A case of hair dye-induced contact anaphylaxis

Anaphylaxis is a sudden-onset life-threatening systemic hypersensitivity reaction. Allergens, such as foods, stinging insect venoms, and drugs, are the globally important causative factors for anaphylaxis. Para-phenylenediamine (PPD), an aromatic amine, is a well-known hair dye component that can act as a skin irritant and/or a skin sensitizer. As an allergen, PPD can induce various reactions; the most common being contact dermatitis, a delayed-type hypersensitivity reaction. Anaphylaxis or other immediate hypersensitivity reactions by hair dye contact is extremely rare, with only a few cases reported worldwide. Here, we report a case of a 63-year-old female who presented to the Emergency Department with dyspnea, rash, vomiting, and diarrhea within minutes after using a hair dye product containing PPD. Her past medical history includes urticaria of unknown cause. Her total IgE antibody level was increased to 630 kU/L. Skin prick and patch tests with the hair dye she applied at the time of anaphylaxis demonstrated an immediate reaction. An additional patch test with 25 common contact allergens showed positive reaction to PPD. This is the first case report of hair dye-induced contact anaphylaxis presenting sensitization to PPD in Korea.

Patch tests with commercial hair dye products in patients with allergic contact dermatitis to para‑phenylenediamine.

Background: Hair dye is one of the most common causes of allergic contact dermatitis. The main allergen has been identified as para‑phenylenediamine. To prevent the recurrence of contact dermatitis to para‑phenylenediamine, patients should discontinue the use of para‑phenylenediamine‑containing hair dye products. However, many patients are unable to discontinue their use for cosmetic or social reasons. Sometimes, they continue to have symptoms even after switching to so‑called “less allergenic” hair dyes. Objectives: To evaluate the safety of 15 commercially available hair dye products in patients with allergic contact dermatitis due to para‑phenylenediamine. Methods: We performed patch tests using 15 hair dyes that were advertised as “hypoallergenic,” “no para‑phenylenediamine” and “non‑allergenic” products in the market. Results: Twenty three patients completed the study and 20 (87.0%) patients had a positive patch test reaction to at least one product. While four (26.7%) hair dye products contained para‑phenylenediamine, 10 (66.7%) out of 15 contained m‑aminophenol and 7 (46.7%) contained toluene‑2,5‑diamine sulfate. Only one product did not elicit a positive reaction in any patient. Limitations: Small sample size and possibility of false‑positive reactions. Conclusions: Dermatologists should educate patients with allergic contact dermatitis to para‑phenylenediamine about the importance of performing sensitivity testing prior to the actual use of any hair dye product, irrespective of how it is advertised or labelled.

Contact dermatitis to hair dye: An update.

Exposure to hair dyes has long been known as a significant risk factor for development of allergic contact dermatitis among the exposed population as these lead to severe eczema of face and upper trunk in the consumer and hand eczema in hair-dressers. Currently, para-phenylenediamine (PPD) is the main ingredient used in permanent hair color products in the market and is the most important allergen. Prevalence of PPD sensitization is high in patients with contact dermatitis across all continents, with hair dye use being the commonest cause. In order to decrease the burden of disease, use of alternative natural dyeing agents among consumers and use of barrier neoprene gloves among hairdressers should be encouraged apart from stringent legislation to reduce the amount of PPD reaching the consumer.

Contact Vitiligo Associated with Allergic Contact Dermatitis to Para-phenylenediamine / 대한피부과학회지

Contact vitiligo with allergic contact dermatitis is a rare condition. Early diagnosis of contact vitiligo is imperative, as it could halt the progression of depigmentation, unlike idiopathic vitiligo. We herein report a case of contact vitiligo with allergic contact dermatitis due to para-phenylenediamine.

Suicide by para-phenylenediamine poisoning.

Twenty three cases of acute para-phenylenediamine poisoning were examined clinically at emergency ward of Rama Medical College Hospital, Kanpur (Uttar Pradesh) irrespective of age, sex and socio-economic strata along with route and manner of administration of the poison. Albuminuria, anaemia, hypocalcemia, leucocytosis, thrombocytopenia, increased serum bilirubin, prolonged bleeding and clotting time alongwith increased levels of liver enzymes and serum creatinine were observed as significant bio-chemical parameters; on investigation in respect to complete haemogram, liver function test, renal function test, serum electrolytes, serum CPK levels and arterial blood gas analysis. The para-phenylenediamine is the ingredient of a traditional cosmetic hair dye available with the trade name Godrej expert powder hair dye, which is orally administered mainly with an intention to commit suicide, sometimes accidentally and very rarely as homicidal poison by hair dye users. The suicidal poisoning is more common in females as compared to males. The systemic toxicity of PPD has serious consequences which may eventually lead to death. The cases are reported with the advice “public education and strict control over the sale and distribution of para-phenylenediamine should be done to reduce poisoning by this agent”.

Severe inflammatory and keloidal, allergic reaction due to para-phenylenediamine in temporary tattoos.

Hair coloring with henna has been popular in Turkey for years. In recent years since the tattoos are applied by the street vendors in most of the beach places in Turkey, skin coloring with henna has also increased. Henna can be used alone or in combination with other coloring agents. Henna alone can be safe but due to additives such as para-phenylenediamine (PPD), p-toluenediamine and various essential oils, allergic contact reactions may occur. We report a 22-year-old man who developed severe inflammatory and keloidal, moderately bullous allergic reaction after henna paint-on tattoo. We did a patch test separately with these painting products (henna powder, PPD) and with the European standard series. PPD was strongly positive (+++) on day 2 and remained positive for following days. After treating with topical clobetasol-17 butyrate, resolution was obtained in two weeks. But some keloidal reaction remained.

Contact dermatitis with henna tattoo.

Allergic and irritant reactions to henna are rare. Para-phenylenediamine, which is sometimes added to obtain a dark, blackish henna, causes the majority of contact dermatitis reported related with tattoos. Allergic contact dermatitis due to temporary paint-on tattoo with black henna is described in two adolescents.

A Case of Allergic Contact Dermatitis due to Henna Tattooing / 대한피부과학회지

Tattooing and other forms of body art have recently become popular fashion accessories worldwide. Temporary henna tattooing has also become increasingly popular and is readily available. Henna, which is called Mehndi in Indian, is a plant that is commonly used as a temporary dyeing agent. Para-phenylenediamine (PPD) is added to the Henna tattooing process in most cases to hasten the drying process and enhance darkness. Since PPD is widely recognized as a sensitizer, the risk of allergic contact dermatitis from henna tattoo mixtures is increasing. We report a case of contact dermatitis from a henna tattoo mixture, which developed 2 weeks after henna tattooing.