Patch testing with hair cosmetic series in Europe: a critical review and recommendation

Notification of hand eczema as an occupational disease among Danish hairdressers: a national survey on patients' perception

OBJECTIVES

Self-reported hand eczema was previously found under-reported as an occupational disease to the authorities among Danish hairdressers graduating from 1985 to 2007. This study investigates whether self-reported hand eczema among Danish hairdressers graduating from 2008 to 2018 is under-reported as an occupational disease to the authorities.

METHODS

A cross-sectional study on all Danish hairdressers graduating from 2008 to 2018 was conducted. The participants were identified using information from the Danish Hairdressers' and Beauticians' Union. In May 2020, a self-administered survey on hand eczema was sent to all hairdressers.

RESULTS

A response rate of 30.7% (1485/4830) was obtained. The lifetime prevalence of self-reported hand eczema was 40.1%, and 84.1% of hairdressers with hand eczema believed it to be occupational of whom 27.0% answered it was reported as an occupational disease to the authorities. Of hairdressers believing their hand eczema was occupational, consulting a doctor and answering it was reported as an occupational disease, 94.4% had consulted a dermatologist. The main reason for not reporting was 'I would probably not gain anything from it anyway' (40.0%).

CONCLUSIONS

Based on hairdressers' perception, occupational hand eczema still seems to be an under-reported disease which may lead to underestimation of the problem and impair prevention, diagnosis and treatment.

Regulation of Dendritic Cell Functions by Vitamins as Promising Therapeutic Strategy for Immune System Disorders

A functional immune system is crucial for a healthy life, protecting from infections, tumors, or autoimmune disorders; these are accomplished by the interaction between various immune cells. Nourishment, particularly micronutrients, are very important components in the immune system balance, therefore this review emphasizes the vitamins (D, E, A, C) and Dendritic cells' subsets due to vitamins' roles in immune processes, especially on dendritic cells' functions, maturation, and cytokine production. Current studies reveal significant benefits related to vitamins, including vitamin E, which can contribute to the control of dendritic cells' function and maturation. Furthermore, vitamin D plays an immunoregulatory and anti-inflammatory role in the immune system. Metabolite of vitamin A which is called retinoic acid leads to T cells' differentiation to T helper 1 or T helper 17, so low levels of this vitamin exacerbate the menace of infectious diseases, and vitamin C has anti-oxidant effects on dendritic cells and modulate their activation and differentiation program. Additionally, the correlation between the amount of vitamin and the occurrence or progression of allergic diseases and autoimmunity disorders is discussed according to the results of previous studies.

Contact allergy to ingredients of hair cosmetics in female hairdressers and female consumers-An update based on IVDK data 2013-2020

BACKGROUND

Hair cosmetic products contain several, partly potent contact allergens, including excipients like preservatives. Hand dermatitis in hairdressers is common, scalp and face dermatitis in clients or self-users (summarised here as 'consumers') may be severe.

OBJECTIVE

To compare frequencies of sensitization to hair cosmetic ingredients and other selected allergens between female patch tested patients working as hairdressers and consumers without professional background, respectively, who were tested for suspected allergic contact dermatitis to such products.

METHODS

Patch test and clinical data collected by the IVDK (https://www.ivdk.org) between 01/2013 and 12/2020 were descriptively analysed, focusing on age-adjusted sensitization prevalences in the two subgroups.

RESULTS

Amongst the 920 hairdressers (median age: 28 years, 84% hand dermatitis) and 2321 consumers (median age: 49 years, 71.8% head/face dermatitis), sensitization to p-phenylenediamine (age-standardised prevalence: 19.7% and 31.6%, respectively) and toluene-2,5-diamine (20 and 30.8%) were most common. Contact allergy to other oxidative hair dye ingredients was also more commonly diagnosed in consumers, whereas ammonium persulphate (14.4% vs. 2.3%) and glyceryl thioglycolate (3.9 vs. 1.2%) as well as most notably methylisothiazolinone (10.5% vs. 3.1%) were more frequent allergens in hairdressers.

CONCLUSIONS

Hair dyes were the most frequent sensitizers both in hairdressers and in consumers; however, as indication for patch testing may differ, prevalences cannot directly be compared. The importance of hair dye allergy is evident, often with marked coupled reactivity. Workplace and product safety need to be further improved.

Systematic review on skin adverse effects of important hazardous hair cosmetic ingredients with a focus on hairdressers

BACKGROUND

The burden of occupational hand eczema in hairdressers is high, and (partly strong) allergens abound in the hair cosmetic products they use.

OBJECTIVES

To systematically review published evidence concerning contact allergy to an indicative list of active ingredients of hair cosmetics, namely, p-phenylenediamine (PPD), toluene-2,5-diamine (PTD), persulfates, mostly ammonium persulfate (APS), glyceryl thioglycolate (GMTG), and ammonium thioglycolate (ATG), concerning the prevalence of sensitization, particularly in terms of a comparison (relative risk; RR) between hairdressers and non-hairdressers.

METHODS

Following a PROSPERO-registered and published protocol, eligible literature published from 2000 to February 2021 was identified, yielding 322 publications, and extracted in standardized publication record forms, also considering risk of bias.

RESULTS

Based on 141 publications, the contact allergy prevalence to PPD was 4.3% (95% CI: 3.8-4.9%) in consecutively patch tested patients. Other ingredients were mostly tested in an aimed fashion, yielding variable, and partly high contact allergy prevalences. Where possible, the RR was calculated, yielding an average increased sensitization risk in hairdressers of between 5.4 (PPD) and 3.4 (ATG). Additional evidence related to immediate-type hypersensitivity, experimental results, exposures, and information from case reports was qualitatively synthesized.

CONCLUSIONS

An excess risk of contact allergy is clearly evident from the pooled published evidence from the last 20 years. This should prompt an improvement in working conditions and product safety.

The 2-Methoxymethyl Modification of p-Phenylenediamine Reduces the Sensitization Risk for Hairdressers to Hair Dyes-An Occupational Hand Exposure-Based Risk Assessment

BACKGROUND

Allergic contact dermatitis involving the hands is a common occupational skin disease for hairdressers and the potent sensitizers p-phenylenediamine (PPD) and toluene-2,5-diamine (PTD) are associated with the development of occupational allergic contact dermatitis.

OBJECTIVE

The aim of the study was to analyze whether the use of the moderate sensitizer 2-methoxymethyl-PPD (ME-PPD) in professional hair dyes is a suitable tool to reduce the occupational contact allergy risk for hairdressers.

METHODS

Hand exposure of hairdressers (N = 11) to ME-PPD was analyzed under routine hair coloring conditions in commercial salons. By accounting for wet work and uneven hand exposure, the daily hand exposure was derived and compared with the occupational acceptable exposure level (AEL), that is, the sensitization induction threshold of ME-PPD adjusted for interindividual variability among workers.

RESULTS

The daily hand exposure to ME-PPD was 1.6 μg/cm2, and the occupational AEL was 215 μg/cm2. The ratio of hand exposure to AEL was calculated as the margin of safety (MOS) against occupational sensitization. For ME-PPD, the MOS of 134 indicates a low likelihood of sensitization versus PPD and PTD with MOS values of 2.7 and 5.9, respectively.

CONCLUSIONS

Our data predict that the use of ME-PPD in professional hair color products improves the protection of hairdressers against hair dye-related contact allergy versus the use of PPD and PTD.

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.

Prevalence and incidence of hand eczema in hairdressers - a systematic review and meta-analysis of published literature from 2000-2021

BACKGROUND

Hairdressers are commonly affected by hand eczema (HE), due to skin hazardous exposure such as irritants and allergens in the work environment.

OBJECTIVE

To give an overview of the current prevalence, incidence, severity as well as the pattern of debut and the contribution of atopic dermatitis on HE in hairdressers.

METHODS

A systematic review according to the PRISMA guidelines was performed. Studies published from 2000 to April 2021 that fulfilled predefined eligibility criteria were retrieved.

RESULTS

A pooled lifetime prevalence of 38.2% (95%CI 32.6-43.8), a pooled 1-year prevalence of 20.3% (95%CI 18.0-22.6) and a pooled point prevalence of 7.7% (95%CI 5.8-9.6) of HE was observed in hairdressers. The lifetime prevalence in fully trained hairdressers and hairdressing apprentices was almost identical. The pooled incidence rate of HE was 51.8 cases/1000 person-years (95%CI 42.6-61.0) and the pooled prevalence of atopic dermatitis was 18.1% (95%CI 13.6-22.5).

CONCLUSION

HE is common in hairdressers and most have debut during apprenticeship. The prevalence of atopic dermatitis in hairdressers is comparable with estimates in the general population, indicating that occupational exposures are the main factor in the increased prevalence of HE in hairdressers. This warrants a strategic and collective effort to prevent HE in hairdressers. This article is protected by copyright. All rights reserved.

Contact Dermatitis Associated With Hair Care Products: A Retrospective Analysis of the North American Contact Dermatitis Group Data, 2001-2016

BACKGROUND

Hair care products (HCPs) may cause both allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD).

OBJECTIVES

The aims of the study were to determine the prevalence of HCP-associated ICD/ACD and to characterize relevant allergens.

METHODS

This study is a retrospective analysis of North American Contact Dermatitis Group (NACDG) patch test data, 2001-2016.

RESULTS

Of 38,775 patients tested, 3481 (9.0%) had positive patch test reactions associated with HCPs. The HCP-positive patients were significantly more likely to be female (79.9% vs 66.0%) and/or have primary sites of dermatitis on the face (32.0% vs 27.8%) or scalp (15.4% vs 2.2%) compared with the HCP-negative patients (P < 0.0001). Of 4908 HCP-associated positive patch test reactions, 86.9% (n = 4263) were due to allergens on the NACDG screening series; p-phenylenediamine (35.8%), methylisothiazolinone (9.7%), methylchloroisothiazolinone/methylisothiazolinone (8.7%), and cocamidopropyl betaine (5.9%) were the most frequent. Most reactions (87.7%, 3736/4263) were currently clinically relevant. The most common job associated with 366 occupationally related NACDG HCP-associated allergens was hairdresser/cosmetologist (71.9%). Two hundred eighty-two patients (0.7%) had ICD associated with HCPs. Shampoo/conditioners were the most frequent source of NACDG HCP-associated reactions (47.3%) and HCP-associated ICD (45.0%).

CONCLUSIONS

Of the HCP-positive patients, 18.5% had HCP reactions to allergens not on the NACDG screening series, underscoring the importance of patch testing to expanded series in patients suspected of HCP allergy.

The European baseline series: Criteria for allergen inclusion (with reference to formaldehyde releasers)

Existing criteria for inclusion in the European baseline series are summarized. Additional criteria are developed to aid decision making where the current criteria do not yield an unequivocal result. These include a consideration of whether an allergen (hapten) is better placed in a special series and the frequency with which an allergen cross-reacts with existing markers in the baseline series.

Risks associated with cosmetic ingredients

The media and social networks often echo fears about the potential toxicity of cosmetics and the dangers they pose to the environment. Dermatologists may be asked about these topics, but despite regulatory labelling constraints and the proliferation of specialized sites and applications, they do not always have access to reliable information. It is for this reason that we are providing the present overview of current knowledge on the subject.

Developing a cosmetic series: Results from the ESSCA network, 2009-2018

BACKGROUND

There is considerable variability across European patch test centres as to which allergens are included in local and national cosmetics series.

OBJECTIVES

To propose a standardized, evidence-based cosmetic series for Europe based on up-to-date analysis of relevant contact allergens.

METHODS

We collated data from the European Surveillance System on Contact Allergies (ESSCA) from 2009 to 2018 to determine which cosmetic allergens produce a high yield of contact allergy. Contact allergens with a prevalence of >0.3% that were considered relevant were included. Rare contact allergens were excluded if deemed no longer relevant or added to a supplemental cosmetic series for further analysis.

RESULTS

Sensitization prevalences of 39 cosmetic contact allergens were tabulated. Thirty of these allergens yielded >0.3% positive reactions and are therefore included in our proposed European cosmetic series. Six were considered no longer relevant and therefore excluded. Three were included in a supplementary European cosmetic series. An additional nine allergens were included in either the core or supplemental European cosmetic series following literature review.

CONCLUSION

We have derived a potential European cosmetic series based upon the above methods. This will require ongoing investigation based upon the changing exposure profiles of cosmetic allergens as well as new and evolving substances.

Simultaneous Determination of Cysteamine and Cystamine in Cosmetics by Ion-Pairing Reversed-Phase High-Performance Liquid Chromatography

Cysteamine has been used in cosmetics as an antioxidant, a hair straightening agent, and a hair waving agent. However, recent studies indicate that cysteamine can act as an allergen to hairdressers. The objective of this study was to develop and validate a simple and effective reversed-phase high-performance liquid chromatography (RP-HPLC) method for the measurement of cysteamine and its dimer, cystamine. Sodium 1-heptanesulfonate (NaHpSO) was used as an ion-pairing agent to improve chromatographic performance. Separation was performed on a Gemini C18 column (250 mm × 4.6 mm, 5 μm particle size) using a mobile phase composed of 85:15 (v/v) 4 mM NaHpSO in 0.1% phosphoric acid:acetonitrile. UV absorbance was monitored at 215 nm. The RP-HPLC method developed in this study was validated for specificity, linearity, limit of detection, limit of quantitation, precision, accuracy, and recovery. Cysteamine and cystamine were chromatographically resolved from other reducing agents such as thioglycolic acid and cysteine. Extraction using water and chloroform resulted in the recovery for cysteamine and cystamine ranging from 100.2-102.7% and 90.6-98.7%, respectively. This validated RP-HPLC method would be useful for quality control and monitoring of cysteamine and cystamine in cosmetics.

Non-oxidative hair dye products on the European market: What do they contain?

BACKGROUND

Hair dyeing is very common and may cause allergic contact dermatitis. Oxidative (often termed permanent or semi-permanent) hair dye products have constituted the focus of market surveys and toxicological risk assessments, while non-oxidative (semi-permanent, temporary or direct) products have not been assessed.

OBJECTIVES

To identify the hair dye substances presently used in non-oxidative hair dye products in Europe.

METHODS

Ingredient label data on eligible products in 5 European countries were collected, and 289 different non-oxidative hair dye products were included in this study.

RESULTS

Up to 9 hair dye substances were present in each product. Sixty-eight individual hair dye substances were identified on the 289 product labels, and their occurrence ranged from 0.3% to 34%. There were differences concerning substances used and their number per product between products of different consistency and colour.

CONCLUSIONS

The hair dye substances in non-oxidative hair dye products are different from those in oxidative hair dye products, and are currently not covered by patch test series. The toxicological and skin-sensitizing profile of the substances in non-oxidative hair dye products, as well as their concentrations, should be further investigated.

Alternative Methods to Animal Testing for the Safety Evaluation of Cosmetic Ingredients: An Overview

The safety of cosmetics sold in Europe is based on the safety evaluation of each individual ingredient conducted by those responsible for putting the product on the market. However, those substances for which some concern exists with respect to human health (e.g., colorants, preservatives, UV-filters, nanomaterials) are evaluated at the European Commission level by a scientific committee, currently called the Scientific Committee on Consumer Safety (SCCS). According to the Cosmetics Regulation (European Commission, 2009), it is prohibited in the European Union (EU) to market cosmetic products and ingredients that have been tested on animals. However, the results of studies performed before the ban continue to be accepted. In the current study, we evaluated the use of in vitro methods in the dossiers submitted to the SCCS in the period between 2013 and 2016 based on the published reports issued by the scientific committee, which provides a scientific opinion on these dossiers. The results of this evaluation were compared with those of an evaluation conducted four years previously. We found that, despite a slight increase in the number of studies performed in vitro, the majority of studies submitted to the SCCS is still done principally in vivo and correspond to studies performed before the ban.

A multi-institutional joint study of contact dermatitis related to hair colouring and perming agents in Japan

BACKGROUND

In Japan, allergic contact dermatitis caused by hair colouring agents is a considerable problem for those occupationally exposed and also for consumers. Over the last 20 years, p-phenylenediamine (PPD) has been a common allergen, with ∼7% positive patch test reactions.

OBJECTIVES

To investigate which ingredients caused allergic contact dermatitis related to hair dye and perming solutions in Japan, to assess whether PPD is suitable for screening for hair dye allergy, and to propose allergens for a Japanese hairdresser series.

METHODS

We selected 19 hair cosmetic allergens, including PPD, Bandrowski's base, cysteamine HCl, and ammonium thioglycolate. Altogether 203 patients (26 males and 177 females) with suspected contact allergy to hair colouring or perming solutions at 14 hospitals in Japan were included.

RESULTS

The highest prevalence of positive reactions (35.1%) was for PPD. p-Methylaminophenol and o-aminophenol were often positive, both in the PPD-positive and in the PPD-negative patients. Moreover, cysteamine HCl often yielded positive test reactions.

CONCLUSIONS

PPD is insufficient to diagnose contact allergy caused by to hair dyes. We recommend 13 allergens to be included in a Japanese hairdresser series.

Influence of vitamin C on the elicitation of allergic contact dermatitis to p-phenylenediamine

BACKGROUND

Hair dyes represent one of the most important causes of allergic contact dermatitis resulting from the use of cosmetic products. The principal causative chemistry is associated with oxidation products of p-phenylenediamine (PPD) and closely related substances.

OBJECTIVES

To examine whether prior application of the antioxidant vitamin C to the skin was able to reduce the cutaneous allergic response to PPD.

METHODS

Twenty eight volunteers with a proven history of contact allergy to PPD were recruited. Each was tested with a range of PPD doses and PPD-containing hair dye on untreated skin and skin pretreated for 10 min with a vitamin C formulation.

RESULTS

Pretreatment of skin sites with vitamin C led to a reduction in the intensity, or even ablation, of the cutaneous allergic reaction to PPD in ∼75% of cases as compared with untreated skin.

CONCLUSIONS

The results suggest that treatment of the skin adjacent to the hair-bearing area with antioxidant could form part of a strategy to reduce the burden of cosmetic allergic contact dermatitis caused by hair dyeing.