Permanent wave contact dermatitis: contact allergy to glyceryl monothioglycolate

Allergic Contact Dermatitis of the Scalp Associated With Scalp Applied Products: A Systematic Review of Topical Allergens

ABSTRACT

Hair products are commonly used to maintain hair health or cosmesis. Products applied to the scalp and hair contain multiple active and inactive ingredients that can potentially cause irritant and/or allergic contact dermatitis. The objectives of this study were to identify and to discuss the most common allergens in scalp and hair applied products causing scalp allergic contact dermatitis (ACD). A PubMed search identified 99 studies, with 3185 patients and 31 categories of scalp products. Hair products reportedly associated with scalp ACD were hair dyes (41%), shampoos (28%), and conditioners (22%). The most commonly reported patch test-positive allergens were p-phenylenediamine (23%), nickel (15%), fragrance mix (13%), balsam of Peru (10%), cocamidopropyl betaine/3-dimethylaminopropylamine (7%), and methylchloroisothiazolinone/methylisothiazolinone (6%). Common symptoms and signs include eczematous lesions, pruritus, and a burning sensation. Medical practitioners should be aware of causative agents to provide appropriate patient education, counseling, and/or treatment.

A Skin Moisturizing Cream Containing Quaternium-18-Bentonite Effectively Improves Chronic Hand Dermatitis

Background:

Irritant and allergic hand dermatitis is difficult to control in individuals who are unable to avoid causative exposures. Effectiveness of “protective” creams has been poor.

Objective:

To determine if hand dermatitis, primarily of an occupational nature, could be improved by the use of a newly developed moisturizing cream containing Quaternium-18-Bentonite.

Methods:

Adult male and female subjects with chronic hand dermatitis felt to be either allergic, irritant, or combined in nature, after a 2-week observation period, were given the study cream for routine application. At 2, 4, and 8 weeks, the investigator and the subject evaluated the skin parameters, including redness, scaling, fissuring, blistering, and pruritus, on a numerical scale. A global evaluation was also performed. Photographs were taken at each visit. Use of topical corticosteroids was recorded. No systemic therapies other than antihistamines were allowed.

Results:

Thirty-seven subjects were enrolled in the study and 33 completed it. The physician's and the subject's initial global evaluations averaged 6.0 and 5.8, respectively (0–10 scale). The final scores were 2.9 and 2.8, respectively, an improvement of 50% (p < 0.001). Topical corticosteroid usage was reduced in 29 of 33 subjects. Fifteen of 35 had a final score of 0–2, indicating complete or almost complete clearing. Only 10, including 2 of the dropouts, failed to show improvement. No adverse effects were noted.

Comment:

This moisturizing cream significantly improved chronic hand dermatitis in a majority of individuals with previously uncontrolled dermatitis despite continuing in their regular occupation.

Final Report on the Safety Assessment of Ammonium and Glyceryl Thioglycolates and Thioglycolic Acid

Ammonium and Glyceryl Thioglycolates and Thioglycolic Acid are used predominantly in cosmetic permanent waving lotions at concentrations up to 15.4% (as Thioglycolic Acid). At use concentrations, these cosmetic ingredients are only slightly toxic in acute single oral and dermal exposures. In repeated dermal tests for extended periods of exposure, these ingredients were toxic. Commercial permanent wave products produced transient conjunctival redness to both rinsed and unrinsed eyes.

The results of skin testing for irritation and sensitization of these Thioglycolates depends on the type of test system used. Under occlusive patch testing, the data indicate that these ingredients are cumulative irritants and possibly weak sensitizers, but not under semi-occlusive test conditions. In clinical patients, mainly hairdressers, Glyceryl Thioglycolate elicited allergic reactions at concentrations down to 0.25%. It is concluded that these cosmetic ingredients may be safely used at infrequent intervals. However, hairdressers should avoid skin contact.

Contact dermatitis: a practice parameter-update 2015

This parameter was developed by the Joint Task Force on Practice Parameters, which represents the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Contact Dermatitis: A Practice Parameter-Update 2015." This is a complete and comprehensive document at the current time. The medical environment is changing and not all recommendations will be appropriate or applicable to all patients. Because this document incorporated the efforts of many participants, no single individual, including members serving on the Joint Task Force, are authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information or interpretation of this practice parameter by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. These parameters are not designed for use by the pharmaceutical industry in drug development or promotion. Previously published practice parameters of the Joint Task Force on Practice Parameters for Allergy & Immunology are available at http://www.JCAAI.org or http://www.allergyparameters.org.

Final Amended Report on the Safety Assessment of Ammonium Thioglycolate, Butyl Thioglycolate, Calcium Thioglycolate, Ethanolamine Thioglycolate, Ethyl Thioglycolate, Glyceryl Thioglycolate, Isooctyl Thioglycolate, Isopropyl Thioglycolate, Magnesium Thioglycolate, Methyl Thioglycolate, Potassium Thioglycolate, Sodium Thioglycolate, and Thioglycolic Acid

This safety assessment includes Ammonium and Glyceryl Thioglycolate and Thioglycolic Acid Butyl, Calcium, Ethanolamine, Ethyl, Isooctyl, Isopropyl, Magnesium, Methyl, Potassium, and Sodium Thioglycolate, as used in cosmetics. Thioglycolates penetrate skin and distribute to the kidneys, lungs, small intestine, and spleen; excretion is primarily in urine. Thioglycolates were slightly toxic in rat acute oral toxicity studies. Thioglycolates are minimal to severe ocular irritants. Thioglycolates can be skin irritants in animal and in vitro tests, and can be sensitizers. A no-observable-adverse-effect level for reproductive and developmental toxicity of 100 mg/kg per day was determined using rats. Thioglycolates were not mutagenic, and there was no evidence of carcinogenicity. Thioglycolates were skin irritants in some clinical tests. Clinically significant adverse reactions to these ingredients used in depilatories are not commonly seen, suggesting current products are formulated to be practically nonirritating under conditions of recommended use. Formulators should take steps necessary to assure that current practices are followed.

Occupational contact dermatitis

Skin reactions are common in the workplace. The skin, which constantly is exposed to chemicals and industrial processes, develops inflammatory reactions, most commonly dermatitis, which may have an allergic or irritant basis. The epidemiology, pathophysiology, and clinical features of common occupational dermatoses are discussed. Irritant, allergic, and urticarial contact reactions are compared, and their clinical features are outlined. Important occupational irritants and allergens, their sources, and the industries in which they most commonly are found are listed. The prognosis and therapy of these occupational reactions are examined.

Immediate-type latex hypersensitivity in a hairdresser

Hairdressers commonly develop contact dermatitis caused by either skin irritants or allergens to which they are exposed. Those using latex gloves are also at risk of developing immediate hypersensitivity reactions to latex. We present a hairdresser with hand dermatitis, primarily as a result of immediate-type hypersensitivity to latex causing contact urticaria, diagnosed with radioallergosorbent testing. Only three previous studies have reported latex allergy in hairdressers. This condition needs to be considered as a differential diagnosis in hairdressers presenting with hand dermatitis and a history of wearing either rubber or disposable latex gloves.

Occupational skin disease in hairdressers

Hairdressers belong to an occupational group that is commonly affected by occupational skin disease, specifically contact dermatitis, which may be allergic or irritant and, less commonly, contact urticaria. Occupational contact dermatitis predominantly affects apprentices, and atopy is a recognized risk factor associated with a poor prognosis. Repetitive wet work leading to irritant contact dermatitis, followed by exposure to allergens and the development of allergic contact dermatitis, are the main factors contributing to occupational contact dermatitis. Once developed, it is often difficult to manage and is a cause of significant morbidity. Early education, training and prevention is the best approach to the management of this disorder that is endemic among hairdressers.

What is new in clinical research in contact dermatitis

The field of cutaneous allergy has enjoyed dynamic research advances in epidemiology and clinical contact dermatitis. Studies regarding outcomes analysis, validity, predictive value, and sensitivity have allowed clinicians to better understand the importance of patch test results. In the clinical arena, new and clinically relevant allergens are being discovered, such as corticosteroids, metals, preservatives, surfactants, and glues. Continued epidemiologic surveillance of new allergens will enable manufacturers to develop safer products for patients to use.

Technical and ethical problems associated with patch testing

When relevant allergens are identified by patch testing, and patients can avoid them in their environment, improvement of dermatitis is the rule. Some forms of chronic dermatitis may not clear completely, but patients are usually satisfied with modification of their previously more severe problem. In 1981 when asked what he felt were the five most important advances in clinical dermatology during the 20th century, Dr. Marion B. Sulzburger, an icon in American dermatology, said that, "The increased use and usefulness of the patch test and the international standardization of test concentrations and methods" was number one. Those of us who are enthusiastic patch testers and fascinated by the evaluation of patients with irritant and allergic contact dermatitis would agree. It is a thrilling clinical experience to be able to tell a machinist that he need not stop his lifelong occupation, but instead will do fine if he will simply avoid the waterless hand cleanser he has been using which is preserved with glutaraldehyde. The woman whose facial dermatitis has embarrassed her for years and clears when she stops using the Quaternium-15 preserved moisturizer that you have identified in your patch testing is grateful to you forever, and again happy in her own life. In 1991, my research assistants, Patricia Norris and Mary Lou Belozer, and I studied 30 university hospital workers who answered our advertisement asking for individuals who believed they were troubled by their rubber gloves (unreported study). By evaluating these people through history, physical examination, and patch testing, we were able to prove glove relatedness in 14 of them. Nine of the 14 had contact urticaria to latex, and only 5 had allergic contact dermatitis to rubber glove ingredients. Fifteen of our patients had irritant dermatitis. In this study, none of the patients with allergic contact dermatitis to glove ingredients had contact urticaria. However, since that time, we have observed a number of patients who had both forms of allergic reaction. Three of our patients who presented with nummular (patchy) hand dermatitis also had contact urticaria to latex, but no positive patch tests. With latex glove avoidance, their dermatitis resolved; an example of how scratching urticaria can eventuate in longer lasting dermatitis in some people ("the itch that rashes"). The patients presented to their dermatologist with dermatitis, but their true initiating event was urticaria which lasted only hours. The gratifying part of this study was that patch testing and contact urticaria testing allowed us to discover the 5 patients with allergic contact dermatitis and the 9 patients with contact urticaria who could benefit from glove alternatives. We were also able to assure patients in the remainder of the group that their hand eczema was not glove induced, but rather was related to their wet work. In most instances, therapeutic intervention helped, but in several cases job changes were required. Patch testing, when done properly, produces exciting results. When done improperly, it confuses and misleads patients and results in embarrassment to physicians who cannot properly interpret their results. Should a physician choose to include patch testing in his or her evaluation of patients with contact dermatitis it is essential, in my view, that he or she have highly developed skills in the diagnosis and treatment of skin diseases, and that these physicians be elaborately trained in the techniques of application and the methods of interpretation of patch tests.

Occupational hand dermatoses of hairdressers in Tainan City

OBJECTIVES

To determine the prevalence, clinical features, and patterns of hand dermatosis in hairdressers in Tainan, Taiwan, and to examine the associations between patterns of dermatosis and risk factors such as job description, work exposure, and sensitisation to common allergens.

METHODS

Interviews, examinations, and patch tests of the hairdressers from nine hairdressing stores randomly selected from Tainan City. Patch test agents included 41 substances with common allergens, shampoo preservatives, hair dyes, permanent waving and bleaching agents.

RESULTS

98 hairdressers finished the examination, 83% of them had occupational dermatosis and 32% had scissor induced scars or wounds. Most of the dermatoses belonged to either dry metacarpophalangeal dermatitis or eczema of the fingers. 44% of the hairdressers showed positive skin reaction to one or more patch test agents. The patch test results were different from previous reports in that the most common allergens were nickel, thimerosal, Captan, Kathon CG, and fragrance mix, and that the sensitivity to hair dye and permanent wave ingredients were low. The dry metacarpophalangeal dermatitis was associated with exposure to shampoo, and the eczema of the fingers with skin sensitivity to patch test agents.

CONCLUSION

Hairdressers in Tainan City had a high prevalence of dermatoses including traumatic wounds, and allergic and irritant contact dermatitis. The rates of sensitivity to some of the common sensitising agents were different from previous reports.

Dermatitis in hairdressers. (I). The experience of the past 4 years

Contact dermatitis among hairdressers is common. In The Netherlands, registered sick leave for hand dermatitis among hairdressers rose from 21,050 days in 1986 to 54,293 in 1991. In a survey among 45 hairdressers in 5 different salons, 12 had a history of hand dermatitis and 16 showed moderate to severe hand dermatitis. After extensive investigations, 13 were classified as having allergic contact dermatitis and 3 cumulative irritant contact dermatitis. In the past 4 years, 103 hairdressers were extensively patch tested and glyceryl thioglycolate (GTG), ammonium persulfate and nickel sulfate were responsible for the majority of positive reactions. Hair dyes and preservatives were responsible for a moderate % of the positive reactions. Positive reactions were also found to cocamidopropyl betaine and sodium coco hydrolyzed animal protein. These 2 allergens show a rather capricious patch test reaction pattern and irritant reactions may easily be confused with allergic. The relevance of positive patch test reactions to these chemicals should always be questioned. Atopy was not a frequent cause of hand dermatitis in this study. Chemicals with a thiol group can be demonstrated with a chemical spot test. With this test, contamination of the hairdressing salon with thioglycolates was demonstrated. It is emphasized that contamination of hairdressing salons with GTG is probably a significant factor in explaining the severe flare-ups in GTG-sensitized hairdressers who no longer use GTG permanent-waving solutions.

Allergic reactions to a hairdressers' series: results from 9 European centres. The European Environmental and Contact Dermatitis Research Group (EECDRG)

To obtain data on the frequency of sensitization among European hairdressers, the patch test results from 9 centres were evaluated. 8 allergens recommended by the ICDRG and EECDRG in the hairdressing series and PPD from the standard series were used to patch test 809 hairdressers and 104 clients suspected of contact sensitization. Among hairdressers, the mean frequencies of sensitization ranked as follows: GMT 19%, PPD 15%, APS 8%, PTD 8%, ONPPD 4% and PADH 4%. In contrast to GMT in acid permanent waves, the frequency of sensitization to AMT in alkaline permanent waves was only 4%. Frequencies of sensitization to pyrogallol and resorcinol were 0.8% and 0.6%, respectively. The frequencies of sensitization showed marked regional variations, particularly that to GMT, which was highest in Germany (51%), followed by Spain (22%) and London (19%). Clients of hairdressers showed a similar rank order of sensitization frequency, with the exception of APS, which was completely negative in this (small) series.

Contact dermatitis in hairdressers: the Italian experience. Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali

A multicenter study was performed in 9 Italian centers by members of the GIRDCA, to evaluate the frequency and source of contact sensitization in a group of 302 hairdressers with dermatitis. Occupational habits and use of preventive measures were specifically investigated both in these 302 hairdressers and in a further group of 240 hairdressers who answered a questionnaire. The results showed the presence of an occupationally relevant sensitization in 60.9% of the 302 hairdressers. This proportion included 52 hairdressers who had negative patch tests to the hairdressers' series but showed positive reactions to other allergens, such as nickel, rubber additives, preservatives and fragrances, which were judged relevant to their occupation. Among hair dyes, PPD caused 73 reactions (24.2%), PAP 32 reactions (10.6%), ONPPD 24 reactions (7.9%), and PTD 40 reactions (13.2%). A low incidence of sensitization was detected in our hairdressers to resorcinol and pyrogallol (1.3% for each substance). Among permanent wave allergens, positive reactions to GMTG were found in 11.3% of patients, while ATG gave a lower rate of positive reactions (5.0%). Allergic contact dermatitis due to APS was also relatively common (11.3%). 4 hairdressers in this study gave a positive reaction 30 min after a provocative test with latex gloves, patch testing to the rubber series being negative. Enquiry regarding preventive measures revealed that the majority of hairdressers use gloves when doing hair dyeing, but rarely use them for washing dyed hair or for doing permanent waving. The infrequent use of preventive measures by Italian hairdressers was confirmed by the results of the questionnaire, and possibly explains the high frequency of skin problems (12.5%) in the hairdressing population that was specifically interviewed.

Allergic and irritant reactions to rubber gloves in medical health services. Spectrum, diagnostic approach, and therapy

Delayed-type allergies account for most reactions to gloves. These have been found in 32 of 39 patients (82%) attending our department with occupationally induced contact dermatitis to gloves. Accelerators, mainly of the thiuram group, antioxidants, vulcanizers, organic pigments, and, presumably, glove powder ingredients are known responsible allergens. In contrast, immediate-type allergies to rubber gloves were less frequent (13 of 39 patients [33%] with occupationally induced glove allergies). They usually present as contact urticaria. Responsible allergens are latex, glove powder, and accelerators. On the basis of the numerous glove-related allergens, a comprehensive schedule of diagnostic tests is proposed. In addition, we introduce a new classification of hypoallergenic gloves according to their basic materials and ingredients and thus provide a guideline for individual therapy.

Panels of allergens for specific occupations

It is important to have available panels of materials for patch testing patients working in specific occupations. Although it is not essential in every case to test with each substance listed on a given panel, careful consideration of the patient's work environment should suggest the specific test items that will provide the highest diagnostic yield in cases of allergic contact dermatitis.

Persistence of an allergen in hair after glyceryl monothioglycolate-containing permanent wave solutions

Glyceryl monothioglycolate, a reducing agent used in permanent waving solutions, is a recognized cause of allergic contact dermatitis. Because of an unexplained persistence of dermatitis in beauty shop clients after exposure to permanent wave solutions containing glyceryl monothioglycolate, we looked for the presence of this or a cross-reacting substance in permanent-waved hair as a possible source of continued exposure to the allergen. Seventeen subjects sensitive to glyceryl monothioglycolate underwent patch testing with hair samples collected before and at various times after a permanent wave containing glyceryl monothioglycolate. None reacted to hair that had not received a permanent, while 7 of 17 showed positive reactions to the permanent-waved hair. Positive reactions were seen in hair collected as long as 3 months after the permanent. This suggests that a glyceryl monothioglycolate-related allergen is retained in hair for up to 3 months after the permanent, which may explain the long-lasting dermatitis that occurs in clients sensitive to glyceryl monothioglycolate.

Occupational allergic contact dermatitis in beauticians

We patch tested 13 beauticians with hand dermatitis between 1982 and 1986. They were all young female novice beauticians or those in training. The onset of their allergic dermatitis was noticed within 1 month to 1 year of their starting this occupation. Definite positive reactions to products were seen from hair dyes (as is, open test) (6/12), cold permanent wave primary solutions (as is, open test) (7/13) and a shampoo (1% aq., closed test) (1/13). Positive reactions to allergens were seen with para-phenylenediamine (1% pet) (12/13), ammonium thioglycolate (5% aq., open test) (3/7), para-toluylenediamine (1% pet) (7/9), para-aminophenol (1% pet) (1/4), ortho-aminophenol (1% pet) (1/4), Quinoline yellow SS (0.5% pet) (1/4), nickel sulfate (2.5% pet) (1/12), cobalt sulfate (2.3% pet) (1/12), thimerosal (0.05% pet) (1/12) and procaine hydrochloride (1% pet) (1/12). Study of the prognosis showed that 5 out of 12 cases could continue their occupation, but 4 cases had persistent hand dermatitis despite protecting their hands from hair dyes with gloves, 7 cases quitted their jobs, and in 5 their hands healed while 2 cases continued to have atopic hand dermatitis. A personal or family history of atopy was frequent among the cases, so we recommend that those who have such a history should not become beauticians.

Contact dermatitis. A review

In recent years, there has been a dramatic rise in our understanding of contact dermatitis. This paper is a review of our knowledge of the mechanisms involved in contact dermatitis and related phenomena, the investigation of these events and the emergence of significant new allergens during the last 5 years.

Contact allergen alternatives: 1986

Repeated episodes of allergic contact dermatitis burden patients with disability and expense, as well as considerable discomfort. In this paper we describe safe and practical alternatives for allergens present on the 1984-1985 "standard patch test tray" of the American Academy of Dermatology. In addition, we have provided information on alternatives for other important and common allergens encountered today. For each allergen, in addition to the molecular weight, we have given the Chemical Abstracts Number (CAS). This will be especially useful when the American Academy of Dermatology has in operation its computerized data bank, cross-linking chemicals with commercial products. In the near future, a physician will be able to obtain rapidly either the ingredients of a given product, or a list of commercial products containing a specific allergen, or both. This information will increase immensely the importance of searching for allergens by patch testing.