TOXIC AND ALLERGIC COMPLICATIONS OF HAIR DYES 125 have disclosed the presence of hypersensitivity to the hair coloring, and thus could have prevented the resulting skin involvement. He makes the rather strong statement that neither he nor his collaborator are aware of any single instance in which a claim of systemic effects was substan- tiated. In view of this rather wide divergence of opinion of Schwartz and Barban as against all other experts in the field it is important for us to go a little further into the methods which they used and the reasons they gave for this apparent decrease in the sensitizing properties of modern hair dye solutions. Schwartz and Barban carried out more than five thousand patch tests upon one thousand subjects without eliciting any reactions. In addition, uncovered patch tests were performed by two other der- matologists on 234 women with the dyes that were to be used on their hair and there were no reactions. Therefore, they seem to have records of open patch tests in about 1234 subjects without reactions. They make the claim that a home hair dye which has now become commercially avail- able for about one year and had about ten million packages sold is rela- tively safe. They base this on the fact that the company has received less than one hundred and twenty-five letters from users stating that there has been skin irritation. That is one complaint to eighty thousand packages sold. They conclude, therefore, that the use of modern para hair dyes as now regulated by law is not unduly hazardous. It is not quite valid to use the number of complaints received as a basis for determining the incidence of hair dye dermatitis. Many of the cases I have seen have not taken the trouble to report irritation to the manufac- turer. This was especially true of the mild cases. When an authority such as Schwartz takes such a strong stand for the relative non-toxicity of the modern para dyes it cannot be dismissed lightly. However, it is not the consensus of opinion of nearly all other authorities that have been heard, both in print and at the hearing mentioned pre- viously. The author sees a great many cases of para dye sensitivities among users of para dyes. In every instance at some time or other these users have gone through a beauty parlor patch test routine or have carried out a patch test themselves for whatever it is worth. The users are very anxious to continue to use a hair dye which will not give them any toxic symptoms. The directions for proper patch testing which come with the hair dye solution are as follows: Five drops of the solution from Bottle 1 are mixed in a small glass with the proper proportional amount from Bottle 2 and the mixture allowed to stand for five minutes. The site to be used should be washed with soap and water and dried. Then with a cotton ap- plicator the mixture should be painted on the skin at the bend of the

126 JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS elbow or behind the ear, the application covering an area not less than the size of a 25 cent piece. It should be allowed to dry and to remain on the skin uncovered for 2 a, hours. If at the end of this time there is no itching or sign of irritation the dye can safely be used on the hair. This test should be repeated each time the dye is used, even for retouching the hair. The dye should not be used if there is any sign of irritation. Schwartz carried out the prophetic patch test with a new hair dye for home use as follows: He mixed the contents of the two bottles of the home use hair dye as required in the directions..He allowed the mixture to stand'for five minutes before painting it on the'cleansed skin. He chose the thin skin. of the inner fold of the elbow. The site was washed with soap and water and dried. The mixture was then painted on an area not smaller than a silver half dollar, and later was increased to a, sq. in. and allowed to dry. The subjects were instructed not to wash the site. The dye mixture was discarded after standing for 20 minutes and a fresh mixture was made. The procedu're was repeated with the same subject on the same site for three successive days. Twenty-four hours after the third application the subjects were seen again and examined for reactions and then were told to wash off the dye. To do this required several days since the skin was deeply dyed. Ten days after the last reading the contents of the two bottles were again mixed and applied as described be- fore. Twenty-four hours later the subjects were examined for reactions and then told to report if any late reactions developed. A para dye long used in beauty parlors was employed as a control patch. There were no reactions from any of the patches on any of the subjects. In every instance of true cases of allergic contact dermatitis due to hair dye which I have studied they not only gave a positive reaction to the hair dye which they used, but to a 1 or 2 per cent para solution. In order to avoid the primary irritant effect of the ammonia used in the hair dye it has been my habit after applying the test solution to allow it to dry thor- oughly on the skin for at least ten minutes before the patch is applied. An open patch test is always used at the same time. When all is said and done, one has only to discuss the problem of para sensitivity with the proprietor of any large beauty parlor to obtain a real insight into the sensitizing potency of the para dyes. There are always one or two of the operators who suffer from contact dermatitis from hair dyes and there are always one or two operators who will lose time because of this. This example may be argued against as a poor one to indicate the possible hazard of the para dyes for home use because the beauty parlor operator has much greater contact with the para dye than any person who applies it at home. I believe, however, that it is only a question of time before continuous use by any one person at home will result in increasing the number of those who are sensitive to para and allied compounds. The