116 JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS Reports of dermatitis and systemic poisoning from the use of aromatic amines in hair dyes are too numerous for the abstraction of all of them in this work. The outstanding ones, which not only report cases but con- tribute additional knowledge about the subject, are as follows: Scanto (18), who tested 46 people with two hair dyes containing aro- matic diamines and aminophenols, obtained 19 positive reactions. He tested 32 subjects with sulfo-paraphenylenediamine, sulfo-ortho-aminophenol, and sulfo-aminodiphenylamine and obtained 6 positive reactions. He concludes that sulfonation does not destroy the toxicity of the aromatic diamines and aminophenols. He tested 47 subjects with quinone compounds formed by the oxidation of these hair dyes and obtained 28 reactions, showing that the oxidation products are the most active irritants. Baba (19) described the symptoms in 40 cases of systemic poisoning from the ingestion of paraphenylenediamine. They were vomiting, pains, mus- cular rigidity, convulsions, paralysis, edema of'the larynx and tongue, urticarial rash, and albuminuria. He devised a test for paraphenylene- diamine in the body fluids in cases of poisoning (20). Cases of occupa- tional dermatitis among hairdressers from organic hair dyes were reported by Berger (21) from 2,4-diaminotoluene, and by Gougerot and Delzant (22) from paraphenylenediamine. An attempt to desensitize the individ- ual against the latter caused a generalized eczematous reaction. In a case of scalp injury from a preparation which contained a trihy- droxybenzene as "active" ingredient the plaintiff was awarded the verdict because a patch test was not specified to determine the existence of an idio- syncrasy. Keschner and Rosen (23) reported a case of bilateral optic neuritis which developed suddenly three days after the application of a synthetic hair dye which they assumed to be of the phenylenediamine type. A review of the incidence of toxic and allergic reactions following ex- posure to para and allied compounds through 1946 can be found in the text- book by Schwartz, Tulipan and Peck (24). In a fur dyeing plant where seven hundred workers were employed four cases of dermatitis due to para were found among these workers. All gave a positive patch test with a 2 per cent solution ofpara, and negative reactions to other substances which they handled. In a factory employing an average of two hundred men where rabbit fur was dyed with para, para-aminophenol, and orthoaminophenol to resem- ble beaver, nine cases of dermatitis occurred in two years. Two workers were also found to have asthma due to hypersensitivity to para. In another factory employing 40 workers where synthetic dyes were used two cases of dermatitis and one case of asthma due to para were found. In three similar plants employing 130 men two cases of dermatitis due to para were found. In one factory employing about one hundred workers

TOXIC AND ALLERGIC COMPLICATIONS OF HAIR DYES 117 where synthetic dyes were not used there were no cases of dermatitis or as thm a. Six cases of dermatitis occurring in various small fur dyeing establish- ments and supposedly due to fur dyes were studied. All six were patch tested with a 2 per cent solution of para for 48 hours. Four gave positive reactions and two negative reactions. Less than one per cent of workers employed were found to be suffering from dermatitis due to the. dyes. Combined statistics of the Labor Commission of New York and Ohio showed that in 1934, out of about sixteen hundred cases of occupational der- matiris reported to the Commission, 29 were attributed to the handling of dyed furs. These cases occurred among fur salesmen, fur cleaners, fur garment makers, and fur ironers. For mordant dyes to cause dermati- tis they must be so poorly applied to the fur that they readily come off or dissolve in the skin secretions of a sensitive wearer or handler. Such condi- tions are present only in poorly dyed and insufficiently washed and dyed furs, called "dirty furs" in the trade. Moreover, sensitivity to these substances must be present. The skin may be sensitive to any of the mordant dyes, but the chrome mordant and synthetic oxidation dyes, based on paraphenylenediamine, para-aminophenol and orthoaminophenol have been the chief causes of der- matiris. Rajka (25) studied 23 subjects sensitive to chemically related compounds of the so-called para group which includes various dyes used in coloring both foods and fabrics and numerous drugs, among them local anesthetics and sulfonamides and found that in the individual case the compounds included in the patient's allergic spectrum could not be predicted. Re- actions that would be expected on the basis of chemical structure did not necessarily follow. Thus, in patch test reactions to metol and hydro- quinone they were closely related as were relations to p-aminophenol and dimethylparaphenylenedia. mine in contrast to the results that chemical relationship would suggest. It seems that in certain instances a chemical allergen produces reactions on the basis of heptane linkage to protein, but in others it does not occur, the linkage being qualitatively and quanti- tatively different. In a woman who had become sensitized to various substances of the para group the injection of azo dyes used to color food was repeatedly followed by the occurrence of a papular eruption on the neck. Since sensitization to one drug in the para group entails a whole train of allergic reactions to chemically related substances patients with an allergic reaction to any of the sulfonamides, p-aminosalicylic acid, p-amino- benzoic acid, procaine and other drugs of para (para-amino) structure should be given another drug of related chemical structure only after