We report the case of a 41-year-old female showing severe hair loss approximately 90% after the use of a hair dye. These symptoms developed six days after the use of a hair dye containing PPD. A patch test showed a (++) reaction at 48 h to 1% PPD in petrolatum, whereas all metals and white petrolatum were negative. She was therefore diagnosed with contact dermatitis due to PPD, resulting in hair loss. The skin lesions gradually improved after starting treatment with the systemic corticosteroids. The possibility that allergic contact dermatitis from hair dyes may be responsible for telogen effluvium should always be considered in a patient with increased hair loss.
A 41-year-old female was referred because of edema on the face and hair loss with severe itching of the scalp. The itching of the scalp started 1 day after the use of a hair dye containing PPD, and hair loss symptoms developed 6 days after the use of the hair dye (Figure
(a) A female with an allergic reaction to hair dye with severe hair loss on the scalp. This picture was taken 6 days after she had colored her hair. (b) The hair loss spread to approximately 90% of the scalp 2 months later. Partial white hair regrowth was also observed.
Several cases of severe facial and scalp dermatitis have been reported following the use of permanent hair dyes, and these dyes often contain paraphenylendiamine (PPD). PPD is known to be the most frequent contact allergen found in hair dyes [
Hair dye reactions are usually diagnosed by the patients themselves, and epidermological studies found a range between 0.1% and 1% of the patients sensitized to PPD [
Sosted et al. reported that many cases of PPD allergy go unreported, probably because the patient is able to make the connection between the reaction and the hair dye and therefore does not seek medical advice. Our case had a severe face edematous reaction, with approximately 90% hair loss that required treatment with systemic corticosteroids.
Many cases of dermatitis due to hair dye may be overlooked, but severe dermatitis may sometimes last for more than 3 weeks [
The authors state no conflict of interests.