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.