic contact dermatitis involving the hands is a common occupational skin disease for hairdressers and the potent sensitizers p -phenylenediamine (PPD) and toluene-2,5-diamine (PTD) are associated with the development of occupational allergic contact dermatitis. OBJECTIVE: The aim of the study was to analyze whether the use of the moderate sensitizer 2-methoxymethyl-PPD (ME-PPD) in professional hair dyes is a suitable tool to reduce the occupational contact allergy risk for hairdressers. METHODS: Hand exposure of hairdressers (N = 11) to ME-PPD was analyzed under routine hair coloring conditions in commercial salons. By accounting for wet work and uneven hand exposure, the daily hand exposure was derived and compared with the occupational acceptable exposure level (AEL), that is, the sensitization induction threshold of ME-PPD adjusted for interindividual variability among workers. RESULTS: The daily hand exposure to ME-PPD was 1.6 µg/cm 2 , and the occupational AEL was 215 µg/cm 2 . The ratio of hand exposure to AEL was calculated as the margin of safety (MOS) against occupational sensitization. For ME-PPD, the MOS of 134 indicates a low likelihood of sensitization versus PPD and PTD with MOS values of 2.7 and 5.9, respectively. CONCLUSIONS: Our data predict that the use of ME-PPD in professional hair color products improves the protection of hairdressers against hair dye-related contact allergy versus the use of PPD and PTD.

Haemophilus Influenzae-Induced Corneal Ulcer and Endophthalmitis Triggered by Hair Dye.

ABSTRACT: The present report describes a 79-year-old woman developed eye pain in her right eye after accidental exposure to the hair dye when she dyed her hair. Her visual acuity was no light perception and intraocular ocular pressure was 10 mmHg in her right eye. Slit-lamp biomicroscopy revealed a huge corneal ulcer with the central cornea almost perforated and severe hypopyon in anterior chamber and moderate opacity in vitreous. Time-of-flight mass-spectrum of cornea scraping confirmed that the pathogen was haemophilus influenzae. Right-eye enucleation was performed. Topical chloramphenicol eye drops (0.25%) and ciprofloxacin (0.3%) and the ceftezole intravenous infusion were applied. The infection was controlled and the patient recovered well on 1 month follow-up. Doctors should be aware of the diagnosis and treatment of this complication associated with the application of hair dye as the popularity of this procedure increases.

Occupational hand eczema reduces career length in hairdressers: a prospective cohort study of Danish hairdressers graduating from 1985 to 2007.

BACKGROUND: Occupational hand eczema (OHE) is common in hairdressers, and many leave the trade because of the disease. However, the exact impact of OHE on career length is unknown. OBJECTIVE: To assess the effect of OHE on career length and risk factors associated with leaving the trade because of OHE in hairdressers followed-up for up to 35 years. METHODS: A prospective cohort study of Danish hairdressers graduating between 1985 and 2007 (n=5219) was performed. A questionnaire was sent in 2009 and 2020. The Danish Labor Marked Supplementary Pension Scheme provided information on affiliation to the hairdressing profession. Career length was assessed by Kaplan-Meier analyses. RESULTS: The median survival time was 12.0 (95% CI 11.0 to 13.0) years in graduates with OHE and 14.0 (95% CI 12.6 to 15.4) years in graduates without OHE (p<0.001). Graduates with a frequency of hand eczema (HE) of 'once', 'several times' and 'almost all the time' had a median survival time of 20.0 (95% CI 14.6 to 25.4), 12.0 (95% CI 10.7 to 13.3) and 7.0 (95% CI 5.6 to 8.4) years, respectively. Graduates with OHE that left the trade (partly) because of HE constituted 11.7% of the study population. Factors associated with leaving the trade because of HE included a history of atopic dermatitis (adjusted OR (aOR) 2.2 (95% CI 1.2 to 4.0), a history of a positive patch test (aOR 5.1 (95% CI 2.3 to 11.0) and allergy to hair dyes (aOR 9.4 (95% CI 3.4 to 25.6). CONCLUSION: Career length is reduced in hairdressers with OHE, especially if frequently relapsing or caused by contact allergy, for example, to hair dyes.