Cosmetics, Hair Dyes Are Potential Contact Allergens - Brief Article

Family Practice News, April 1, 2000 by Guang-Shing Cheng

CLEVELAND -- Common cosmetic practices--such as use of hair dyes--may be the culprits in cases of facial contact dermatitis, said Dr. James Taylor of the Cleveland Clinic.

"When considering facial dermatitis, cosmetic reactions should come to mind," he said at a dermatology seminar sponsored by the Cleveland Clinic Foundation.

The majority of the patients will be women, and often allergic dermatitis is not suspected by either the patient or the clinician. Ingredients of directly applied lotions and creams, such as fragrances and preservatives, are the most frequent causes.

Hair dye, in particular, may be underappreciated as an allergen in contact dermatitis. Para-phenylendiamine (PPDA) in permanent hair coloring products is the major culprit, causing contact dermatitis on the face and circumferentially around the scalp and behind the ears. The condition also occurs in Middle Eastern men who dye their beards.

Contact leukoderma, or depigmentation, as a reaction to PPDA is "exceedingly uncommon but one that you should be aware of," Dr. Taylor warned.

In one patient, pigment loss on the forehead and behind the ears expanded 2 years after he had used hair dye, showing that the effects of PPDA long after the application. Several other such cases have been reported.

Of note, none, of the patients had evidence of idiopathic vitiligo or other causes of leukoderma. "It's important to remember that irritation or sensitization is not always a prerequisite for leukoderma," Dr. Taylor said.

Hairdressing as a profession can pose even greater hazards. Bron-chospasm as a consequence of PPDA is usually seen in hairdressers, who are constantly exposed to PPDA. Other immediate reactions to PPDA, including contact urticaria, angioedema, and anaphylaxis, have been reported from hair dyes.

"When asking about other symptoms, it's important to concentrate on other potential reactions to these chemicals, particularly asthma, which may occur in some hairdressers," he said.

One woman developed alopecia from persistent contact dermatitis caused by glutaral (glutaraldehyde), a preservative in some hair conditioners.

When contact leukoderma from a potent depigmenting chemical is suspected, patch tests done to determine the allergen should be done on the buttocks, not on the arms, Dr. Taylor said. Be sure to follow up the patient for several weeks, because certain reactions such as depigmentation take as long as 6 weeks.

Other cosmetic practices associated with contact dermatitis include the Bindi applied to the forehead of women in India. Some of these women may develop lichenoidlike dermatitis and chemical leukoderma from p-tertiary butylphenol. Conventional makeup, such as eyeshadow and mascara, also contain dermatitis-causing allergens.

Manicuring products can cause contact dermatitis; nail polish is well known for causing eyelid dermatitis. For example, a 71-year-old man with a 4-year history of intermittent eyelid dermatitis patch tested positive to tosylamide formaldehyde resin in clear nail polish, which he wore regularly--a common practice for men in some cultures.

In Dr. Taylor's experience, nail polish can cause diffuse dermatitis on the face as well as eyelid dermatitis.

Nail products present an occupational hazard to beauticians as well. "Manicuring, while an old trade, has new polishes," he said. The popular acrylic sculptured nails can produce local nail, hand, and face reactions from direct contact. The resins used to produce them can give off vapors that can also cause facial dermatitis.

If nail products are suspected in a case of contact dermatitis, selected individual ingredients of the glue or the polish should be tested to determine the allergen, Dr. Taylor said.