Dermatitis in Hairdressers as a Problem in Chemical Control

Abstract

Much occupational disease in Europe is skin related and is mostly eczemas, usually on the hands (Dickel et al., 2001). In Britain, there are 31 000 cases of skin diseases that are reported by the sufferers to be work-related (HSE, 2005). Occupational dermatitis is a well-known problem among hairdressers, as either irritant contact dermatitis or allergic contact dermatitis, or often a combination of both. Hairdressers are exposed to extensive wet work that can cause irritant contact dermatitis, and they have daily skin contact with innumerable cosmetic products containing compounds that are known to cause contact allergy. In Britain, hairdressers and barbers are in the top three occupational groups in terms of prevalence of dermatitis (HSE, 2004), and have been selected as a priority area for intervention within HSE’s Skin Disease Project, which in turn forms part of the Disease Reduction Programme. In this issue, we report the levels of pertinent aromatic amines and resorcinol on hairdressers’ hands in Sweden (Lind et al., 2005). Amongst other chemicals, we found potentially sensitizing levels of p-phenylenediamine (PPD) on their hands during hair dyeing. As PPD was formerly banned in Sweden, and now permission is supposed to be obtained for its use, it provides an interesting example of the problems of chemical control. In Sweden there has long been a trend in occupational welfare work where many opinion leaders have considered that the chemical problems—if not already solved—are easily dealt with. You simply remove the hazardous chemical and the problems will disappear. Of course, this is not always true, and hair dyes are a good example: in Sweden, efforts to remove a potentially hazardous chemical from the market have failed. Today, the constituents of hair dyes most known to cause sensitization are the aromatic amines (PPD), and toluene-2,5-diamine (TDA) or its sulphate, toluene-2,5-diaminesulphate (TDS). These are used in permanent, ‘oxidative’, hair dyes, which are the most common type in the world market (Corbett, 1991). Permanent hair dyes have been in use since the late nineteenth century (Wall, 1957). Several clinical studies show that hairdressers run a high risk of developing occupational allergic contact dermatitis. PPD and TDA (or TDS) are often the most common agents responsible for allergic reactions, 17–58% of patch-tested hairdressers showing positive reactions to PPD and 14–25% to TDA or TDS in different studies (Armstrong et al., 1999; Iorizzo et al., 2002; Nettis et al., 2003; Uter et al., 2003). Apart from the local effect, systemic diseases can also follow exposure to the ingredients in permanent hair dyes. Studies of hair dye exposure indicate an increased risk of bladder carcinoma, both among hairdressers and women who use permanent hair dyes (GagoDominguez et al., 2001). Owing to the risk of sensitization, the use of PPD in hair dyes was prohibited in Sweden between 1943 and 1992, and TDA between 1943 and 1964. From 1964 to 1992 TDA was used in permanent hair dyes instead of PPD (Wahlberg et al., 2002). With Sweden’s entry to the European Union in 1992, the national prohibition on the use of PPD was lifted, to bring Swedish law into line with the EU. Under the EEC Cosmetic Directive, PPD is allowed in hair dye products with a concentration limit of 6%; the TDA limit is 10%. *Author to whom correspondence should be addressed. Tel: +46-8-619-6995; fax: +46-8-619-6896; e-mail: marie-louise.lind@niwl.se