Neutrophilic and Eosinophilic Dermatitis Caused by Contact Allergic Reaction to Paraphenylenediamine in Hair Dye

Abstract

Paraphenylenediamine (PPD) in hair dyes can cause systemic as well as cutaneous allergic reactions such as neutrophilic and eosinophilic dermatitis. The symptoms are often severe. The acute lesion is normally histologically indistinguishable from any eczematous reaction with marked spongiosis. We report a case of allergic contact dermatitis caused by the use of hair dye containing PPD that developed in a patient who had been using the same hair dye for many years. Her symptoms included scalp dermatitis and widespread skin lesions as well as lymphadenopathy and quite possibly dyspnea resembling asthma. What is most remarkable about this case is the histopathologic finding of neutrophilic cellulitis and a marked neutrophilic infiltrate with variable spongiosis. This unique finding was confirmed by histologic analysis of a patch test lesion specimen. It is always important to consider contact allergic dermatitis as a cause of dermatitis because of the variable presentation of the disease, including unique histologic findings that do not fit the conventional picture, as in the present case.