title: Patch testing with hydroxyethyl-p-phenylenediamine sulfate - cross-reactivity with p-phenylenediamine.
abstract: BACKGROUND
  Adverse reactions to permanent hair dyes are frequent, and primarily result from sensitization to p-phenylenediamine (PPD).
  
  
  OBJECTIVE
  To investigate the degree of cross-reactivity to a chemically similar dye, hydroxyethyl-p-phenylenediamine sulfate (HPPS), and whether this might be a dyeing alternative for patients who are sensitive to PPD.
  
  
  METHODS
  HPPS was patch tested in two concentrations in a total of 216 patients suspected of having contact dermatitis caused by hair dyes and/or hair cosmetics. A regular use test with a hair dye containing HPPS was suggested to every patient who had had an adverse reaction to a PPD hair dye in the past.
  
  
  RESULTS
  Forty of 216 (19.9%) patients reacted to 1% PPD, whereas only 2/216 (0.9%) showed a positive reaction to 1% HPPS. Reactivity to 2% HPPS was only slightly higher (5/216, 2.3%). On the basis of the 43 PPD-positive patients, the reactivity to 2% HPPS amounted to 12%; the corresponding figure for toluene-2,5-diamine was 15% (5/33). In a use test on two PPD-positive patients with a hair dye containing HPPS, no adverse reaction was seen, even after several years of regular dyeing. CONCLUSIONS. HPPS may be an alternative hair dye for individuals not tolerating PPD-containing dyes. However, cross-reactivity with PPD and other aromatic amines may occur. HPPS is also a known sensitizer, and the risk of de novo sensitization can only be assessed by a controlled study on a large panel and under regular use conditions.
authors.affiliation: Department of Dermatology, Klinikum Dortmund gGmbH, University of Witten/Herdecke, D-44137 Dortmund, Germany. peter.frosch@klinikumdo.de
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Frosch
authors.forename: Katrin
authors.initials: K
authors.lastname: Kügler
authors.forename: Johannes
authors.initials: J
authors.lastname: Geier
mesh_terms: D000328:Adult; D004396:Coloring Agents / Q000009:adverse effects / Q000737:chemistry; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D005260:Female; D005858:Germany / Q000453:epidemiology; D006202:Hair Dyes / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010328:Patch Tests; D010655:Phenylenediamines / Q000009:adverse effects / Q000737:chemistry*; D015995:Prevalence; D012680:Sensitivity and Specificity
chemical_list: D004396:Coloring Agents; D006202:Hair Dyes; D010655:Phenylenediamines; C050768:N,N-bis-(2-hydroxyethyl)-4-phenylenediamine; C029728:4-phenylenediamine