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Severe Hair Loss of the Scalp due to a Hair Dye Containing Para phenylenediamine

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Waka Ishida
Waka Ishida
Waka Ishida
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Teruhiko Makino at University of Toyama
Teruhiko Makino
Tadamichi Shimizu at University of Toyama
Tadamichi Shimizu
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We report the case of a 41-year-old female showing severe hair loss approximately 90% after the use of a hair dye. These symptoms developed six days after the use of a hair dye containing PPD. A patch test showed a (++) reaction at 48 h to 1% PPD in petrolatum, whereas all metals and white petrolatum were negative. She was therefore diagnosed with contact dermatitis due to PPD, resulting in hair loss. The skin lesions gradually improved after starting treatment with the systemic corticosteroids. The possibility that allergic contact dermatitis from hair dyes may be responsible for telogen effluvium should always be considered in a patient with increased hair loss.
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International Scholarly Research Network
ISRN Dermatology
Volume 2011, Article ID 947284, 2pages
doi:10.5402/2011/947284
Case Report
Severe Hair Loss of the Scalp due to a Hair Dye Containing
Para phenylenediamine
Waka Ishida,1Teruhi k o Makino,2and Tadamichi Shimizu2
1Department of Dermatology, Niigata Central Hospital, Jyoetsu, Niigata 943-0192, Japan
2Department of Dermatology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama,
Sugitani, Toyama 930-0194, Japan
Correspondence should be addressed to Tadamichi Shimizu, shimizut@med.u-toyama.ac.jp
Received 23 February 2011; Accepted 11 April 2011
Academic Editor: C. K. Janniger
Copyright © 2011 Waka Ishida et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
We report the case of a 41-year-old female showingsevere hair loss approximately 90% after the use of a hair dye. These symptoms
developed six days after the use of a hair dye containing PPD. A patch test showed a (++) reaction at 48 h to 1% PPD in petrolatum,
whereas all metals and white petrolatum were negative. She was therefore diagnosed with contact dermatitis due to PPD, resulting
in hair loss. The skin lesions gradually improved after starting treatment with the systemic corticosteroids. The possibility that
allergic contact dermatitis from hair dyes may be responsible for telogen effluvium should always be considered in a patient with
increased hair loss.
1. Case Report
A 41-year-old female was referred because of edema on the
face and hair loss with severe itching of the scalp. The itching
of the scalp started 1 day after the use of a hair dye containing
PPD, and hair loss symptoms developed 6 days after the
use of the hair dye (Figure 1(a)). Hair loss had spread to
approximately 90% of the scalp 4 months later (Figure 1(b)).
Detailed anamneses revealed that the patient had started
to use hair dye 5 years prior to the current presentation
and had developed sprier itching of the scalp 1 to 2 days
after her hair was dyed at a hair dresser’s several months
ago . All parameters examined during a blood test were
within the normal limits. There was no history of associated
dermatitis. A patch test showed a (++) reaction at 48 h and
72 h to 1% PPD in petrolatum. She was therefore diagnosed
with contact dermatitis due to PPD, resulting in hair loss.
The skin lesions gradually improved after starting treatment
with the systemic corticosteroids. The patient has not had a
recurrence for 18 months since she stopped using the hair
dye in question.
2. Discussion
Several cases of severe facial and scalp dermatitis have been
reported following the use of permanent hair dyes, and
these dyes often contain paraphenylendiamine (PPD). PPD is
known to be the most frequent contact allergen found in hair
dyes [1]. The possibility that allergic contact dermatitis from
hair dyes may be responsible for telogen effluvium should
always be considered in a patient with increased hair loss [2].
This report presents the case of a patient who experienced
severe hair loss after the use of a hair dye containing PPD.
We concluded that the explanation for the severe hair loss in
our case was a concurrent sensitization and allergic reaction
to PPD, as the product had been applied repeatedly over a
long period of time.
Hair dye reactions are usually diagnosed by the patients
themselves, and epidermological studies found a range
between 0.1% and 1% of the patients sensitized to PPD [3,4].
The most frequent symptoms tend to be erythema of the
face, scalp, and ears following the use of permanent hair dyes
containing PPD. Severe facial and scalp dermatitis with PPD
has been reported in several cases, with symptoms of edema,
suppuration, and ulceration of the face, scalp and eyelids
[5]. The reports of hair loss in the scalp due to hair dyes
containing PPD is rare, and there have been only 2 reported
cases of hair loss in the scalp due to a PPD allergy associated
with dermatitis in a consumer-based study [5]. Wachsmuth
and Wilkison reported a case of eyelash loss due to an allergic
reaction to PPD in mascara [6].
International Scholarly Research Network
ISRN Dermatology
Volume 2011, Article ID 947284, 2 pages
http://dx.doi.org/10.5402/2011/947284
2ISRN Dermatology
(a) (b)
Figure 1: (a) A female with an allergic reaction to hair dye with severe hair loss on the scalp. This picture was taken 6 days after she had
colored her hair. (b) The hair loss spread to approximately 90% of the scalp 2 months later. Partial white hair regrowth was also observed.
Sosted et al. reported that many cases of PPD allergy go
unreported, probably because the patient is able to make
the connection between the reaction and the hair dye and
therefore does not seek medical advice. Our case had a severe
face edematous reaction, with approximately 90% hair loss
that required treatment with systemic corticosteroids.
3. Conclusions
Many cases of dermatitis due to hair dye may be overlooked,
but severe dermatitis may sometimes last for more than
3 weeks [5]. Therefore, dermatologists need to pay more
attention to hair dye allergies.
Conflict of Interests
The authors state no conflict of interests.
References
[1]C.Benezra,C.C.Sigman,D.Bagheri,C.T.Helmes,and
H. I. Maibach, “A systematic search for structure-activity
relationships of skin sensitizers. II. Para-phenylenediamines,”
Seminars in Dermatology, vol. 8, no. 2, pp. 88–93, 1989.
[2]A.Tosti,B.M.Piraccini,andD.J.vanNeste,“Telogen
effluvium after allergic contact dermatitis of the scalp,” Archives
of Dermatology, vol. 137, no. 2, pp. 187–190, 2001.
[3] N.H.Nielsen,A.Linneberg,T.Menn
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[4] T. Sch¨
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[5] H. Sosted, T. Agner, K. E. Andersen, and T. Menne, “55
cases of allergic reactions to hair dye: a descriptive, consumer
complaint-based study,” Contact Dermatitis,vol.47,no.5,pp.
299–303, 2002.
[6] R. Wachsmuth and M. Wilkinson, “Loss of eyelashes after use
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54, no. 3, pp. 169–170, 2006.
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55 Cases of allergic reactions to hair dye: A descriptive, consumer complaint-based study
Article
  • Dec 2002
Severe facial and scalp dermatitis following the use of permanent hair dyes has been reported in several cases. Para-phenylenediamine (PPD) is known as a potent contact allergen, and PPD is allowed in hair dye at a concentration of 6%. Hair dye reactions are usually diagnosed by the patients themselves, and adverse reactions to hair dye may not necessarily be recorded by the health care system, unless the reactions are especially severe. Based on this assumption, we suspected that hair dye dermatitis was occurring more frequently than reported in the literature. Consumer complaint-based data were obtained by advertising for persons with adverse reactions to hair dye. Among those responding to the advertisement, 55 cases of severe, acute allergic contact dermatitis were identified. The main symptoms were severe oedema of the face, scalp and ears, and clinically this was often mistaken for angio-oedema. The 55 cases comprised a total of 75 visits to the health service and 5 admissions to hospital. 18 persons had sick leave, which supports the impression of very severe dermatitis reactions. 60% were treated with antihistamine, while 52% were treated with corticosteroids. 29% of the cases were patch tested and all were found positive to PPD. Our data presented here clearly show that PPD and its derivatives in hair dye at the present concentrations presents a significant health risk for the population. Furthermore, the severe acute allergic skin reactions are often misdiagnosed in the health care system. The frequency of allergic contact dermatitis resulting from hair dye is likely to be underestimated. New methods to survey the frequency of adverse reactions should be considered.
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