Analysis of the Results from the Patch Test to Para-Phenylenediamine in the TRUE Test in Patients with a Hair Dye Contact Allergy

Abstract

BackgroundPara-phenylenediamine (PPD) is the primary patch test screening agent for hair dye contact allergy (HDCA). However, no recent studies have been published that describe the results of reactions to patch tests using PPD and hair dyes in Korea.ObjectiveTo analyze the results of the patch tests to PPD using the thin-layer rapid use epicutaneous (TRUE) Test system in patients with HDCA and to investigate patients' awareness that hair dyes contains allergens, which cause the development of HDCA.MethodsEighty-four patients with suspected HDCA (32 men and 52 women) underwent patch testing using the TRUE Test system and their own hair dyes. The patients' demographic data, behavior associated with hair dyeing, and clinical manifestations of HDCA were examined retrospectively.ResultsPositive patch-test reactions to hair dyes occurred in 53.6% of patients who used hair dyes, and they were diagnosed with HDCA. Although there was a significant correlation between HDCA and PPD sensitization (p=0.001), only 40% of the patients with HDCA showed positive reactions to PPD. Of the 45 patients diagnosed with HDCA, only 7 (15.6%) were aware that their hair dyes contained allergens that caused HDCA.ConclusionThis study's findings show that PPD is an effective HDCA marker. However, we propose that investigations on hair dye components other than PPD should be conducted to develop and validate additional predictive HDCA markers.

Continuous usage of a hair dye product containing 2‐methoxymethyl‐para‐phenylenediamine by hair‐dye‐allergic individuals

“…Thus, differences regarding the reactivation threshold may also have impacted the individual onset of the (cross‐) elicitation responses observed in two individuals with symptoms occurring within 15 min or as late as 1 week after the hair colour treatment (Table ). This is in line with the recently described variability of time intervals between hair dyeing and dermatitis onset (1 day up to 1 month) …”

“…This is in line with the recently described variability of time intervals between hair dyeing and dermatitis onset (1 day up to 1 month). 19 Ho et al 20 analysed the tolerance of PPD-containing hair dye products in PPD-allergic individuals based on the strength of their previous response to PPD under diagnostic patch testing: tolerance was recorded in 73% of 55 cases with a mild strength (+) and 49% of 61 patients with a moderate strength (++), but in none of 14 with a severe strength (+++). In contrast, we found tolerance to ME-PPDcontaining hair colorants in five cases with a strong diagnostic patch test reaction to PPD (+++), for three of them with a frequency of full hair colour treatments of every 4-7 weeks for dark to medium-dark and medium-light shades ( Table 4).…”

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

“…From these results, it may appear that positive reactions to 1.0% o-aminophenol might have included false-positive reactions, and that a 1.0% concentration of this reagent may have been too high for patch testing. Lee et al reported that only 40% of patients with hair dye-related contact dermatitis showed positive reaction to PPD, and they concluded that, for diagnosing hair dye-related contact allergy, hair dye compounds other than PPD should be included (21). From the results of this study, we would be able to diagnose most patients by using PPD; however, testing only with PPD is insufficient to actually find all patients, because contact allergy to p-methylaminophenol, o-aminophenol and m-phenylenediamine will often be missed.…”

Henna Tattoos and Present Day Dangers

“…PPD is one of the most powerful skin allergic sensitizers, with topical application of 10% PPD shown to cause contact allergy in 100% of subjects within 5 applications [5] . Similarly, about 40% of hair dye allergy has been linked to PPD sensitivity [6] . Positive skin patch test to PPD can remain positive for over a month, which is unusual and another indicator of the intense sensitization [7] .…”