DIAGNOSIS OF COSMETIC DERMATITIS 49 ANTI-PE RS PIRANTS AND DEODORANTS Dermatitis in the axilla is not un- common from the use of anti- perspirants. Solutions containing high concentrations of aluminum chloride have been more at fault than those containing aluminum sulfate. The anti-perspirants swell the epithelium at the mouth of the sweat ducts and thus tend to close the openings and dam back the per- spiration. This may result in cyst formation, and sometimes in secon- dary infection forming pustules. The diagnosis is made from the appearance, site of the lesions, and the history of using an anti-perspir- ant. Patch tests are unnecessary. 'Dermatitis has not been reported from deodorants powders. The dis- eases to be considered in differential diaghosis, are furunculosis, hydra- denitis suppuritiva Fox-Fordyce dis- ease and Acanthosis Nigricans. HAIR PREPARATIONS These have caused the majority of cases of dermatitis from cos- metics. The synthetic hair dyes, the chemical hair wavers, straighten- ers, depilatories, hair lacquers, and hair tonics, have been the worst offenders. HAIR DYES The vegetable hair dyes, henna, sage tea, walnut hull juice, indigo (used with henna to produce brown shades) have caused no trouble. The metallic salt of lead, silver, copper, cadmium, and tin have not caused dermatitis, but argyria has been reported from hair dyes con- taining silver. Lead poisoning has not been reported from salts of lead used for hair dyes. Since the parenting of para- phenylenediamine in 188a by Erd- man for dyeing hair and feathers, there have been thousands of cases of dermatitis from hair dyes con- taining it. Conjunctivitis and keratitis re- suiting in blindness in a few cases occurred from the use of para- phenylenediamine as an eye lash and eyebrow dye. So many cases of dermatitis re- sulted from the use of para- phenylenediamine that in some countries its use on humans is pro- hibited and in others tests are re- quired to be performed on the sub- ject before it can be applied as a hair dye. Paraphenylenediamine, para- to]uylenediamine, paramidophenol, and aniline black, and other re- lated oxidation dyes are the chief causes of dermatitis and asthma among furriers using them as fur dyes. The predyeing patch test with paraphenylenediamine is useless because sensitization is established at least 5 days after the hair is dyed, therefore unless the pa- tient was sensitized by the hair being dyed with it previously, or the pa- tient was sensitized by wearing fur, dyed with paraphenylenediamine, the patch test will be negative and still the dermatitis may occur 5 days after the hair is dyed. The actual irritant in dermatitis from paraphenylenediamine is one of the

50 ,JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS early unstable oxidation products quinone-di-imine. The late oxi- dation products such as "Band- rowski's Base" are harmless. Therefore, in dyelug the hair with paraphenylenediamine care should be taken to do a thorough job of oxi- dizing it, and to wash out of the hair all the excess paraphenylene- diamine and oxidation products. T)ermatitis from paraphenylene- diamine is usually localized to the face and scalp, but generalized dermatitis has been reported. The diagnosis of dermatitis from hair dye is made from the history of having used the hair dye previous to the onset of the dermatitis and by positive patch tests with the dye solutions, either singly o'r in com- bination if 2 or more bottle dyes are used. CHEMICAL HAIa WAVEaS AND STRAIGHTENEKS Chemicals used for permanent waving and straightening the hair are often reported as causing derma- titis. The earlier chemicals used for waving depended on their alkalinity to soften the keratin, thus permit- ting the hair to be stretched and curled and when it dried the curl was retained. The process was reversed when kinky hair was to be straightened. The dermatitis which occurred consisted of alkali burns of the skin. The alkalis were followed by the so-called "heatless" waving com- pounds and 1 case of death was attributed to absorbrich through the scalp, of hydrogen sulfide liberated from the ammonium sulfide con- tained in one of them. At present, the cold waving solu- tions are being used. They depend for their action on the softening of the hair caused by the reducing agent ammonium thioglycollate which they contain. Dermatitis can occur and has been reported both among the beauticians and those on whom the cold waving solu- tions were used. The thioglycol- lates reduce the epithelium of the skin just as they reduce the keratin and cause dermatitis if the cold wav- ing is done carelessly so that the reducing solution s. tays on the skin for a sufficient time to cause derma- titis. The diagnosis of depmatitis' from cold waving solutions is made from the location of the lesions, on the forehead,' face, and neck 6f the person taking the wave and the history of having taken it shortly before the dermatifis appeared. Patch tests are not indicated be- cause the reducing solution is a pri- mary irritant.* Beauticians giving cold waves get dermatitis on the hands and arms if they do not wear rubber gloves and impervious sleeves. The reported cases of sys- temic poisoning attributed to taking cold waves have not been sub- stantiated. Diseases of the scalp to be differentiated from the effects of cold waving are Alopecia areata, Folliculitis decalvans, Lupus ery- thematosis and Syphilitic Alopecia. * The loss of hair from the improper use of cold waves is temporary because the hair follicle is not affected.