Ann Dermatol.  2018 Jun;30(3):316-321. 10.5021/ad.2018.30.3.316.

P-Phenylenediamine Hair Dye Allergy and Its Clinical Characteristics

  • 1Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.


P-phenylenediamine (PPD) has been identified as the most frequent contact sensitizer of hair dye and the clinical characteristics of hair dye contact allergy (HDCA) are diverse.
The purpose of this study was to identify the clinical characteristics of HDCA and to assess the relationships between HDCA, exposure time to PPD and PPD positivity.
We analyzed 105 patients with patch test-confirmed hair dye allergy who presented between July 2009 and March 2015. Clinical symptoms, signs, associated skin diseases, involved ACD area, and patterns of hair dye use were obtained by reviewing medical records and by interview.
HDCA was more common in women and in individuals aged more than 50 years. Pruritus was the most common symptom; erythematous macules and patches were the most frequently observed clinical signs. The most common site of HDCA was the face and non-specific eczema and urticaria were frequently observed with HDCA. Exposure time to hair dye, represented as frequency and duration, showed a positive correlation with the area affected by hair dye allergy (p < 0.001). Hair dye allergy was identified in most patients (80%) before diagnosis by patch test. However, only 28.6% of all patients stopped using hair dye, even after the diagnosis was confirmed.
The extent of hair dye allergy involvement was related to exposure time to hair dye. For effective treatment of HDCA, it is important to properly educate patients with HDCA about the clinical manifestations of HDCA and to keep away from allergens.


Allergic contact dermatitis; Hair dyes; Phenylenediamines

MeSH Terms

Dermatitis, Allergic Contact
Hair Dyes
Medical Records
Patch Tests
Skin Diseases
Hair Dyes


  • Fig. 1 Duration of hair dye use, frequency of hair dye use, P-phenylenediamine (PPD) positivity and combined dermatologic problems. Exposure time to hair dye (duration [years]×frequency [number of applications/year]) and extent of hair dye contact allergy involvement (direct; mean=60.0 and indirect; mean=130.0) showed a statistically significant correlation (p=0.001). Regarding exposure time to hair dye and PPD positivity (weakly positive, mean=116.83; strongly/extremely positive, mean=127.64), no statistically significant relationship was found (p=0.27). Exposure time to hair dye and the presence of combined dermatologic problems (no, mean=128.7; yes, mean=117.4) did not show a statistically significant correlation (p=0.30). HDCA: hair dye contact allergy.


1. Almeida PJ, Borrego L, Limiñana JM. Age-related sensitization to p-phenylenediamine. Contact Dermatitis. 2011; 64:172–174. PMID: 21272028.
2. Patra AP, Shaha KK, Rayamane AP, Dash SK, Mohanty MK, Mohanty S. Paraphenylenediamine containing hair dye: an emerging household poisoning. Am J Forensic Med Pathol. 2015; 36:167–171. PMID: 26056768.
3. Kim H, Kim K. Prevalence of potent skin sensitizers in oxidative hair dye products in Korea. Cutan Ocul Toxicol. 2016; 35:204–207. PMID: 26340697.
4. Handa S, Mahajan R, De D. Contact dermatitis to hair dye: an update. Indian J Dermatol Venereol Leprol. 2012; 78:583–590. PMID: 22960813.
5. Kim JE, Jung HD, Kang H. A survey of the awareness, knowledge and behavior of hair dye use in a Korean population with gray hair. Ann Dermatol. 2012; 24:274–279. PMID: 22879710.
6. Chey WY, Kim KL, Yoo TY, Lee AY. Allergic contact dermatitis from hair dye and development of lichen simplex chronicus. Contact Dermatitis. 2004; 51:5–8. PMID: 15291824.
7. Lee HS, Lin YW. Permeation of hair dye ingredients, p-phenylenediamine and aminophenol isomers, through protective gloves. Ann Occup Hyg. 2009; 53:289–296. PMID: 19279162.
8. Pot LM, Scheitza SM, Coenraads PJ, Blömeke B. Penetration and haptenation of p-phenylenediamine. Contact Dermatitis. 2013; 68:193–207. PMID: 23510340.
9. Lee JY, Kim CW, Kim SS. Analysis of the results from the patch test to para-phenylenediamine in the TRUE test in patients with a hair dye contact allergy. Ann Dermatol. 2015; 27:171–177. PMID: 25834356.
10. Krasteva M, Bons B, Ryan C, Gerberick GF. Consumer allergy to oxidative hair coloring products: epidemiologic data in the literature. Dermatitis. 2009; 20:123–141. PMID: 19470299.
11. Thyssen JP, White JM. European Society of Contact Dermatitis. Epidemiological data on consumer allergy to p-phenylenediamine. Contact Dermatitis. 2008; 59:327–343. PMID: 19076884.
12. Patel S, Basketter DA, Jefferies D, White IR, Rycroft RJ, McFadden JP, et al. Patch test frequency to p-phenylenediamine: follow up over the last 6 years. Contact Dermatitis. 2007; 56:35–37. PMID: 17177707.
13. Handa S, De D, Mahajan R. Epidemiological trends in contact dermatitis to hair dye: Comparing para-phenylenediamine positivity after a decade long interval. Indian J Dermatol Venereol Leprol. 2011; 77:511–512. PMID: 21727702.
14. Lee GY, Kim JK, Kim KJ. A study of the results of patch test in patients with contact dermatitis. Korean J Dermatol. 2007; 45:908–914.
15. Hong YJ, Choi HY, Kim KJ, Lee GY, Kim DW, Kim SJ, et al. TRUE test in patients with contact dermatitis: a multicenter study. Korean J Dermatol. 2011; 49:661–669.
16. Thomas BR, White IR, McFadden JP, Banerjee P. Positive relationship-intensity of response to p-phenylenediamine on patch testing and cross-reactions with related allergens. Contact Dermatitis. 2014; 71:98–101. PMID: 24850439.
17. LaBerge L, Pratt M, Fong B, Gavigan G. A 10-year review of p-phenylenediamine allergy and related para-amino compounds at the Ottawa Patch Test Clinic. Dermatitis. 2011; 22:332–334. PMID: 22653006.
18. Coenraads PJ, Nater JP, van der. Prevalence of eczema and other dermatoses of the hands and arms in the Netherlands. Association with age and occupation. Clin Exp Dermatol. 1983; 8:495–503. PMID: 6227435.
19. Ho SG, Basketter DA, Jefferies D, Rycroft RJ, White IR, McFadden JP. Analysis of para-phenylenediamine allergic patients in relation to strength of patch test reaction. Br J Dermatol. 2005; 153:364–367. PMID: 16086750.
20. Schäfer T, Böhler E, Ruhdorfer S, Weigl L, Wessner D, Filipiak B, et al. Epidemiology of contact allergy in adults. Allergy. 2001; 56:1192–1196. PMID: 11736749.
21. Søsted H, Hesse U, Menné T, Andersen KE, Johansen JD. Contact dermatitis to hair dyes in a Danish adult population: an interview-based study. Br J Dermatol. 2005; 153:132–135. PMID: 16029338.
22. Diepgen TL, Ofenloch RF, Bruze M, Bertuccio P, Cazzaniga S, Coenraads PJ, et al. Prevalence of contact allergy in the general population in different European regions. Br J Dermatol. 2016; 174:319–329. PMID: 26370659.
23. Schuttelaar ML, Vogel TA, Rui F, Kręcisz B, Chomiczewska-Skora D, Kieć-Świerczyńska M, et al. ESSCA results with the baseline series, 2002-2012: p-phenylenediamine. Contact Dermatitis. 2016; 75:165–172. PMID: 27199097.
24. Diepgen TL, Naldi L, Bruze M, Cazzaniga S, Schuttelaar ML, Elsner P, et al. Prevalence of contact allergy to P-phenylenediamine in the European general population. J Invest Dermatol. 2016; 136:409–415. PMID: 26802237.
25. Jo SJ, Paik SH, Choi JW, Lee JH, Cho S, Kim KH, et al. Hair graying pattern depends on gender, onset age and smoking habits. Acta Derm Venereol. 2012; 92:160–161. PMID: 22113716.
26. Helaskoski E, Suojalehto H, Virtanen H, Airaksinen L, Kuuliala O, Aalto-Korte K, et al. Occupational asthma, rhinitis, and contact urticaria caused by oxidative hair dyes in hairdressers. Ann Allergy Asthma Immunol. 2014; 112:46–52. PMID: 24331393.
27. Barrientos N, Abajo P, de Vega MM, Dominguez J. Erythema multiforme-like eruption following allergic contact dermatitis in response to para-phenylenediamine in a temporary henna tattoo. Int J Dermatol. 2014; 53:e348–e350. PMID: 24602051.
28. Gupta M, Mahajan VK, Mehta KS, Chauhan PS. Hair dye dermatitis and p-phenylenediamine contact sensitivity: a preliminary report. Indian Dermatol Online J. 2015; 6:241–246. PMID: 26225326.
29. Søsted H, Agner T, Andersen KE, Menné T. 55 cases of allergic reactions to hair dye: a descriptive, consumer complaint-based study. Contact Dermatitis. 2002; 47:299–303. PMID: 12534535.
30. Buckley WR. Lichenoid eruptions following contact dermatitis. AMA Arch Derm. 1958; 78:454–457. PMID: 13582187.
31. Mandel EH. Lichen planus-like eruptions caused by a color-film developer. Arch Dermatol. 1960; 81:516–519. PMID: 14420540.
32. Roed-Petersen J, Menné T. Allergic contact dermatitis and lichen planus from black-and-white photographic developing. Cutis. 1976; 18:699–700. PMID: 139296.
33. Goon AT, Gilmour NJ, Basketter DA, White IR, Rycroft RJ, McFadden JP. High frequency of simultaneous sensitivity to Disperse Orange 3 in patients with positive patch tests to para-phenylenediamine. Contact Dermatitis. 2003; 48:248–250. PMID: 12868964.
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