Brote de dermatofitosis en región de cabeza y cuello asociadas al rasurado en peluquerías: estudio descriptivo multicéntrico de una serie de casos / Outbreak of Dermatophyte Infections on the Head and Neck Related to Shave Haircuts: Description of a Multicenter Case Series

Introducción Desde 2021 se ha detectado un aumento de casos de tiñas del cuero cabelludo en adolescentes que se cortan el pelo mediante rasurado o degradado. Pacientes y métodos Estudio observacional retrospectivo multicéntrico de casos de dermatofitosis del polo cefálico con el antecedente de haber sido contraídas tras el rasurado frecuente en peluquería. Se realizó una llamada a dermatólogos de la Academia Española de Dermatología y Venereología (AEDV) para que aportaran casos observados entre enero de 2021 y diciembre de 2022. Se incluyeron pacientes con confirmación microbiológica mediante cultivo o examen directo con KOH. Resultados Se recogieron 107 casos, siendo 106 pacientes varones. Se observaron 78 formas no inflamatorias frente a 29 inflamatorias. El hongo aislado con mayor frecuencia fue Trichophyton tonsurans (75,7% de los casos). Las lesiones aparecieron predominantemente en la nuca y en el área temporal. Conclusiones La distribución por sexo, edad y localización lesional parece apuntar a que una nueva tendencia social, en la que adolescentes varones acuden asiduamente a peluquerías para el afeitado de las zonas occipital y temporal, sería la causante de esta agrupación de casos de tiña del cuero cabelludo. El microorganismo más frecuente en nuestro estudio (T.tonsurans) coincide con el más prevalente en nuestro medio. Con el presente estudio se evidencia un acúmulo de casos susceptible de ser tenido en cuenta por organismos competentes de salud pública, a los cuales corresponde velar por el cumplimiento de las normas de desinfección del material empleado para el rasurado (AU)

Introduction Since 2021, an increase in cases of tinea capitis has been detected in adolescents who shave their hair with fade haircut. Patients and methods Multicenter retrospective observational study of cases of cephalic pole dermatophytosis with a history of having been acquired after frequent shaving in hairdressing. A call was made to dermatologists from the Spanish Academy of Dermatology and Venereology (AEDV) to provide cases observed between January 2021 and December 2022. Patients with microbiological confirmation by culture or direct examination with KOH were included. Results 107 cases were collected, 106 of which were male. 78 non-inflammatory forms were observed, compared to 29 inflammatory. The most frequently isolated fungus was Trichophyton tonsurans (75.7% of cases). The lesions appeared predominantly on the nape of the neck and temporal area. Conclusions The distribution by sex, age and lesional location seems to indicate that a new social trend, in which male adolescents regularly go to hairdressers to shave the occipital and temporal areas, would be the cause of this grouping of cases of ringworm of the scalp. The most frequent microorganism in our study (T.tonsurans) coincides with the most prevalent in our environment. This study shows an accumulation of cases that can be taken into account by competent Public Health agencies, which are responsible for ensuring compliance with the rules of disinfection of the material used for shaving (AU)

[Translated article] Outbreak of Dermatophyte Infections on the Head and Neck Related to Shave Haircuts: Description of a Multicenter Case Series / Brote de dermatofitosis en región de cabeza y cuello asociadas al rasurado en peluquerías: estudio descriptivo multicéntrico de una serie de casos

Introduction Since 2021, an increase in cases of tinea capitis has been detected in adolescents who shave their hair with fade haircut. Patients and methods Multicenter retrospective observational study of cases of cephalic pole dermatophytosis with a history of having been acquired after frequent shaving in hairdressing. A call was made to dermatologists from the Spanish Academy of Dermatology and Venereology (AEDV) to provide cases observed between January 2021 and December 2022. Patients with microbiological confirmation by culture or direct examination with KOH were included. Results 107 cases were collected, 106 of which were male. 78 non-inflammatory forms were observed, compared to 29 inflammatory. The most frequently isolated fungus was Trichophyton tonsurans (75.7% of cases). The lesions appeared predominantly on the nape of the neck and temporal area. Conclusions The distribution by sex, age and lesional location seems to indicate that a new social trend, in which male adolescents regularly go to hairdressers to shave the occipital and temporal areas, would be the cause of this grouping of cases of ringworm of the scalp. The most frequent microorganism in our study (T.tonsurans) coincides with the most prevalent in our environment. This study shows an accumulation of cases that can be taken into account by competent Public Health agencies, which are responsible for ensuring compliance with the rules of disinfection of the material used for shaving (AU)

Introducción Desde 2021 se ha detectado un aumento de casos de tiñas del cuero cabelludo en adolescentes que se cortan el pelo mediante rasurado o degradado. Pacientes y métodos Estudio observacional retrospectivo multicéntrico de casos de dermatofitosis del polo cefálico con el antecedente de haber sido contraídas tras el rasurado frecuente en peluquería. Se realizó una llamada a dermatólogos de la Academia Española de Dermatología y Venereología (AEDV) para que aportaran casos observados entre enero de 2021 y diciembre de 2022. Se incluyeron pacientes con confirmación microbiológica mediante cultivo o examen directo con KOH. Resultados Se recogieron 107 casos, siendo 106 pacientes varones. Se observaron 78 formas no inflamatorias frente a 29 inflamatorias. El hongo aislado con mayor frecuencia fue Trichophyton tonsurans (75,7% de los casos). Las lesiones aparecieron predominantemente en la nuca y en el área temporal. Conclusiones La distribución por sexo, edad y localización lesional parece apuntar a que una nueva tendencia social, en la que adolescentes varones acuden asiduamente a peluquerías para el afeitado de las zonas occipital y temporal, sería la causante de esta agrupación de casos de tiña del cuero cabelludo. El microorganismo más frecuente en nuestro estudio (T.tonsurans) coincide con el más prevalente en nuestro medio. Con el presente estudio se evidencia un acúmulo de casos susceptible de ser tenido en cuenta por organismos competentes de salud pública, a los cuales corresponde velar por el cumplimiento de las normas de desinfección del material empleado para el rasurado (AU)

Outbreak of Dermatophyte Infections on the Head and Neck Related to Shave Haircuts: Description of a Multicenter Case Series. / Brote de dermatofitosis en región de cabeza y cuello asociadas al rasurado en peluquerías: estudio descriptivo multicéntrico de una serie de casos.

INTRODUCTION: Since 2021, an increase in cases of tinea capitis has been detected in adolescents who shave their hair with fade haircut. PATIENTS AND METHODS: Multicenter retrospective observational study of cases of cephalic pole dermatophytosis with a history of having been acquired after frequent shaving in hairdressing. A call was made to dermatologists from the Spanish Academy of Dermatology and Venereology (AEDV) to provide cases observed between January 2021 and December 2022. Patients with microbiological confirmation by culture or direct examination with KOH were included. RESULTS: 107 cases were collected, 106 of which were male. 78 non-inflammatory forms were observed, compared to 29 inflammatory. The most frequently isolated fungus was Trichophyton tonsurans (75.7% of cases). The lesions appeared predominantly on the nape of the neck and temporal area. CONCLUSIONS: The distribution by sex, age and lesional location seems to indicate that a new social trend, in which male adolescents regularly go to hairdressers to shave the occipital and temporal areas, would be the cause of this grouping of cases of ringworm of the scalp. The most frequent microorganism in our study (T.tonsurans) coincides with the most prevalent in our environment. This study shows an accumulation of cases that can be taken into account by competent Public Health agencies, which are responsible for ensuring compliance with the rules of disinfection of the material used for shaving.

Gender differences, ergonomics risks and upper quadrant musculoskeletal pain in hairdressers.

Objectives. This study examined ergonomic risk levels and upper quadrant musculoskeletal pain (UQMP) levels of hairdressers, and the difference and correlation between genders. Methods. Volunteers participating in the study were assessed with the descriptive data form, rapid upper limb assessment (RULA), Cornell musculoskeletal discomfort questionnaire (CMDQ) and disabilities of the arm, shoulder and hand (DASH) score. Results. In total, 229 (female, 26.6%; male, 73.4%) hairdressers participated in the study. Prevalence of the first three frequencies of pain in the musculoskeletal system was 48.5% in the neck, 41.5% in the upper back and 33.6% in the shoulder. The mean DASH score of the hairdressers was 10.75 ± 10.70, quick DASH-work modulated score was 6.85 ± 10.24 and mean ergonomic risk score was moderate to high (5.36 ± 1.22) according to RULA. Although there was no difference in terms of gender in the ergonomic risk level, a higher level of UQMP was significant in females (p < 0.05). RULA score correlated with CMDQ and DASH scores in both genders (p < 0.05). Conclusions. Hairdressers perform their jobs in work environments with moderate to very high ergonomic risk levels. There is a possibility of UQMP in hairdressers, especially females, due to the effect of their movement patterns as a requirement of their profession.

Bleaching powders, bleaching creams and other hair lightening preparations as sources for (airborne) allergic contact dermatitis and other health effects in hairdressers: Results of an empirical study.

BACKGROUND: Various products are available for lightening hair. There are no data on which applications are actually used in hairdressing, impeding proper estimation of actual exposure and necessary preventive measures. OBJECTIVES: To assess information about availability, usage and formulation of lightening preparations in the German hairdressing trade. METHODS: A market survey was conducted and hairdressers were surveyed by online questionnaires. RESULTS: Of 783 hairdressers clicking the link, 565 hairdressers (91.2% female, mean age of 40.2 ± 11.7 years) from all German states responded (response rate: 72.2%). The questionnaire survey has shown that available hair-lightening preparations in the German hairdressing trade are (multiple selection possible): dust-free (88.5%) and non-dust-free bleaching powders (22.1%), bleaching creams (41.9%), high-lifting hair colour creams (88.8%) and normal hair colour creams (58.4%). Five hundred eighteen (91.7%) hairdressers favour lightening hair with powder. The market survey revealed that bleaching powders and creams contain potassium persulfate, ammonium persulfate and sodium persulfate or combinations of these persulfate salts. CONCLUSIONS: Hairdressers are exposed to various hair-lightening applications containing different chemicals. Preventive measures need to address adverse skin and respiratory effects. Implementation of targeted health education already in early career stages (i.e., apprenticeship) seems advisable and can be maintained by refresher trainings.

Skin Toxicity of Selected Hair Cosmetic Ingredients: A Review Focusing on Hairdressers.

The safety assessment of cosmetics considers the exposure of a 'common consumer', not the occupational exposure of hairdressers. This review aims to compile and appraise evidence regarding the skin toxicity of cysteamine hydrochloride (cysteamine HCl; CAS no. 156-57-0), polyvinylpyrrolidone (PVP; CAS no. 9003-39-8), PVP copolymers (CAS no. 28211-18-9), sodium laureth sulfate (SLES; CAS no. 9004-82-4), cocamide diethanolamine (cocamide DEA; CAS no. 68603-42-9), and cocamidopropyl betaine (CAPB; CAS no. 61789-40-0). A total of 298 articles were identified, of which 70 were included. Meta-analysis revealed that hairdressers have a 1.7-fold increased risk of developing a contact allergy to CAPB compared to controls who are not hairdressers. Hairdressers might have a higher risk of acquiring quantum sensitization against cysteamine HCl compared to a consumer because of their job responsibilities. Regarding cocamide DEA, the irritant potential of this surfactant should not be overlooked. Original articles for PVP, PVP copolymers, and SLES are lacking. This systematic review indicates that the current standards do not effectively address the occupational risks associated with hairdressers' usage of hair cosmetics. The considerable irritant and/or allergenic potential of substances used in hair cosmetics should prompt a reassessment of current risk assessment practices.

Task-specific dystonia in hairdressers: a questionnaire survey and review of the literature.

Hairdresser dystonia is one of the occupational dystonias and task-specific movement disorders occurring as a result of long-term repetitive cutting with scissors. The task-specific dystonia manifests itself as a loss of voluntary motor control during extensive practice of cutting requiring a high level of technical proficiency. The prevalence rate of hairdresser dystonia is not well-known worldwide. A questionnaire regarding dystonia was prepared for hairdressers. After sending the questionnaires to 800 hairdressers by direct mail, 134 answers were received by mail. Five of the 134 were suspected to have hairdresser-associated focal dystonia. Thus, 3.7% of hairdressers might have task-specific dystonia. This report was limited because of the small number of participants. However, this research is valuable because it was difficult to find a patient with suspected dystonia due to concerns related to job security.

Respiratory afflictions during hairdressing jobs: case history and clinical evaluation of a large symptomatic case series.

OBJECTIVES: Respiratory symptoms at work are common among hairdressers. Various working materials, most notably bleaching ingredients such as ammonium persulfate, have been made responsible. The objective of this study is to achieve a better understanding of work-related respiratory symptoms of hairdressers by describing common features in a large affected collective. METHODS: One hundred forty-eight hairdressers with respiratory symptoms at work presenting between 2012 and 2019 were consecutively included in a case series. Anamnestic and diagnostic data including pulmonary function and allergy testing were retrospectively compiled from records and analysed. Additionally, cases were categorised in five groups with respect to occupational causation certainty. RESULTS: 30% of the predominantly female collective had changed jobs or were on longer sick-leave. Besides respiratory symptoms, 10% also reported contact urticaria to blonde dyes. In 60% an obstructive airway disease was confirmed. A specific hypersensitivity reaction to ammonium persulfate was found in 15%. Group 1 with a proven immunological occupational causation showed significantly lower age (p < 0.001) and tenure time (p = 0.001), higher sensitization rates against environmental allergens as well as a higher total IgE (p = 0.015), compared to group 4 (obstructive airway disease, specific occupational causation unlikely). CONCLUSIONS: This case series contributes to a better characterization of work-related respiratory symptoms in hairdressing as one of the largest examined collectives of symptomatic hairdressers. Ammonium persulfate as the most common specific cause showed signs of a type-I-like hypersensitivity reaction with typical risk factors for atopy. Prick testing is recommended in all symptomatic cases. However, a specific occupational causation often cannot be proved.

A saúde da haste capilar e do couro cabeludo: saberes de cabeleireiros / Health of capillary stem and hairdressing leather: knowledge of hairdressers

Introdução: o cabelo tem uma forte representação para os seres humanos, causando grande impacto na estrutura emocional, imagem pessoal e qualidade de vida e saúde. Objetivo: investigar, junto a profissionais cabeleireiros, saberes acerca das principais patologias e/ou intercorrências de interesse ao profissional de estética capilar. Metodologia: pesquisa descritiva, realizada em salões de um município ao noroeste do Rio Grande do Sul, no primeiro semestre de 2020. A coleta de dados foi feita por meio de um questionário e o tratamento dos dados se deu pela análise de conteúdo temática. Foram respeitados os aspectos éticos da pesquisa com seres humanos legislados pela Resolução 466/2012. Resultados: identificou-se, que apesar da formação destes profissionais ser voltada quase que totalmente para o tecnicismo, com quase nenhuma base teórica e científica, os mesmos denotam algum saber em torno das questões relativas ao exercício da sua profissão tais como biossegurança, autocuidado, transmissão de doença no ambiente de trabalho e execução de suas técnicas. No que tange às doenças relativas a haste capilar e ao couro cabeludo, pode-se observar lacunas sobre esse tema por parte dos participantes, visto que, grande parte dos seus conhecimentos demonstrados valem-se de saberes empíricos, seja pela deficiência formativa seja pela escassez de material produzido por profissionais da área. Conclusão: foram observadas algumas deficiências nos saberes dos profissionais sobre o tema. Destaca-se a importância do estímulo para a produção de objetos de aprendizagem, bem como a elaboração de cursos de atualização direcionados a este setor.

Introduction: hair has a strong representation for human beings, causing great impact on emotional structure, personal image and quality of life and health. Objective: to investigate, together with hairdressing professionals, knowledge about the main pathologies and / or complications of interest to the professional of hair aesthetics. Methodology: descriptive research, carried out in salons of a municipality in the northwest of Rio Grande do Sul, in the first semester of 2020. The data collection was done through a questionnaire and the treatment of the data was done through the analysis of thematic content. The ethical aspects of research with human beings legislated by Resolution 466/2012 were respected. Results: it was identified that, although the training of these professionals is almost totally focused on technicality, with almost no theoretical and scientific basis, they show some knowledge around issues related to the exercise of their profession such as biosafety, self-care, transmission of disease in the work environment and execution of its techniques. Regarding diseases related to the hair shaft and the scalp, gaps on this topic can be observed on the part of the participants, since most of their demonstrated knowledge is based on empirical knowledge, either due to the training deficiency or the scarcity of material produced by professionals in the field. Conclusion: some deficiencies were observed in the knowledge of professionals on the subject. The importance of the stimulus for the production of learning objects is highlighted, as well as the elaboration of refresher courses directed to this sector.

Nickel and cobalt: Underestimated contact allergens in hairdressers?

INTRODUCTION: Nickel and cobalt were not regarded as pertinent contact allergens in the hairdressing trade for the last decades. It was even stated that the relevance of nickel allergy in the hairdressing trade has been overestimated for several years. Recently, nickel and cobalt release from a multitude of metal tools in the German hairdressing trade was documented in two field studies. METHODS: Review of two field studies. RESULTS: In 2019, nickel release from 9.2% of 229 tested metallic hairdressing tools was evidenced, and in 2021, nickel release from 27.6% as well as cobalt release from 2.1% of 475 tested tools was detected in overall 30 North German hairdressing salons. Tweezers, sectioning clips, hair clips, and straight razors were identified as nickel as well as cobalt releasing tools. Crochet hooks and tail combs were identified as only nickel releasing tools. DISCUSSION: A variety of metallic tools - which are used daily by hairdressers - release nickel and/or cobalt in allergologically relevant amounts. This circumstance has to be considered problematic with regard to the development of work-related allergic contact dermatitis. Thus, nickel and cobalt should possibly receive greater attention as potential contact allergens in the hairdressing trade. CONCLUSION: The proven nickel and cobalt release from metallic hairdressing tools might entail legal ramifications in terms of insurance law. In case of nickel and cobalt allergies within the occupational group of hairdressers, metal tools might be considered as feasible sources for nickel and cobalt exposure.

Allergic contact dermatitis caused by 2-hydroxyethyl methacrylate and ethyl cyanoacrylate contained in cosmetic glues among hairdressers and beauticians who perform nail treatments and eyelash extension as well as hair extension applications: A systematic review.

Current cosmetic regulations primarily focus on protecting consumers, not the professional user who is subjected to a partly different, and certainly more intense exposure to hazardous substances. Against this background, this systematic review aims to compile and appraise evidence regarding skin toxicity of 2-hydroxyethyl methacrylate (HEMA; CAS no. 212-782-2) and ethyl cyanoacrylate (ECA; CAS no. 7085-85-0) contained in cosmetic glues used among hairdressers and beauticians who perform nail treatments and eyelash extension as well as hair extension applications. This systematic review followed the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) 2020 recommendations for reporting systematic reviews and meta-analysis. In total, six publications from six countries were eligible for this systematic review. A meta-analysis revealed that hairdressers and beauticians have a ninefold increased risk of developing contact allergy to HEMA compared with controls who are not hairdressers and beauticians. Results for ECA are lacking. The results of this systematic review clearly show that-regarding contact allergy to acrylates-it is not appropriate to apply risk assessment for consumers to hairdressers and beauticians who occupationally handle cosmetic glues. The regulations in existence do not adequately address occupational risks for hairdressers and beauticians connected with the use of acrylate-containing cosmetic substances and need reconsideration.

Exposición química y síntomas dérmicos y respiratorios en estilistas del sector informal de Palmira 2020 / Chemical exposure and dermal and respiratory symptoms in hairstylists in the informal sector in Palmira 2020

Introducción: Los productos cosméticos utilizados en los tratamientos de belleza contienen diferentes sustancias químicas toxicas irritantes y cancerígenas como el formaldehido, clasificado por la Agencia Internacional de Investigación sobre el Cáncer IARC (siglas en inglés) como tipo 2, probablemente cancerígeno en humanos (1) ; y el amoniaco también clasificado como cancerígeno por el Instituto Nacional para la Seguridad y Salud Ocupacional NIOSH (2) (siglas en inglés) , los cuales pueden ingresar al organismo por inhalación, vía oral, contacto en globo ocular y contacto con la piel produciendo diferentes síntomas clínicos en los estilistas. Objetivo: Identificar la exposición química y los síntomas relacionados en estilistas del sector informal del municipio de Palmira Colombia. Método: Se evaluaron las características de la población con una encuesta sociodemográfica de elaboración propia, las características de exposición química en los salones de belleza con el cuestionario de evaluación cualitativa Stoffenmanager, y los síntomas en la piel, mucosa ocular y vía aérea superior de los estilistas con el cuestionario nórdico de enfermedades cutáneas de origen profesional NOSQ-2002/SHORT. Las peluquerías fueron seleccionadas al azar de un universo de 35 peluquerías clasificadas según el número de trabajadores. Resultados: Las condiciones de exposición a químicos se evaluaron en 12 peluquerías, la exposición por inhalación fue alta en el proceso de alisado; la exposición dérmica por contacto fue alta en el alisado y en la coloración , y fue muy alta en la decoloración; la exposición dérmica por absorción fue alta en la coloración y muy alta en el alisado y la decoloración. Los síntomas dérmicos y respiratorios se evaluaron en 64 estilistas, encontrando síntomas dérmicos en el 51,6 % , y síntomas respiratorios en el 60,9 %. (AU)

Introduction: Cosmetic products used in beauty treatments contain different irritating toxic chemicals and carcinogens such as formaldehyde, classified by the International Agency for Research on Cancer I.A.R.C. as type 2, probably carcinogenic in humans(1); and ammonia also classified as carcinogenic by the National Institute for Occupational Safety and Health NIOSH(2), which can enter the body through inhalation, oral route, eye contact and skin contact producing different clinical symptoms in stylists. Objective: To identify chemical exposure and related symptoms in hairdressers in the informal sector in Palmira, Colombia. Method: The characteristics of the population were assessed with a self-made sociodemographic survey, the characteristics of chemical exposure in the salons with the Stoffenmanager qualitative assessment questionnaire, and the symptoms in the skin, ocular mucosa and upper airway of the hairdressers with the Nordic questionnaire of occupational skin diseases NOSQ-2002/SHORT. The hairdressers were randomly selected from a universe of 35 hairdressers classified into three strata according to the number of workers. Results: Chemical exposure conditions were evaluated in 12 hairdressers, finding that inhalation exposure was high in the straightening process; dermal contact exposure was high in straightening and coloring, and very high in bleaching; dermal exposure by absorption was high for coloring and very high for smoothing and bleaching. Dermal and respiratory symptoms were evaluated in 64 stylists, finding dermal symptoms in 51.6%, and respiratory symptoms in 60.9%. (AU)

Working Conditions and Health Risk Assessment in Hair Salons.

Objective:The aim of this study was to assess the chemical and physical work conditions in hair salons and to analyze health risk of exposure to VOCs for the hairdressers of hair salons. Methods: This study was carried out at 4 selected hair salons close to universities in Surat Thani province, Thailand. VOCs were collected by area sampling using charcoal tubes (9 samples per salon). The air samples were analyzed using GC/FID. The noise levels, illumination, and temperature were measured by using sound level meter, lux meter, and WBGT, respectively. Results: Toluene, cyclohexanone, xylene, and hexane were the most frequently found across the hair salons. All of the VOCs concentration was highest in the mixing area. All of hair salons had cancer risk exceeding 1 × 10-6 and HI > 1.0, indicating that indoor air pollution may affect hairdresser's health. The average VOCs concentrations after installation of local exhaust ventilation and open the door for 30 minutes before closing the hair salon, was significantly lower than before and after installation of the local exhaust ventilation. The WBGT indoors varied within 22 to 28°C, sound pressure levels within 71 to 76 dBA, and illumination within 70 to 400 lux. The noise levels and temperature in the hair salons were satisfactory on the scale of the Ministry of Labor (Thailand). Conclusions:Installing and using proper ventilation in hair salon are recommended to eliminate health effects. Hairdresser worked in poor lighting that should be improved to appropriate levels (>1000 lux).

Occupational allergic contact dermatitis: A 24-year, retrospective cohort study from Turkey.

BACKGROUND: Limited data exist on occupational allergic contact dermatitis (OACD) in Turkey. OBJECTIVES: To investigate the epidemiologic profile of OACD in Turkey. METHODS: A retrospective cohort study on 294 patients with OACD among 2801 consecutively patch-tested patients in the Allergy Unit of the Dermatology Department of Istanbul Faculty of Medicine between 1996 and 2019. RESULTS: The overall prevalence of OACD was 10.5%, showing a male predominance. OACD was most frequently seen in construction workers (45.2%), followed by hairdressers, metalworkers, health care workers, and miscellaneous. The main relevant allergens were chromium in cement, thiurams in rubber gloves, hairdressing chemicals, resins/glues/plastics, metals, isothiazolinones, and fragrances. Hands were the mainly involved site (95.6%). Airborne eczema was observed in 21.4%. Hand and foot eczema and co-sensitizations to chrome and thiuram and chrome and cobalt were significantly associated with being a construction worker. Sensitizations to isothiazolinones in house painters, ammonium persulfate and p-phenylenediamine in hairdressers, and colophonium increased after 2010. CONCLUSION: This was the largest group of data on OACD from Turkey, reflecting the importance of rubber glove allergy in all occupations and the striking increase in ammonium persulfate allergy among hairdressers. Chrome and cobalt were still the main cement allergens in Turkey, where the cement directive is not yet in force.

A Case of Liver Injury after Exposure to Isopropanol: A Challenging Diagnosis.

Drug-induced liver injury is hardly diagnosed, considering not only the wide range of hepatotoxic substances but also the diversity of associated phenotypes and the absence of specific biomarkers. Symptom chronology, drug or toxic exposure, and temporal association help to establish the diagnosis. Exposure to isopropanol has known but rare toxic effects. We report the clinical case of a 33-year-old female hairdresser admitted to the hospital with fatigue, epigastric pain, and jaundice. She presented the following values: aspartate aminotransferase, 485 U/L; alanine transaminase, 908 U/L; ALP, 240 U/L; GGT, 370 U/L; total bilirubin, 3.5 mg/dL; and direct bilirubin, 2.1 mg/dL. Albumin, platelet, and INR values were normal. Structural, infectious, immune, and vascular causes were excluded. Liver biopsy was suggestive of toxic hepatitis. A possible association with ibuprofen intake was considered. The patient resumed professional activity, with fatigue and jaundice relapse, as well as a new liver enzyme increase, despite ibuprofen withdrawal. It was concluded that a new hair product containing isopropanol had recently been introduced. As soon as its professional use was discontinued, there was no recurrence of the symptoms. Given the temporal association between the development of acute hepatitis and the use of an isopropanol-containing product, liver toxicity by exposure to isopropanol was assumed. This substance is metabolized in the liver and toxicity may occur by ingestion, skin exposure, or inhalation, and it is described in cases of occupational or accidental exposure. The treatment is symptomatic and comprises toxic suspension.

A lesão hepática induzida por tóxicos é um dos distúrbios de mais difícil diagnóstico, quer pela existência de múltiplos hepatotóxicos, quer pela diversidade de fenótipos associados e ausência de biomarcadores específicos. A cronologia dos sintomas, exposição a fármacos ou tóxicos e associação temporal auxilia o diagnóstico. A exposição a isopropanol tem efeitos tóxicos conhecidos e raros. Descrevemos o caso clínico de uma mulher de 33 anos, cabeleireira, admitida por fadiga, epigastralgias e icterícia. Apresentava AST 485 U/L, ALT 908 U/L, FA 240 U/L, GGT 370 U/L, bilirrubina total 3,5 mg/dL e bilirrubina direta 2,1 mg/dL; o doseamento sérico de albumina, plaquetas e o valor de INR eram normais. Foram excluídas lesões estruturais, causas infeciosas, imunes e vasculares. Biópsia hepática sugestiva de hepatite tóxica. Considerada possível associação a toma de ibuprofeno. Retomou atividade profissional, com recorrência de fadiga e icterícia, bem como elevação das enzimas hepáticas novamente, apesar de suspensão de ibuprofeno. Apurada exposição a tóxicos profissionais, percebendo-se que o quadro coincidiu com início da utilização de novo produto capilar contendo isopropanol. A doente retomou atividade profissional, não utilizando o produto, sem recorrência. Dada a relação temporal entre o desenvolvimento de hepatite aguda e a utilização de produtos contendo isopropanol, assumiu-se hepatotoxicidade por exposição profissional ao isopropanol. Esta substância é metabolizada no fígado e a toxicidade pode ocorrer por ingestão, exposição cutânea ou inalação, estando descrita em casos de exposição ocupacional ou acidental. O tratamento é sintomático e inclui a suspensão do tóxico.

Patch-test results in terms of the recently recommended allergens in children and adolescents: A retrospective cohort study over 22 years from Turkey.

BACKGROUND: A European pediatric patch-test series was suggested recently. OBJECTIVES: To evaluate the patch-test results in children (<10-years-old) and adolescents (10- to 18-years-old) in Turkey, focusing on the clinical/occupational relevance and the diagnostic value of the recently suggested series. PATIENTS AND METHODS: A retrospective cohort study on 317 consecutively patch-tested patients ≤18 years of age, between 1996 and 2017. RESULTS: The contact sensitization rate was 46.1%. Allergic contact dermatitis (ACD) was diagnosed in 30.9%, comprising non-occupational (84.7%) and occupational (15.3%) ACD. Nickel was the leading allergen in almost every age group. Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) was the clinically most relevant allergen, followed by p-phenylenediamine (PPD), ammonium persulfate, fragrance mix I, nickel sulfate, and mercury/mercury(II)amidochloride. Occupational ACD was most frequently seen in hairdresser apprentices (adolescents only) who were sensitized with PPD ± ammonium persulfate. ACD from MCI/MI increased to 5-fold, ammonium persulfate and mercurial compounds to 2-fold, and PPD to 1.7-fold after 2007. Almost one third of patients would be missed by testing only with the recommended allergens. CONCLUSIONS: For patch testing in Turkish children and adolescents, we suggest additionally testing with ammonium persulfate, mercury/mercury(II)amidochloride, toluenesulfonamide formaldehyde resin, and polyethylene glycol, the latter as a marker for nitrofurazone allergy, in appropriate patients.

Nickel release from metal tools in the German hairdressing trade-A current analysis.

BACKGROUND: Nickel is one of the most common contact allergens. Despite EU regulations concerning the maximum permissible release of nickel from metal objects, nickel release at inappropriately high levels from metal objects has been detected in various studies. OBJECTIVES: To screen current nickel release from metal tools in the German hairdressing trade. METHODS: Two hundred and twenty-nine metal tools from the German hairdressing trade were tested with the dimethylglyoxime (DMG) test for nickel release. Additionally, an employee survey was conducted to collect data about the metal tools. RESULTS: The DMG test showed that 21 of 229 metal tools (9.2%) released nickel. Nickel release was detected in 8 of 45 hair clips (17.8%), 2 of 27 tail combs (7.4%), and 11 of 17 tweezers (64.7%). CONCLUSION: It must be assumed that hairdressers in Germany have prolonged skin contact with nickel-releasing metal tools. This should prompt further testing for nickel release from metal tools, and the development of regulations to eliminate nickel-releasing metal tools in the (German) hairdressing trade.

The Question on the Potential Cancerous Effects of Hair Dyes: The Monitoring of the Oxidative Stress Induced by the Hair Dyes with the Dosage of the Salivary Free Radicals.

BACKGROUND: Many studies indicate the difficulty on assessing the possible carcinogenic effects of hair dyes, for their high time of the latence. OBJECTIVES: Our objective is to determine their prognostic index, by monitoring the oxidative stress, produced exposed to hair dyes, in hairdressers, and in consumers, by measuring the concentration of salivary malondialdehyde. MATERIALS AND METHODS: Saliva samples are provided by the hairdressers, working in private (NP) or shopping center (CC), by users of hair dyes, for at least 10 years, and by a control group. The values of malondialdehyde are determined using the thiobarbituric acid method. The results are statistically analyzed by Kruskal-Wallis and Mann-Whitney test. RESULTS: Comparing the three groups with tests for K-independent Kruskal-Wallis samples (dyed vs. control vs. dyed at least 10 years), there is a significant difference for the amount of MDA (P < 0.001). Proceeding for the median MDA in the subgroups by testing for two independent U-samples of Mann-Whitney: control versus dyed, P < 0.001; control versus CC, P = 0.013; control versus NP, P < 0.001; control versus 10 years, P = 0.111; CC versus NP, P = 0.001; CC versus 10 years, P = 0.462; and NP versus 10 years, P < 0.001. DISCUSSION: In hairdressers, the increase of the salivary MDA versus control group is statistically significant (P ≤ 0.05), with an accentuation in small workplace, for age, probably for a more direct exposure to dyes' gas. Another statistically significant increase of salivary MDA is for the consumers versus control group, also function of the increasing age. CONCLUSIONS: The results of this study show a significant increase of oxidative stress in the hairdressers. This factor involves a potential carcinogenic risk, especially for the bladder, difficult to assess in the short term.

Micronucleus Assay of Buccal Mucosal Cells in Hairdressers: The Importance of Occupational Exposure

Background and objective: Today, the chemical materials available in hair dyes are considered risk factors for many cancers, particularly oral cancer. This study was performed to study the effect of occupational exposure on micronucleus (MN) frequency of buccal mucosa cells in hairdressers. Materials and methods: This historical cohort study was performed on 28 hairdressers and 28 control samples. To eliminate the gender variable, all the samples were women and they were matched by age. Buccal mucosa cells were removed using a wet spatula and after fixation, Papanicolaou staining method was applied. The percentage of the cells containing MN was registered. T-test was used to compare the results between the two groups. Results: The mean percentages of MN in buccal mucosa cells of hairdresser's and control sample were 16.61±4.95 and 8.84±4.74, respectively, with a significant difference (P<0.001). In addition, higher MN mean percentage was reported in subjects working more than 60 hours weekly compared with those working 60 hours and less; however, the difference was not statistically significant (P=0.14). Conclusion: In the present study, hairdressers demonstrate significantly higher average of MN in buccal mucosa cells. Also, it seems increment in their working time can increase MN frequency in these studied samples.