Thesaurosis following inhalation of hair spray; a clinical and experimental study

Hairspray Inhalation-induced Interstitial Pneumonitis Evaluated by a Transbronchial Lung Cryobiopsy

A 60-year-old Japanese woman was admitted to our hospital with a fever and shortness of breath occurring immediately after using hairspray. Chest high-resolution computed tomography (HRCT) showed ground-glass opacities (GGOs) predominantly distributed around the bronchovascular bundles, and a pathological evaluation by a transbronchial lung cryobiopsy (TBLC) revealed fibrotic non-specific interstitial pneumonia (f-NSIP). Her symptoms disappeared without the use of corticosteroids, and GGOs on HRCT improved markedly over time. This case suggests that a pathological evaluation by a TBLC for lung injury due to inhalation pathogen exposure may provide a more accurate diagnosis and a better understanding of the pathology from bronchial to interstitial lesions than transbronchial lung biopsy.

Final Report On the Safety Assessment of Polyvinylpyrrolidone (PVP)

Polyvinylpyrrolidone (PVP) is a linear polymer of 1-vinyl-2-pyrrolidone monomers used as a binder, emulsion stabilizer, film former, hair fixative, and suspending agent-nonsurfactant. The molecular weight of the polymer ranges from 10,000 to 700,000. PVP K-30, with an average molecular weight of 40,000, is typically used in cosmetic formulations. The highest concentration reported to be used is 35%. There was no significant absorption of PVP K-30 given orally to rats, and the acute oral LD50 was >100 g/kg for rats and guinea pigs. Neither toxic effects nor gross lesions were found in rats maintained for two years on a diet containing 10% PVP K-30. Short-term PVP inhalation studies produced mild lymphoid hyperplasia and fibroplasia in rats, but no inflammatory response. In animal studies, no evidence of significant ocular irritation, skin irritation, or skin sensitization was found at PVP-iodine solution concentrations of 10%. While PVP-iodine is not a cosmetic ingredient, these negative findings were considered to support the safety of the PVP component. Undiluted PVP K-30 was not a dermal irritant or sensitizer in clinical tests. No developmental toxicity was seen in vehicle controls where PVP was used as a vehicle for another agent. In certain assay systems, PVP was genotoxic, but was negative in the majority of studies. Orally administered PVP significantly decreased the rate of bladder tumors in mice exposed to bracken fern. Several studies tested the carcinogenicity of subcutaneous implants of particulate PVP in rats, mice, and rabbits. Although the majority of these studies conducted in rats were positive, tumors (sarcomas) were localized to the site of implantation. Based on the available data, it was concluded that PVP is safe as used in cosmetics.

6 Final Report on the Safety Assessment of Vinyl Acetate/Crotonic Acid Copolymer

Vinyl Acetate/Crotonic Acid (VA/CA) Copolymer is a polymer formed from vinyl acetate and crotonic acid monomers. VA/CA Copolymer is primarily used as a film forming agent in aerosol hair sprays and other hair preparations.

An aqueous solution containing 3.7% VA/CA Copolymer and a hair spray containing 13.75% of the ingredient were relatively harmless when administered to rats in single oral doses of up to 50 ml/kg and 5 g/kg, respectively. These same test materials elicited no skin irritation in rabbits and minimal, transient eye irritation. Hair spray formulations containing 0.86% of the copolymer caused no skin irritation or sensitization when tested in a repeated insult patch test on humans.

On the basis of the available information, Vinyl Acetate/Crotonic Acid Copolymer is considered safe as a cosmetic ingredient under present practices of product and concentration use.

Self reported respiratory symptoms and diseases among hairdressers

OBJECTIVES

Hairdressers are exposed to many irritative and allergenic substances capable of causing occupational respiratory symptoms and diseases. The self reported prevalence of respiratory symptoms and diseases was studied, and the risks among hairdressers compared with saleswomen was estimated.

METHODS

A cross sectional prevalence study of respiratory symptoms and diseases was carried out among hairdressers and supermarket saleswomen, with a computer assisted telephone interview method (CATI). The study population comprised all the female hairdressers and supermarket saleswomen aged 15-54 years in the Helsinki metropolitan area, Finland. Disproportionate random samples of female hairdressers and sales-women were drawn from the trade union membership registers. The interviews were carried out between February and April 1994. A response rate of 80.5% (355/440) was obtained for hairdressers and 82.2% (583/709) for saleswomen. Atopy, smoking, chronic illnesses, type of work, working hours, working conditions, personal and professional use of hair products, and the use of personal protective devices were assessed. The outcome variables were self reported symptoms of the upper and lower respiratory tract. These were used to define chronic bronchitis, and asthma, laryngitis, and allergic rhinitis diagnosed by a physician.

RESULTS

There was a considerable difference in the prevalence of chronic bronchitis; 6.8% in hairdressers versus 1.9% in saleswomen. The odds ratio (OR) adjusted for age, smoking, and atopy for chronic bronchitis indicated an increased risk of chronic bronchitis (OR 4.8, 95% confidence interval (95% CI) 2.2 to 10.1). No association was found between work as a hairdresser and asthma, laryngitis, and allergic rhinitis. Also the prevalence of rhinitis, rhinitis with eye symptoms, cough with phlegm, dyspnoea, and dyspnoea accompanied by cough was increased among hairdressers. The corresponding adjusted risk ORs were 1.7 (95% CI 1.3 to 2.3) for rhinitis, 1.9 (95% CI 1.4 to 2.6) for rhinitis with eye symptoms, 1.4 (CI 1.1 to 1.9) for cough with phlegm, 1.5 (95% CI 1.0 to 2.2) for dyspnoea, and 1.6 (95% CI 1.0 to 2.7) for dyspnoea with cough.

CONCLUSIONS

Our results indicate an increased prevalence of upper and lower respiratory symptoms among hairdressers. Allergenic and irritative chemicals in hairdressing are likely candidates explaining the difference found between the hairdressers and controls. Work related reasons should be considered when a hairdresser presents with airway symptoms. Preventive actions are needed to improve the working conditions and personal protection.

'Mucoid dissolution' of bones and multiple pathologic fractures in a patient with past history of intravenous administration of polyvinylpyrrolidone (PVP). A case report

Polyvinylpyrrolidone (PVP) has been used in industry as well as in medicine for various purposes, e.g. as a component of hair-sprays, 'retardant' for subcutaneous injections, and given intravenously as a plasma expander. The latter usage results in deposition of PVP in the reticulo-endothelial system and other mesenchymal cells, including osteocytes. A middle aged woman in Taiwan, who for 10 years received repeated intravenous injections of PVP, suffered pathologic fractures of both femora and her right humerus with additional destructive lesions seen radiologically in other bones. Biopsies of the fracture sites showed both intracellular PVP deposits and mucoid changes in the involved cells, a characteristic secondary complication of PVP deposition. This phenomenon, if of sufficient severity, may cause, as in this case, a virtual 'melting down' of osseous tissue with pathological fractures as a consequence.

Acetylene-derived polymers and their applications in hair and skin care

Synopsis Since the introduction over 30 years ago of polyvinylpyrrolidone (PVP) as the first synthetic hairspray resin, acetylene-derived polymers have found wide and increasing applications in the cosmetics and toiletries industry. This review covers the two main classes of acetylenic polymers. In the first class, in which the chemistry may be traced back to reaction of acetylene with formaldehyde, are included PVP homopolymers and copolymers of VP with vinyl acetate, dimethylaminoethyl methacrylate, vinylcaprolactam and styrene. In the second class, stemming from reaction of acetylene with methanol, are the poly (vinyl methyl ether/maleic acid) monoester resins.

Nasal mucociliary clearance in hairdressers: correlation to exposure to hair spray

It has previously been demonstrated that hair spray sprayed onto the hair of experimental subjects reduces the mucociliary transport in the trachea and nose. Ladies hairdressers are exposed to the effects of hair spray throughout the whole working day, and we therefore investigated the nasal mucociliary transport of 60 hairdressers and 15 control subjects before and after a working day by the saccharin method. We found a significant reduction in the mucociliary transport of the ladies hairdressers during the working day (P less than 0.001), but not in control subjects. The reduction in mucociliary transport could be correlated to the amount of hair spray applied by the individual hairdresser to the hair of the customer during the day.

A perspective on particulate size analysis of consumer aerosol products

Various aspects of size distribution analysis of commercial aerosol spray products and their relevance to toxicity are discussed. Mechanisms of respiratory deposition, sizing methods, and aerosol terminology are reviewed. A presentation of much of the published aerosol size data is given, along with comments about the sizing and sampling techniques used in the reported studies.

The effects of pressurized aerosols on respiratory symptoms and physiology

In a general population sample, use of pressurized aerosols appears to be associated with transient symptoms, but it does not appear to lead to chronic respiratory complaints or to functional abnormalities. This is true in both atopic and non-atopic subjects. Furthermore, changing patterns of aerosol use are not associated with changes in respiratory symptoms. Thus, household and cosmetic aerosols do not appear to be important risk factors for respiratory diseases.

Alveolitis due to hair-spray. Ultrastructural observations in two patients and the results of experimental investigations

Observation of two patients with hair-spray induced lung disease have prompted us to study the ultrastructure of the lung lesion. We have compared the results with experimental lesions in animals injected with hair-spray extracts and with human monocyte cell cultures exposed to hair-spray. The lungs show a chronic alveolitis with a striking granulomatous reaction including macrophages and multinucleated giant cells of the foreign body type. The intraalveolar and interstitial macrophages and the giant cells all contain PAS-positive material. Ultrastructurally distinct lamellar inclusions are found in the secondary lysosomes of the macrophages and giant cells. Identical structures can be produced in animals injected with hair-spray extracts and with polyvinyl-pyrrolidone and -acetate (PVP/PVA), which are regular ingredients of hair-sprays. Large, presumeably polymeric particles (PVP/PVA) are ingested by giant cells. This "gigantophagocytosis" is associated with the fusion of mononuclear phagocytes and leads to the genesis of giant cells. In cell cultures of human blood monocytes hair-spray extracts and PVP/PVA induce maturation and aggregation of these cells, with PAS-positive cytoplasmatic inclusions. The development of multinuclear giant cells in these monocyte cell cultures is also seen. These observations suggest that hair-spray induced lung disease is caused by the prolonged and extensive body response of the local mononuclear phagocyte system (MPS). Overstimulation of the MPS leads to a quantitative and qualitative change which is followed by a partial blockade of this system. The alveolitis is a consequence of the foreign body response to inhaled hair-spray substances.

Airway response to hair spray in normal subjects and subjects with hyperreactive airways

Short-term 20-second exposure to hair sprays A and B failed to show significant decreases in maximum expiratory flow rates at low pulmonary volumes in normal subjects; however, significant decreases were observed with hair spray B in eight subjects with hyperractive airways (abnormal response to inhalation of methacholine). On the partial flow-volume curves, flows at 40 percent and 25 percent of forced vital capacity decreased 8.9 to 10.3 percent and 14 to 18.7 percent, respectively. The hair sprays differed in their content of perfume and plasticizer, and since the latter is generally considered nontoxic at room temperature, the perfume may be the responsible agent. It would appear from this study that normal healthy individuals are at little risk, at least from brief exposure to hair spray; however, in the presence of hyperreactive airways, as seen in asthmatic subjects and in some people with allergic rhinitis and viral respiratory infections, an immediate response of the airways may result from exposure to some hair sprays.

Electron microscopy of desquamative interstitial pneumonia

The clinical, radiographical, and physiological picture of two patients suffering from desquamative interstitial pneumonia is described. The diagnosis was established by lung biopsy when the characteristic histological features were found on light microscopy. The dramatic response to adequate corticosteroid therapy is recorded, and attention is directed to the danger of serious relapse on early withdrawal of this treatment and the subsequent satisfactory response to a second course. Electron microscopical studies of the tissue from one patient add materially to the understanding of the clinical course and the nature of the tissue response. At the ultrastructural level the attenuated membranous (type 1) pneumonocytes which normally line the alveoli were replaced by granular (type 2) pneumonocytes. The desquamated intra-alveolar cells comprised two main groups. These were granular pneumonocytes, similar to those lining the alveoli, and smaller numbers of macrophages. The cytopathic effects of virus infection were not detected by light or electron microscopy.