Hairdressers - hand eczema, hair dyes and hand protection

Abstract: Hand eczema is a well-known problem in occupations that involve largely manual work, in combination with long periods of wet exposure and skin contact with chemicals. Hairdressing involves dermal exposure to a number of skin damaging substances. Hair cosmetic products such as hair dyes, permanent wave solutions and bleaches can cause contact allergy and extensive wet work can cause irritant contact dermatitis (ICD). In this thesis the occurrence of hand eczema was studied in a nation-wide retrospective longitudinal cohort study comprising 7,203 female hairdressers attending the vocational hairdressing programme during a period of 25 years. A total of 7,355 women from the general population constituted the control group. A hand rinse method for assessment of dermal exposure to permanent hair dyes on hairdressers' hands was developed and validated. The validated hand rinse method was used during hair dyeing in hairdressing salons for assessment of the exposure to p-phenylenediamine (PPD), toluene-2,5-diaminesulfate (TDS), m-aminophenol, resorcinol (RES) and 2-methylresorcinol (MRE). Hand rinse samples were taken before the start of hair dyeing, after application of hair dyes to the hair and after cutting newly dyed hair. The hand rinse samples were analysed with highperformance liquid chromatography (HPLC) together with extracts from newly dyed hair. In another study the permeation of PPD, TDS and RES through protective gloves frequently used in hairdressing was investigated. The gloves were made of natural rubber latex, polyvinyl chloride, nitrile rubber and polyethene. The incidence of hand eczema was 23.8 cases/1,000 person-years for the hairdressers and 9.6 cases/person years for the controls, incidence rate ratio (IRR) 2.5 (95% Cl 2.2-2.8), with an IRR of 3.1 (95% Cl 2.6-3.5) for hairdressers younger than 25 years. The attributable fraction of hand eczema cases from skin atopy was 9.6% in hairdressers. A high frequency of hair treatments that involves risk for exposure to skin damaging substances was reported by the hairdressers. The assessment of dermal exposure to permanent hair dyes in the salons showed that after application of hair dye, positive hand rinse samples were found in 26 out of 33 hairdressers. No statistically significant difference in the amount of hair dye compounds found on the hairdressers' hands was observed between users and non-users of protective gloves. Hair dye compounds were found in samples from 23 out of 29 hairdressers after cutting newly dyed hair. Eleven out of twelve extracts of newly dyed hair contained hair dye compounds. The exposure loadings of hair dye compounds found in the hand rinse samples are at a level at which there is a risk of sensitization. None of the tested protective gloves was permeated by the hair dye compounds before 30 minutes. In conclusion: the incidence of hand eczema among hairdressers was remarkably high. The hand eczema starts early in life for many individuals. About 10% of the hand eczema cases would be prevented if no skin atopics entered the trade. The hairdressers are exposed to hair dye compounds during application of hair dyes and after cutting of newly dyed hair. The exposure levels found on hairdressers hand are in the level where there is a risk for sensitisation. All the tested protective gloves gave good protection against the hair dye compounds.