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Does she have a hair dye allergy?

Does My Mom Have a Hair Dye Allergy?

Doc,

My mom has been dyeing her grey hair for many years. Recently she went to the salon for her usual touch-up and she developed a rash along her hair line. The next time she went, the rash got worse. Has she developed a hair dye allergy?

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Hi K.,

You are correct! It seems as if your mother has developed an allergy to her hair dye. The most likely culprit is Paraphenyldiamine aka PPD. It is the most reliable hair dye ingredient that makes the hair dark brown or black. However, it is widely known to be a sensitiser, i.e. it triggers the body to remember it so that each time it comes into contact with it a reaction occurs. There are instances of persons who used henna mixtures for mehandi (black henna tattoo) only once who later on developed rashes when they started to dye their hair. The henna used for mehandi usually contains very high amounts of PPD.

The problem is that there are very little substitutes out there that do the job as well. There are many natural hair dyes however, they tend to be messier and/or take longer for the dye to set. The most famous of which is natural henna. Ensure that the henna that you purchase is not a henna/chemical dye mash up. Henna dyes the hair red-brown. To get a deep black colour, indigo is usually added.

There are other chemical dyes that use similar ingredients to PPD that do not have the same sensitising profile as PPD. Interestingly, with the advent of the active protein based cosmeceuticals, there are products containing melitane (a protein) that helps the hair follicle to naturally restore its pigment production. Hopefully, we will see more of this on the market soon.

What do if you have a hair dye allergy?

Once the rash develops, you will need to get an antihistamine such as Chlorpheniramine e.g. Benadryl to help with the itching. A Cortisone (steroid) cream will help to minimise the symptoms pretty quickly. If you continue to use PPD containing dyes the rash or reaction will continue to worsen and can take up the entire body. Please read below what happened to NCIS star who had a PPD allergy: http://ow.ly/gOyq307n1rg

It is best that anyone who suspects he/she has a dye allergy should go to a dermatologist or allergist to do what is called a patch test. This involves the placement of small amounts of known allergens on her back and doing readings after day 3 and day 5 to see which one she has developed a reaction to. This will help her determine the exact cause of her rash and then she can avoid products containing that particular ingredient(s).

Alopecia areata

This is a type of non-scarring inflammatory hair loss that can afflict anyone of any age. It is characterised by patchy hair loss that usually starts on the head. It can progress to involve the entire scalp, when it is termed Alopecia Totalis, and Alopecia Universalis, when the entire body is involved. It typically occurs during periods of stress.

The cause of Alopecia areata is unknown. What is clear, however, is that it is an auto-immune disorder, i.e. the body for some reason attacks the hair follicle. It rapidly causes the hair to go from anagen to telogen, causing the hairs to fall out over night. Most persons state that they wake up with coin shaped patches of hair loss where the scalp is usually non-tender, non-itchy, non-scaly and smooth or bare. Some report waking up with grey hairs overnight, as the condition preferentially attacks pigmented hairs.

Rapid Regrowth can occur, however, the hair follicles can stay in a permanent state of telogen and this can be quite frustrating.

Treatment of Alopecia areata

Topical Therapy

Persons who have Alopecia areata are usually given anti-inflammatory corticosteroids injected directly into the scalp, eyebrows, or any other area that is affected as well as topical corticosteroid creams to use at home. For persons with limited (small areas affected), this can be suitable. However, for persons with more extensive hair loss, they may require more options.

Another treatment modality that can be considered is Topical Immunotherapy with contact sensitizers. This involves the use of a highly allergenic agent such as Diphencyclopropenone (DCP) or squaric acid dibutylester (SADBE), most commonly used in Canada and Europe. These solutions are used to deliberately create an allergic reaction in the skin. In essence the compound causes the inflammatory cells acting on the hair follicle to be distracted and attack the solutions instead. The hair follicle is then left relatively free and the hair usually starts to regrow within 8-12 weeks. Most persons may need continued application of these agents indefinitely in order to keep their hair.

A newer, more novel therapy is currently undergoing trials in both mouse models and humans. The novel agent is called a JAK inhibitor. JAK enzymes are one part of the complex environment. When activated, they seem to keep the hairs in a dormant state. The inhibitors when taken orally was found to regrow hair in a person who had Alopecia Universalis. Currently, they are testing topical forms of these agents which are showing some promise.

Oral Therapy

Oral medications are used for those who have have not responded to topical therapy or are in need of their hair to grow back for an event. Oral medications that tend to be used include corticosteroids like Prednisone and immunosuppresive agents such as Methotrexate, and Mycophenolate Mofetil. The problem with oral medications is that once they are stopped, the hair tends to fall out again, which is quite frustrating. Patients have the tendency to want to continue them, but the side effect profile of these medications are not worth trying it especially for a condition that can spontaneously resolve on it its own. Prednisone can stunt growth in children or affect development of secondary sexual characteristics such as beards for teenagers. Prolonged use can also cause thinning of the bones and persons on long term Prednisone can develop diabetes or hypertension as well as a host of other issues . Methotrexate can make persons be prone to more infections.

Non medical treatment

Persons are now trying dermal needling and/or Platelet rich plasma for Alopecia areata to see if they would make a difference. Again, these are novel treatment therapies and have not been rigorously examined to see if they truly work.

For those who have failed all of the above, wigs and other hair prostheses are used as camouflage. There are numerous types of wigs available that can be used in different lifestyles.

Here’s an article by the American Academy of Dermatology on Alopecia areata

https://www.aad.org/public/diseases/hair-and-scalp-problems/alopecia-areata

February QoM

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I heard that if I have Male Pattern Hair Loss and if I start using Rogaine (Minoxidil), I will have to use it forever? Is that true, and why?

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Yes this is true. The main reason for this is that there is no cure for Pattern Hair Loss. The underlying cause is a genetic disorder, and as such would require gene therapy, which does not exist. The medical therapies that exist, including Minoxidil, only reverse the effects of the genes and not the gene itself. Therefore, if you do not continue using the Minoxidil, you will lose the benefits of keeping the regrown hair.

ATHD Investigates Texture Manageability Systems

Texture Manageability or Texture Management or Texture Smoothing Systems are the latest hair straightening products now being marketed to women with highly textured hair. There has been an explosion on the market but most don’t understand how they work and what exactly they are used for.

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What are Texture Manageability Systems?

These consist of a 2 or 3 step hair modification system that is used to straighten hair in a semi-permanent fashion. In essence, they are similar to Brazilian Keratin Treatments, BUT they don’t last as long. The systems usually include a dual chelating and clarifying shampoo and a treatment product. Some include a deep conditioner which is used before the treatment product.

Here’s a reminder of how Brazilian Keratin treatments work:

http://askthehairdoc.com/january-qom-is-brazilian-keratin-treatment-safe/

So how do they work?

The active ingredient in Texture Manageability Systems used to straighten the hair is glyoxyolol carbocysteine, also called oxoacetamide carbocysteine. This reacts with the side chains of the keratin molecule in a similar fashion to what formaldehyde does in Keratin Treatments.

Below is the molecular representation of the active ingredient:

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It does produce some amount of formaldehyde but apparently at a much lower concentration than regular Brazilian Keratin Treatments. Of course, the levels of formaldehyde would be of importance considering the controversy of mislabeled “formaldehyde-free” Keratin Treatments were being found to actually have some other aldehyde at high concentrations. I was able to find one study that compared a typical Brazilian Keratin Treatment to a typical Texture Management System. The results showed that there was significantly lower amounts of formaldehyde and aldehyde released, which is great for both the hair stylist and the client. See the study here:

http://www.midwestscc.org/blog2/wp-content/uploads/presentations/Teamworks2012NonFormaldehydeSmoothing.pdf

What’s the Procedure?

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The same thing is done as with the regular formaldehyde containing Brazilian Keratin Treatment:

Wash hair with stripping, chelating and clarifying shampoo.
Towel dry hair
Apply treatment product in small sections throughout the hair
Allow product to set in the hair for 20 minutes
Blow-dry hair, then flatiron at ~230 deg C
Maintain style using sulphate free products, usually included in the kit.

The Verdict?

There are many Texture Manageability Systems that are now available on the market. Most are marketed for at-home use. These include systems from African Pride, Dark & Lovely, Beautiful Textures and ORS. The only in-salon product I’ve come across is the Avlon Texture Release. There are lots of persons in hair forums and Youtube who have described their experiences with the system.

I, myself, have tried it. I didn’t necessarily want my hair to stay straight for weeks so I didn’t follow up with the maintenance products. I had however gone to a hairdresser, which in my opinion should be the best way to apply these products, as people can inadvertently damage their hair since it requires a lot of manipulation with the blow dryer and flatiron. I was quite pleased that my hair did not revert within 2 hours of straightening and it washed it out really well thereafter. This was my hair after the procedure:

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One positive is that it can be used on both natural as well as hair that is relaxed or transitioning. Another positive is that it can be done within a relatively short period of time compared to older Keratin Treatments. There is definitely no offensive formaldehyde smell when it is activated through heat, and I believe that it may very well be less of a problem than traditional Keratin Treatments.

It unfortunately needs to be maintained like a relaxer in the sense that you have to re-do it every 6-8 weeks. Most are sold as kits, and so if you don’t know that there are other sulphate free shampoos and conditioners that you can use to help maintain the style, you will end up buying several kits to get the maintenance products. This is a serious disadvantage if you have long hair like mine. Just like the Keratin Treatments, your hair should not be dyed on the same day you do the original treatment.

Here’s another blogger’s perspective:

http://www.thenaturalhavenbloom.com/2014/06/beautiful-textures-texture-manageablity.html

Have you tried it as yet? What do you think about it?

Telogen Effluvium

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What is Telogen Effluvium?

Telogen Effluvium is a type of non-scarring hair loss. It is also called “Resting Phase Hair Loss”. Normally, most persons have 90% of the hairs on their head in the Anagen or “growing” phase. That stands to mean that ~10% are in Telogen, the “resting” phase. This is the phase that the hair goes into before it is shed. The new hair that will replace it grows upwards, pushing the hair out allowing for easy extraction when combing, brushing or washing your hair. The shed hair would of course have the white tip at the root.

How does Telogen Effluvium present?

Telogen Effluvium usually starts 3-4 months after the incident that triggers it. It can be Acute or Chronic. Acute cases usually last 6 months. Anything longer than that indicates some chronicity and usually hints at a persistent problem triggering the hair loss.

In general, most persons lose 50-100 hairs per day, but in Telogen Effluvium, the numbers can rise significantly. This excessive shedding is what alarms persons, as they feel that they cannot control the amount of hair that is lost. Persons usually complain of a significant amount of hair being lost when they wash their hair. Some notice their hair showing up in random places like the floor, car seat, clothes, pillow etc. Or others may notice that when they do comb their hair, an insane amount seems to come out.

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Though it causes diffuse thinning all over the scalp, persons may notice that certain areas seem thinner. Women may notice that their hair seems thinned out especially the temples, top or crown of their scalp. Their pony tail seems thinner or their “buns” are smaller than usual. Men often notice thinning in the temples.

What causes Telogen Effluvium?

There are several causes of Telogen Effluvium:

Significant stressful life events: death, divorce, bankruptcy/debt.
Rapid weight loss
Medication- both vitamins (high amounts of Vitamin A), drugs e.g. certain anti-hypertensives, anaesthetics etc.
Major surgery
Anaemia- mainly Iron deficiency
Poor diet- anorexia nervosa, fad diets, malnutrition
Significant illness – e.g. chronic diarrhoea
Post pregnancy

So how do you treat Telogen Effluvium?

Most persons experiencing Telogen Effluvium will notice that it will spontaneously resolve. However, those who have Chronic Telogen Effluvium, will need to be investigated to find out the exact cause, and have that cause corrected. Additionally, certain products like Minoxidil (Rogaine) will help the hairs to stay in the anagen stage longer, thus prolonging the hair on the head and decrease shedding over time. Once the Telogen Effluvium is resolved, the individual will not need to continue using the Minoxidil.