title: Hair highlights and severe acute irritant dermatitis ("burn") of the scalp.
abstract: BACKGROUND
  These days, most celebrities--young and old--have their hair highlighted. That is why it is not surprising that even the youth have their hair highlighted as they emulate their favorite actors, unaware of the harmful consequences of this unsafe procedure. Hair highlighting involves decolorizing melanin pigments of select hair strands through an oxidation reaction under alkaline conditions by the active ingredients of the highlighting mixture--hydrogen peroxide, persulfates, and metasilicate. Hydrogen peroxide and the persulfates are flammable, necessitating that regulatory bodies (namely, the U.S. Food and Drug Administration [FDA] and the Cosmetic Ingredient Review [CIR] Expert Panel, the European Union's (EU), European Economic Community [EEC] directives, the Australian government's National Industrial Chemicals Notification and Assessment Scheme [NICNAS], and the Association of Southeast Asian Nations [ASEAN]) to regulate the permissible amounts of these chemicals in hair highlighting products.
  
  
  OBJECTIVE
  To review published case reports of resulting in severe acute irritant dermatitis ("burns") of the scalp caused by hair highlighting, to explain why these scalp burns happen, to identify preventive measures to avoid such occurrences, and to discuss the implications for society.
  
  
  METHODS
  We searched medical and scientific search engines and used keywords such as hair highlights, scalp burn, and other related terms..
  
  
  RESULTS
  Six articles were obtained, yielding 8 reported cases (2 of the 6 articles had 2 cases each) of hair highlighting resulting in scalp burns; these 8 cases were reviewed and analyzed. Five of the 8 patients belonged to the pediatric age group.
  
  
  CONCLUSIONS
  The causes of scalp burn were classified into 2 categories: chemical (caustic nature of the highlighting mixture, spillage of the hot mixture, toxic reaction to the dyes) and thermal (by contact of the scalp with overheated aluminum foil and by the blow dryer). The 5 pediatric patients in the group unnecessarily suffered pain and embarrassment caused by this procedure, as well as the risk of developing malignancy in the future.
  
  
  CONCLUSIONS
  Hairstylists play a large role in the occurrence of scalp burns. Thus, they need to be careful and knowledgeable of the caustic nature of the highlighting mixture and the potential harm these chemicals may cause. The authors strongly propose that the relevant regulatory bodies review the permissible levels of the caustic chemicals, and that this unsafe procedure should be performed only on adults.
authors.affiliation: Department of Dermatology, University of California, San Francisco, San Francisco, California 94143-0989, USA. heidichan0220@yahoo.com
authors.forename: Heidi P
authors.initials: HP
authors.lastname: Chan
authors.forename: Howard I
authors.initials: HI
authors.lastname: Maibach
mesh_terms: D000645:Ammonium Sulfate / Q000633:toxicity; D002057:Burns, Chemical / Q000209:etiology* / Q000473:pathology; D003257:Consumer Product Safety; D017453:Dermatitis, Irritant / Q000209:etiology* / Q000473:pathology; D006203:Hair Preparations / Q000009:adverse effects*; D006801:Humans; D006861:Hydrogen Peroxide / Q000633:toxicity; D007509:Irritants / Q000009:adverse effects*; D016877:Oxidants / Q000633:toxicity; D012535:Scalp / Q000187:drug effects* / Q000473:pathology; D017640:Silicates / Q000633:toxicity
chemical_list: D006203:Hair Preparations; D007509:Irritants; D016877:Oxidants; D017640:Silicates; C025349:sodium metasilicate; C031276:ammonium peroxydisulfate; D006861:Hydrogen Peroxide; D000645:Ammonium Sulfate