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.
DIAGNOSIS OF COSMETIC DERMATITiS 51 Dermatitis among negroes from hair straighteners is not uncommon. The sulfides and alkalis used to soften the hair are primary skin irri- tants as are the hardening solutions among which are formaldehyde. DEPILATORIES Chemical depilatories have caused derma•itis among their makers and users. The inorganic sulfides of barium, calcium, sodium, and stron- tium, and the thioglycollates are the principal chemicals used and they are all primary skin irritants. The site of the dermatitis and the history of its appearance shortly after the use of the depilatory determine the etiologic diagnosis. Patch tests are not indicated. HAIR LACQUERS These are used to keep stray locks in place and are usually solutions of natural resins. During the war when shellac was not available for hair lacquers, a synthetic resin sub- stitute consisting of a combination of rosin with a glycol maleic an- hydride resin caused an outbreak of dermatitis on the face. It was a sensitization dermatitis proven by patch tests. HAIR To•Ics These usually contain an anti- septic, a rubefacient, an oil, and perfumed alcohol. Dermatitis oc- casionally occurs from their use. The forehead, sides of the face, be- hind the ears, and the eyelids are usually affected. The dermatitis is due to sensitization to one or more of the ingredients. Resorcinol, betanaphthol, and quinine are the principal sensitizers in hair tonics: Cantharides and capsicum may also be the cause. The diagnosis is established by the history of the dermatitis coming on after use of the tonic by the site of the lesions and by patch tests with the tonic and each of its ingredients in proper dilution. LIPSTICK When the kiss-proof or indelible lipsticks were first produced, cheiliris was not at all infrequent from their use. We even saw it in men who used lipstick when dressed as clowns. The principal cause was the tetra- bromfluorescin which induces a photosensitivity. Other dyes in the lipstick may cause sensitization cheiliris as may the perfume. The history of the onset after the use of a new lipstick, site of the lesions, and patch tests with the lipstick, and each of its ingredients estab- lishes the diagnosis. Areas of the skin patch tested with lipstick should always be exposed to light if, when the patch is removed, the skin shows no reaction. NAIL LACQUERS These have been and still are a frequent cause of dermatitis. The site of the lesions are usually on the face and neck. Only rarely do they occur on the arms or covered parts of the body. This because the dermatitis is due to touching the skin with the lacquered finger nails. The solvents, chiefly esther% evapo-
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