How to Manage Hair Relaxer Ingestions

Abstract

Source: Aronow S, Aronow H, Blanchard T, et al. Hair relaxers: a benign caustic ingestion? J Pediatr Gastroenterol Nutr. 2003;36:120–125.These authors report a retrospective chart review of all caustic ingestions admitted to Rainbow Babies and Children’s Hospital between 1990 and 2001. Of the 96 caustic ingestions identified, hair relaxers accounted for 33 (34.4%). Twenty-nine of the 33 patients who ingested hair relaxer underwent endoscopy and were included in the authors’ study. The average patient age was 14 months, 51% were male, and 100% of the patients were African American. The most common presenting symptoms in these patients were drooling and emesis. Mucosal injury was greatest at the patient’s lips and decreased in frequency toward the stomach. No patient had mucosal injury greater than Grade 1 (defined as edema and/or hyperemia limited to the super ficial mucosa) nor were any adverse clinical events noted after an 8-week follow-up. The authors combined their data with all previously published data on hair relaxer ingestions and found no adverse clinical outcomes and no clinically relevant esophageal mucosal injury among the 147 of 211 patients who underwent endoscopy. The authors conclude that patients with hair relaxer ingestions can be referred for endoscopy for persistent symptoms only.Referral to a pediatric gastroenterologist for endoscopy (specifically esophagogastroduodenoscopy or EGD) has been recommended by the American Society of Gastrointestinal Endoscopy and is routine for children following a caustic ingestion.1 The authors have attempted to combine data from multiple studies to show the absence of adverse gastrointestinal sequelae following hair relaxer ingestion. Although they acknowledge that their retrospective case review and small numbers may have resulted in incomplete case and complication ascertainment (Type II error), they recommend overnight observation for evaluation of oral intake. If symptoms resolve, referral for endoscopy is obviated. Other authors have also concluded that endoscopy appears to be unnecessary in patients who are asymptomatic after an accidental caustic ingestion. As endoscopy has inherent risks (ie, anesthesia, perforation, bleeding), it seems reasonable, based on this and prior studies, to observe the asymptomatic patient who has ingested hair relaxer.1,2 If, however, a patient is symptomatic, neurologically impaired with a possible blunted response to pain, or if the parent is very anxious, consultation with a pediatric gastroenterologist is warranted.All ingestibles, including hair relaxers and other cosmetics, must be kept out of the reach of preschoolers because potentially toxic ingestion is a hair-raising experience for all concerned.