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EDITORIALS:
John P McFadden, Ian R White, Peter J Frosch, Heidi Sosted, Jenne D Johansen, and Torkil Menne
Allergy to hair dye
BMJ 2007; 334: 220 [Full text]
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[Read Rapid Response] The other reasons for increase in hair dye allergy
Periasamy Balasubramaniam, Iain S Foulds, Consultant Dermatologist, Birmingham Skin Centre, City Hospital, Birmingham B18 7QH   (10 February 2007)

The other reasons for increase in hair dye allergy 10 February 2007
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Periasamy Balasubramaniam,
Specialist Registrar in Dermatology
Birmingham Skin Centre, City Hospital, Birmingham B18 7QH,
Iain S Foulds, Consultant Dermatologist, Birmingham Skin Centre, City Hospital, Birmingham B18 7QH

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Re: The other reasons for increase in hair dye allergy

We would entirely agree with the authors about the increasing prevalence of Para-phenylenediamine (PPD) allergy to hair dyes amongst the population which is mainly due to increased usage by consumers.1 However we would suggest that it could also be due to three other factors.

Firstly, when an adverse reaction is reported to a manufacturer by a customer many of the companies now offer the patients the opportunity to have their case investigated by a consultant dermatologist and therefore are now more likely to be patch tested.

Secondly, increasing home usage may result in more skin exposure. In practice it is more difficult to sensitise the scalp than the skin. If inadvertently PPD is applied to the skin a severe reaction can ensue. Application of PPD to the skin with patch testing is the most common allergen to induce active sensitisation in a patch test clinic and is the reason why in Germany routine patch testing with PPD has now been discontinued.2

Thirdly, the advice that is given to consumers to test the product on normal skin before usage is unscientific and potentially increases the risk of sensitisation. The more times that an individual undertakes such a test then the more likely they are to become sensitised. It also does not obviate a subsequent reaction when the product is used as they may have been sensitised by the previous test. Although the companies are trying to be responsible to make individuals aware of the risk of sensitisation this latter policy can only contribute to more cases of sensitisation occurring.

Periasamy Balasubramaniam Specialist Registrar p.balasubramaniam@nhs.net, Iain S Foulds Consultant Dermatologist, Birmingham Skin Centre, City Hospital, Birmingham B18 7QH

1. McFadden JP, White IR, Frosch PJ, Sosted H, Johansen JD, Menne T. Allergy to hair dye. BMJ. 2007 Feb 3;334(7587):220. 2. Schnuch A, Geier J, Uter W, Frosch PJ, Lehmacher W, Aberer W et al. National rates and regional differences in sensitization to allergens of the standard series. Population-adjusted frequencies of sensitization (PAFS) in 40,000 patients from a multicenter study (IVDK). Contact Dermatitis. 1997 Nov;37(5):200-9.

Competing interests: None declared