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Hair dyes
Hair dyes See also Food, drug, and cosmetic dyes
GENERAL INFORMATION Hair dyes (for example henna, paraphenylenediamine, and paratoluenediamine) have been reviewed [1]. They have moderate to low acute toxicity. Poisoning is rare and occurs only after oral ingestion. Contact sensitization usually occurs from unprotected professional exposure, but the prevalence has stabilized or fallen over the years. In vitro genotoxicity tests of hair dye ingredients have often been positive, but the relation to in vivo carcinogenicity is not clear and there is no in vivo evidence of genotoxicity. Despite the results of various studies that have suggested an association between the use of hair dyes and bladder cancer, a number of studies, including prospective investigations in large populations and systematic reviews, have shown no convincing associations with bladder cancer and other cancers. The results of direct toxicity studies and epidemiological studies suggest that hair dyes and their ingredients do not cause adverse reproductive effects.
ORGANS AND SYSTEMS Immunologic Allergic reactions to constituents of hair dyes are not uncommon and are generally due to delayed hypersensitivity. Immediate hypersensitivity reactions have been described, but they are rare and seldom life-threatening. Contact allergy to the paraphenylene group of hair dyes is well established [2]. To test for cross-reactivity between these oxidative dyes and the new generation of hair dyes, 40 hairdressers allergic to paraphenylenediamine were selected; none reacted to any of the four acid dyes, two FD&C dyes, or four D&C dyes (see Food, Drug, And Cosmetic Dyes), suggesting that these newer hair dyes are safe alternatives to the paraphenylene-based hair dyes [3]. There is a risk of sensitization from paraphenylenediamine when it is applied to the skin in combination with henna [4–6]. This can result in contact allergic reactions as well as persistent contact leukoderma, as illustrated in five patients with paint-on henna tattoos [7]. All were positive on patch-testing with paraphenylenediamine. One developed erythema multiforme 4 weeks after the last application and the authors found no other causes of erythema multiforme. The use of the combination of henna and paraphenylenediamine in 20 cases over 2 years in Khartoum (Sudan) resulted in severe toxicity [8]. The initial symptoms were those of angioedema, with massive edema of the face, lips, glottis, pharynx, neck, and bronchi. These occurred within hours of the application of the dye mix to the skin. In some the symptoms progressed on the second day to anuria and acute renal insufficiency, with death on the third day.
ã 2016 Elsevier B.V. All rights reserved.
Dialysis helped some patients, but others died from renal tubular necrosis. The oxidation product of paratoluenediamine has been identified as a rare cause of a life-threatening immediate hypersensitivity reaction [9]. A 45-year-old woman developed extensive urticarial lesions 30
minutes after the application of a hair dye, starting on the scalp and face, followed by abdominal cramps, watery diarrhea, vomiting, dysphonia, and loss of consciousness. A prick test with a 1/128 dilution of the hair dye showed a positive reaction, but individual dye constituents did not. Prick testing with the oxidation products of the individual dye constituents showed a strongly positive reaction to oxidized paratoluenediamine, which was weaker after addition of an antioxidant to the mixture.
Ten healthy controls had negative prick tests with the oxidized paratoluenediamine.
LONG-TERM EFFECTS Tumorigenicity In a review of cohort and case–control studies of occupational exposure to hair dyes among hairdressers, barbers, and beauticians, the relative risk of bladder cancer was 1.4 from cohort studies, and somewhat over 1.0 from case– control studies; however, there were confounding factors, particularly since allowance for smoking was lacking or inadequate in most studies [10]. In five case–control studies of personal use of hair dyes, there was no evidence of an increased risk of bladder cancer. In nine cohort studies the relative risk of lymphoid neoplasms overall was 1.2 (1.5 for non-Hodgkin’s lymphomas and 1.1 for multiple myeloma). Of five case–control studies, three reported some association with lymphoid neoplasms, but the estimates of relative risk were only moderately above 1.0 and there was insufficient allowance for potential confounding factors, including social class and greying hair, which could correlate with both hair dye use and lymphoid neoplasms. No other neoplasms, including those of breast, skin, and lung were related to the use of hair dyes. In another study there was an increased risk of Hodgkin’s disease among women who reported the use of hair coloring products before 1980 (OR ¼1.3; CI ¼1, 1.8) [11]. Previous studies have suggested an association between the use of hair dyes and some cancers [12,13]. Several previous studies have found an association of non-Hodgkin lymphoma with the use of hair dyes, particularly permanent dark colors and use before 1980, when hair dye formulations changed. The risk of non-Hodgkin’s lymphoma has been examined in relation to reported hair dye use among 1321 cases and 1057 controls from a US population-based multicenter study. DNA was extracted from blood or buccal cells to identify genetic variations in N-acetyltransferase 1 (NAT1) and 2 (NAT2), which encode enzymes that metabolize aromatic amine compounds found in hair dyes. There was a increased risk of non-Hodgkin lymphoma among women who used dark colored or intense-tone permanent hair dyes before 1980 [14].
644
Hair dyes
DRUG ADMINISTRATION Drug overdose In one case deliberate ingestion of paraphenylenediamine with suicidal intent caused severe oropharyngeal edema, rhabdomyolysis, and cardiac death after 4 hours despite full supportive treatment [15]. Myocarditis has been attributed to paraphenylenediamine poisoning [16]. An 18-year-old woman developed asphyxia and rhabdomyoly-
sis after taking paraphenylenediamine 5 g. An electrocardiogram showed ventricular extra beats and inverted T waves. The serum CK activity was 28 020 mkat/l. Transthoracic echocardiography showed left and right ventricular hypokinesis and a left ventricular apical thrombus. Anticoagulation treatment with heparin was initiated. A follow-up echocardiogram performed on the 15th day showed normalization of ventricular function and disappearance of the thrombus.
In two patients acute oliguric renal insufficiency due to acute tubular necrosis followed paraphenylenediamine intoxication; there was associated vomiting, angioedema, cyanosis, and intravascular hemolysis [17]. One patient recovered and the other died with septicemia. In four other cases acute renal insufficiency was due to rhabdomyolysis.
REFERENCES [1] Nohynek GJ, Fautz R, Benech-Kieffer F, Toutain H. Toxicity and human health risk of hair dyes. Food Chem Toxicol 2004; 42(4): 517–43. [2] Sosted H, Agner T, Andersen KE, Menne T. 55 cases of allergic reactions to hair dye: a descriptive, consumer complaint-based study. Contact Dermatitis 2002; 47(5): 299–303. [3] Fautz R, Fuchs A, van der Walle H, Henny V, Smits L. Hair dye-sensitized hairdressers: the cross-reaction pattern with new generation hair dyes. Contact Dermatitis 2002; 46(6): 319–24. [4] Tosti A, Pazzaglia M, Corazza M, Virgili A. Allergic contact dermatitis caused by mehindi. Contact Dermatitis 2000; 42(6): 356. [5] Mohamed M, Nixon R. Severe allergic contact dermatitis induced by paraphenylenediamine in paint-on temporary “tattoos” Australas J Dermatol 2000; 41(3): 168–71.
ã 2016 Elsevier B.V. All rights reserved.
[6] Lestringant GG, Bener A, Frossard PM. Cutaneous reactions to henna and associated additives. Br J Dermatol 1999; 141(3): 598–600. [7] Jappe U, Hausen BM, Petzoldt D. Erythema multiformelike eruption and depigmentation following allergic contact dermatitis from a paint-on henna tattoo, due to paraphenylenediamine contact hypersensitivity. Contact Dermatitis 2001; 45(4): 249–50. [8] D’Arcy PF. Fatalities with the use of a henna dye. Pharm Int 1982; 3: 217. [9] Pasche-Koo F, French L, Piletta-Zanin PA, Hauser C. Contact urticaria and shock to hair dye. Allergy 1998; 53(9): 904–5. [10] La Vecchia C, Tavani A. Epidemiological evidence on hair dyes and the risk of cancer in humans. Eur J Cancer Prev 1995; 4(1): 31–43. [11] Zhang Y, Holford TR, Leaderer B, Boyle P, Zahm SH, Flynn S, Tallini G, Owens PH, Zheng T. Hair-coloring product use and risk of non-Hodgkin’s lymphoma: a population-based case–control study in Connecticut. Am J Epidemiol 2004; 159(2): 148–54. [12] Miligi L, Costantini AS, Benvenuti A, Veraldi A, Tumino R, Ramazzotti V, Vindigni C, Amadori D, Fontana A, Rodella S, Stagnaro E, Crosignani P, Vineis P. Personal use of hair dyes and hematolymphopoietic malignancies. Arch Environ Occup Health 2005; 60(5): 249–56. [13] Heineman EF, Ward MH, McComb RD, Weisenburger DD, Zahm SH. Hair dyes and the risk of glioma among Nebraska women. Cancer Causes Control 2005; 16(7): 857–64. [14] Morton LM, Bernstein L, Wang SS, Hein DW, Rothman N, Colt JS, Davis S, Cerhan JR, Severson RK, Welch R, Hartge P, Zahm SH. Hair dye use, genetic variation in Nacetyltransferase 1 (NAT1) and 2 (NAT2), and risk of nonHodgkin lymphoma. Carcinogenesis 2007; 28(12): 1759–64. [15] Ashraf W, Dawling S, Farrow LJ. Systemic paraphenylenediamine (PPD) poisoning: a case report and review. Hum Exp Toxicol 1994; 13(3): 167–70. [16] Zeggwagh AA, Abouqal R, Abidi K, Madani N, Zekraoui A, Kerkeb O. Thrombus ventriculaire gauche et myocardite toxique induite par la paraphe´nylene diamine. [Left ventricular thrombus and myocarditis induced by paraphenylenediamine poisoning.] Ann Fr Anesth Reanim 2003; 22(7): 639–41. [17] Bourquia A, Jabrane AJ, Ramdani B, Zaid D. Toxicite´ systemique de la paraphe´nylene diamine. Quatre observations. [Systemic toxicity of paraphenylenediamine. 4 cases.] Presse Med 1988; 17(35): 1798–800.
GENERAL INFORMATION Hair dyes (for example henna, paraphenylenediamine, and paratoluenediamine) have been reviewed [1]. They have moderate to low acute toxicity. Poisoning is rare and occurs only after oral ingestion. Contact sensitization usually occurs from unprotected professional exposure, but the prevalence has stabilized or fallen over the years. In vitro genotoxicity tests of hair dye ingredients have often been positive, but the relation to in vivo carcinogenicity is not clear and there is no in vivo evidence of genotoxicity. Despite the results of various studies that have suggested an association between the use of hair dyes and bladder cancer, a number of studies, including prospective investigations in large populations and systematic reviews, have shown no convincing associations with bladder cancer and other cancers. The results of direct toxicity studies and epidemiological studies suggest that hair dyes and their ingredients do not cause adverse reproductive effects.
ORGANS AND SYSTEMS Immunologic Allergic reactions to constituents of hair dyes are not uncommon and are generally due to delayed hypersensitivity. Immediate hypersensitivity reactions have been described, but they are rare and seldom life-threatening. Contact allergy to the paraphenylene group of hair dyes is well established [2]. To test for cross-reactivity between these oxidative dyes and the new generation of hair dyes, 40 hairdressers allergic to paraphenylenediamine were selected; none reacted to any of the four acid dyes, two FD&C dyes, or four D&C dyes (see Food, Drug, And Cosmetic Dyes), suggesting that these newer hair dyes are safe alternatives to the paraphenylene-based hair dyes [3]. There is a risk of sensitization from paraphenylenediamine when it is applied to the skin in combination with henna [4–6]. This can result in contact allergic reactions as well as persistent contact leukoderma, as illustrated in five patients with paint-on henna tattoos [7]. All were positive on patch-testing with paraphenylenediamine. One developed erythema multiforme 4 weeks after the last application and the authors found no other causes of erythema multiforme. The use of the combination of henna and paraphenylenediamine in 20 cases over 2 years in Khartoum (Sudan) resulted in severe toxicity [8]. The initial symptoms were those of angioedema, with massive edema of the face, lips, glottis, pharynx, neck, and bronchi. These occurred within hours of the application of the dye mix to the skin. In some the symptoms progressed on the second day to anuria and acute renal insufficiency, with death on the third day.
ã 2016 Elsevier B.V. All rights reserved.
Dialysis helped some patients, but others died from renal tubular necrosis. The oxidation product of paratoluenediamine has been identified as a rare cause of a life-threatening immediate hypersensitivity reaction [9]. A 45-year-old woman developed extensive urticarial lesions 30
minutes after the application of a hair dye, starting on the scalp and face, followed by abdominal cramps, watery diarrhea, vomiting, dysphonia, and loss of consciousness. A prick test with a 1/128 dilution of the hair dye showed a positive reaction, but individual dye constituents did not. Prick testing with the oxidation products of the individual dye constituents showed a strongly positive reaction to oxidized paratoluenediamine, which was weaker after addition of an antioxidant to the mixture.
Ten healthy controls had negative prick tests with the oxidized paratoluenediamine.
LONG-TERM EFFECTS Tumorigenicity In a review of cohort and case–control studies of occupational exposure to hair dyes among hairdressers, barbers, and beauticians, the relative risk of bladder cancer was 1.4 from cohort studies, and somewhat over 1.0 from case– control studies; however, there were confounding factors, particularly since allowance for smoking was lacking or inadequate in most studies [10]. In five case–control studies of personal use of hair dyes, there was no evidence of an increased risk of bladder cancer. In nine cohort studies the relative risk of lymphoid neoplasms overall was 1.2 (1.5 for non-Hodgkin’s lymphomas and 1.1 for multiple myeloma). Of five case–control studies, three reported some association with lymphoid neoplasms, but the estimates of relative risk were only moderately above 1.0 and there was insufficient allowance for potential confounding factors, including social class and greying hair, which could correlate with both hair dye use and lymphoid neoplasms. No other neoplasms, including those of breast, skin, and lung were related to the use of hair dyes. In another study there was an increased risk of Hodgkin’s disease among women who reported the use of hair coloring products before 1980 (OR ¼1.3; CI ¼1, 1.8) [11]. Previous studies have suggested an association between the use of hair dyes and some cancers [12,13]. Several previous studies have found an association of non-Hodgkin lymphoma with the use of hair dyes, particularly permanent dark colors and use before 1980, when hair dye formulations changed. The risk of non-Hodgkin’s lymphoma has been examined in relation to reported hair dye use among 1321 cases and 1057 controls from a US population-based multicenter study. DNA was extracted from blood or buccal cells to identify genetic variations in N-acetyltransferase 1 (NAT1) and 2 (NAT2), which encode enzymes that metabolize aromatic amine compounds found in hair dyes. There was a increased risk of non-Hodgkin lymphoma among women who used dark colored or intense-tone permanent hair dyes before 1980 [14].
644
Hair dyes
DRUG ADMINISTRATION Drug overdose In one case deliberate ingestion of paraphenylenediamine with suicidal intent caused severe oropharyngeal edema, rhabdomyolysis, and cardiac death after 4 hours despite full supportive treatment [15]. Myocarditis has been attributed to paraphenylenediamine poisoning [16]. An 18-year-old woman developed asphyxia and rhabdomyoly-
sis after taking paraphenylenediamine 5 g. An electrocardiogram showed ventricular extra beats and inverted T waves. The serum CK activity was 28 020 mkat/l. Transthoracic echocardiography showed left and right ventricular hypokinesis and a left ventricular apical thrombus. Anticoagulation treatment with heparin was initiated. A follow-up echocardiogram performed on the 15th day showed normalization of ventricular function and disappearance of the thrombus.
In two patients acute oliguric renal insufficiency due to acute tubular necrosis followed paraphenylenediamine intoxication; there was associated vomiting, angioedema, cyanosis, and intravascular hemolysis [17]. One patient recovered and the other died with septicemia. In four other cases acute renal insufficiency was due to rhabdomyolysis.
REFERENCES [1] Nohynek GJ, Fautz R, Benech-Kieffer F, Toutain H. Toxicity and human health risk of hair dyes. Food Chem Toxicol 2004; 42(4): 517–43. [2] Sosted H, Agner T, Andersen KE, Menne T. 55 cases of allergic reactions to hair dye: a descriptive, consumer complaint-based study. Contact Dermatitis 2002; 47(5): 299–303. [3] Fautz R, Fuchs A, van der Walle H, Henny V, Smits L. Hair dye-sensitized hairdressers: the cross-reaction pattern with new generation hair dyes. Contact Dermatitis 2002; 46(6): 319–24. [4] Tosti A, Pazzaglia M, Corazza M, Virgili A. Allergic contact dermatitis caused by mehindi. Contact Dermatitis 2000; 42(6): 356. [5] Mohamed M, Nixon R. Severe allergic contact dermatitis induced by paraphenylenediamine in paint-on temporary “tattoos” Australas J Dermatol 2000; 41(3): 168–71.
ã 2016 Elsevier B.V. All rights reserved.
[6] Lestringant GG, Bener A, Frossard PM. Cutaneous reactions to henna and associated additives. Br J Dermatol 1999; 141(3): 598–600. [7] Jappe U, Hausen BM, Petzoldt D. Erythema multiformelike eruption and depigmentation following allergic contact dermatitis from a paint-on henna tattoo, due to paraphenylenediamine contact hypersensitivity. Contact Dermatitis 2001; 45(4): 249–50. [8] D’Arcy PF. Fatalities with the use of a henna dye. Pharm Int 1982; 3: 217. [9] Pasche-Koo F, French L, Piletta-Zanin PA, Hauser C. Contact urticaria and shock to hair dye. Allergy 1998; 53(9): 904–5. [10] La Vecchia C, Tavani A. Epidemiological evidence on hair dyes and the risk of cancer in humans. Eur J Cancer Prev 1995; 4(1): 31–43. [11] Zhang Y, Holford TR, Leaderer B, Boyle P, Zahm SH, Flynn S, Tallini G, Owens PH, Zheng T. Hair-coloring product use and risk of non-Hodgkin’s lymphoma: a population-based case–control study in Connecticut. Am J Epidemiol 2004; 159(2): 148–54. [12] Miligi L, Costantini AS, Benvenuti A, Veraldi A, Tumino R, Ramazzotti V, Vindigni C, Amadori D, Fontana A, Rodella S, Stagnaro E, Crosignani P, Vineis P. Personal use of hair dyes and hematolymphopoietic malignancies. Arch Environ Occup Health 2005; 60(5): 249–56. [13] Heineman EF, Ward MH, McComb RD, Weisenburger DD, Zahm SH. Hair dyes and the risk of glioma among Nebraska women. Cancer Causes Control 2005; 16(7): 857–64. [14] Morton LM, Bernstein L, Wang SS, Hein DW, Rothman N, Colt JS, Davis S, Cerhan JR, Severson RK, Welch R, Hartge P, Zahm SH. Hair dye use, genetic variation in Nacetyltransferase 1 (NAT1) and 2 (NAT2), and risk of nonHodgkin lymphoma. Carcinogenesis 2007; 28(12): 1759–64. [15] Ashraf W, Dawling S, Farrow LJ. Systemic paraphenylenediamine (PPD) poisoning: a case report and review. Hum Exp Toxicol 1994; 13(3): 167–70. [16] Zeggwagh AA, Abouqal R, Abidi K, Madani N, Zekraoui A, Kerkeb O. Thrombus ventriculaire gauche et myocardite toxique induite par la paraphe´nylene diamine. [Left ventricular thrombus and myocarditis induced by paraphenylenediamine poisoning.] Ann Fr Anesth Reanim 2003; 22(7): 639–41. [17] Bourquia A, Jabrane AJ, Ramdani B, Zaid D. Toxicite´ systemique de la paraphe´nylene diamine. Quatre observations. [Systemic toxicity of paraphenylenediamine. 4 cases.] Presse Med 1988; 17(35): 1798–800.