Symposium- Hair cosmetics

Hair Disorders

Nina Madnani, Kaleem Khan1

P. D. Hinduja National Hospital, ABSTRACT

Mahim, Mumbai,
1
Dr. Madnani’s Skin and Hair The hair cosmetic industry has undergone a revolutionary change over the last two decades.
Clinic, Colaba, Mumbai, India
The focus has dramatically veered from merely cleaning to repair, increasing the tensile
strength, reducing oxidative damage, and stimulating growth. Newer shorter procedures to
Address for correspondence:
Dr. Nina Madnani, make hair look naturally more lustrous, smooth, and manageable have evolved. Specialized
P.D. Hinduja National grooming products have been formulated to cleanse, calm, and condition the hair, and are
Hospital, Veer Savarkar tailored for different hair-types, for example, dry, dry-damaged, oily, colored, and gray hair.
Marg, Mahim - 400 016, Other products are formulated to alter the color or structure of the hair shaft, for example,
Mumbai, India.
hair dyes, perming/relaxing. Hair sprays and waxes/gels, can alter the ‘lift’ of the hair-shaft.
E-mail:
ninamadnani@gmail.com Although dermatologists are experts in managing scalp and hair diseases, the esthetic
applications of newer cosmetic therapies still remain elusive. This article attempts to fill the
lacunae in our knowledge of hair cosmetics and esthetic procedures relevant in today’s
rapidly changing beauty-enhancing industry, with special emphasis on the Indian scenario
for chemical and ‘natural’ hair products.

Key words: Cosmetics, hair, hair-dye, herbal, lanthionization

INTRODUCTION structural components is essential to understanding

‘hair care’.
A ‘healthy’ head of hair is described as hair that has
luster, is smooth, long and silky, bouncy, with good STRUCTURE AND PHYSICAL CHARACTERISTICS OF HAIR
volume, and with no evidence of balding.[1] To achieve
this, the hair-care industry has provided us with a Healthy hair is pigmented, smooth, glossy, and flexible
plethora of products to beautify, enhance, strengthen, yet strong, with the ability to withstand shearing
and ‘nourish’ our tresses. Most of the products work forces. The hair gloss depends upon the smooth
at the cuticle level of the exposed hair shaft. A few layering of the cuticle, while the strength depends on
can enter the cortex. Some hair procedures like the integrity of the cortex, which is made up of 15%
coloring, perming, straightening, and the like, result hard keratin (skin contains 2% keratin).
in structural damage. Specialized products then
have to be used to repair and restore (if possible) Hair cosmetics act on the part of the hair shaft that
the natural hair integrity. Hair dressing has evolved projects beyond the scalp surface. The hair consists of
from just cutting, to altering the color, texture, and a cortex surrounded by a multilayered complex cuticle
‘health’ of the hair. Frizzy hair can be straightened with/without a central medulla. The cuticle has a very
and straight hair can be curled. Understanding the important role to play in regulating the entry and exit
of chemicals/water to and from the cortex. It provides
Access this article online
protection from external environmental factors, and
Quick Response Code: Website:
when intact, keeps the hair surface smooth and glossy.
www.ijdvl.com

DOI:
The cuticle is six to eight layers thick and closely
10.4103/0378-6323.116734
adherent to the inner cortical layer of the hair shaft.
PMID:
It is damaged in procedures that require disruption
*****
of the cortex, such as, bleaching, coloring, and

How to cite this article: Madnani N, Khan K. Hair cosmetics. Indian J Dermatol Venereol Leprol 2013;79:654-67.
Received: June, 2013. Accepted: July, 2013. Source of Support: Nil. Conflict of Interest: None declared.

654 Indian Journal of Dermatology, Venereology, and Leprology | September-October 2013 | Vol 79 | Issue 5
Madnani and Khan Hair cosmetics

perming. The individual cuticular cells are made weaker bonds present. The cells of the cortex contain
up of proteins, lipids, and polysaccharides. The melanosomes that are responsible for the color of the
cells are colorless and arranged in an overlapping, hair. Hair color is almost completely dictated by the
roof tile–like pattern, providing for an impenetrable presence of either pheomelanins (red) or eumelanins
barrier to external environmental damage. The open (brown/black) within the melanosomes. Interestingly,
ends of the overlapping tiles are directed away from the melanosomes are more densely arranged in the
the scalp, toward the growing tip. The adjacent hair outer layers of the cortex than at the central core.
grows and moves outward in relation to each other.
This arrangement facilitates the lifting up of dirt and The medulla is at the core of the hair fiber. It is highly
scales, helping for easy removal.[2] The cells overlap variable in human hair and is made up of specialized
such that only one-sixth of each surface is exposed. cells with air spaces in between. It is rich in glycogen
The outermost layer of cells forming the cuticle is and citrulline. It is present only in the thick dark
called the epicuticle, a hydrophobic layer, providing hair of the scalp and is lost in the aging gray hair. Its
for the first line of defense against water. Immediately function is not known.
below is the A-layer, which is high in cysteine content.
The thiol groups of adjacent cysteine residues undergo The structure of unprocessed hair is perfectly
oxidation to form disulfide bonds. This cross-linkage designed and its outermost layer remains smooth,
confers structural strength and rigidity to the cuticle. well-protected, dries quickly when wetted, and resists
The subsequent layers have progressively less cystine diffusion of water into the cortex.[4] This maintains the
content and correspondingly less rigidity. The B-layer structural integrity.
or the exocuticle lies immediately below, followed by
the endocuticle. The endocuticle has the least cystine WEATHERING OF HAIR
content and is much softer. S100A3 is an important
protein component of the endocuticle, and is released The hair surface in untreated hair has a pH of 4.5 to 5.5.
during harsh chemical procedures resulting in This acidic pH helps to keep the cuticular cells closely
instability of the hair structure.[3] It is this layer that opposed to the cortex. Damage to the cuticle results
absorbs water and swells up, allowing for change is in structural changes to the hair shaft over a period of
the physical properties of hair. Finally, the cellular time and constitutes hair weathering. As the scalp hair
membrane complex (CMC) separates each cell from the of women grows over long anagen periods, the hair is
one below. 18-methyleicosanoic acid (18-MEA) is an exposed to several years of cumulative damage from
important lipid component of this hydrophobic layer. external factors [Figure 1a]. The contributing factors
In many ways, the cuticle is similar to the stratum include chronic ultraviolet exposure, excessive wetting,
corneum of the epidermis. An intact, well-organized repeated harsh chemical procedures [Figure 1b], hot
cuticle is representative of healthy hair. combs, blow-drying, and even simple, but repeated
activities, such as rough combing and brushing.[5,6]
The cortex lies immediately beneath the cuticle and Loss of cuticle or lifting-up of the cuticular plates
forms the major component of human hair. It consists
of fusiform spindle cells approximately 100 microns
long, arranged longitudinally. Each spindle cell has
microfibrils and macrofibrils within a cystine-rich
matrix. The cells are held together by an intercellular
substance and have complex keratins numbering
1-17. Disulfide bonds between the cysteine residues
within the cortex are the strongest and structurally the
most important bonds that hold the keratin proteins
together. They are responsible for the ultimate shape
of the hair. These bonds have to be dissolved during
the procedures that change the shape of the hair.
Hydrogen bonds exist as weaker bonds that can stretch a b
during simple wetting of hair. The Van-der-Waal Figure 1: (a and b) Naturally weathered hair, Weathered following
forces and Coulombic interactions (salt-links) are the cosmetic procedures

Indian Journal of Dermatology, Venereology, and Leprology | September-October 2013 | Vol 79 | Issue 5 655
Madnani and Khan Hair cosmetics

exposes the cortex that is then readily susceptible to hence, people moved onto using shampoos formulated
damage resulting in split ends (trichoptilosis) and with better conditioning properties.
frayed tips. Weathered hair loses moisture more rapidly
than normal hair, and hence, looks dull and dry.[7] Shampoos are formulated for cleansing the hair.
Weathering is not a common occurrence in men (except Although historically, that was their only function,
those with long hair styles) as their hair are constantly today specialized benefits are expected, almost
cut, which helps the damage (if any) to be trimmed magical, where shampoos are expected to give shine,
off. Hofbauer Tsambaos, Spycher, and Trueb have volume, easy combability, protection of colored hair
reported that the excessive weathering seen in areas from fading, ultraviolet protection, and so on. The
of androgenetic alopecia is due to a low threshold to media hype has been responsible for these heightened
damage caused by changes of acquired pili annulati.[8] expectations from a product, which in the past merely
Environmental dust, dirt, sebum accumulation, and served to clean the hair.
hair products build up on the hair making it sticky,
dull, and often unmanageable. This is termed as a ‘bad All shampoos have certain basic ingredients[9]
hair day’. Copper from tap water in copper water pipes like: [Table 1]
gets deposited on the hair during washing. Being a 1. Detergent
catalyst, it liberates free radicals and causes the hair to 2. Foaming agents
become dull and damaged. Fortunately in India, we do 3. Conditioners
not have copper water pipes. Water from wells also has 4. Thickeners
a very high mineral content, which can get deposited 5. Opacifiers
on the hair shaft. Hair washed with such water can also 6. Sequestering agents
damage the hair. 7. pH adjusters
8. Preservatives
CLASSIFICATION OF HAIR COSMETICS 9. Additives

The various components of hair at the molecular level Detergents

regulate the efficacy of various hair cosmetic products, These are surfactants that combine and emulsify and
allowing their classification as follows: wash off the grease and dirt (soil). Various types of
Category 1: Those that work on the exocuticle surfactants are formulated to cleanse different types
Category 2: Those that work on the cortex or of hair [Table 2]. The most popular in use are sodium
alter the structural integrity of the
hair shaft. Table 1: Constituents of shampoos
Detergents
Category 1 Anionic Lauryl/laureth sulfates, sarcosines, sulfosuccinates
These hair cosmetics include shampoos, conditioners, Cationic Amino esters, long chain amino acids
serums, hair sprays, waxes, gels, mousses. Amphoteric Imidazoliniums, sultaines, betaines
Non-ionic Polyoxyethylene fatty alcohols/sorbitol esters
Shampoos Natural Soap bark, agave, soapwort
Traditionally, the beauty of Indian ladies was measured Polyoxyethylene sorbitol esters, polyoxyethylene
fatty alcohols, alkanolamides
by the length of their hair and many had plaited hair
Soap nut, acacia concinna
reaching upto their knees. Maintaining a good scalp
Foaming Lauramine oxide, lauramide MEA, cocamide MEA,
and hair hygiene was a very important part to healthy agents cocamidopropyl hydroxysultaine, polysorbate 20
hair. The concept of hair cleansers used in ancient Conditioners Fatty alcohols/esters
India gave rise to the word ‘shampoo’ (India: Champo). Vegetable/mineral oils
Hair cleansers were made by boiling soapnut (Reetha; Hydrolyzed animal protein
Sapindus Mukorossi) with Indian gooseberries (Aamla; Thickeners/ Aqueous: Cellulose gum, guar gum, PEG,
Phyllanthus emblica) and shikakai (Acacia concinna) in opacifiers methylcellulose, clays
water and using the strained water to wash the hair. The Non-aqueous: Organoclays, polyethylenes,
trihydroxystearin, fumed silica
other option was using a paste of Fuller’s earth (multani
Additives Natural: Plant extracts, almond extract, balm mint
matti) on the scalp and rinsing it off with water. The oil, egg yolk, chamomile, citrus, clove, basil
Fuller’s earth would adsorb the grease, which was then Collagen, vitamins, ceramides, and glutamic acid
rinsed off. These natural cleansers left the hair dry, and MEA: Methyleicosanoic acid, PEG: Polyethylene glycol

656 Indian Journal of Dermatology, Venereology, and Leprology | September-October 2013 | Vol 79 | Issue 5
Madnani and Khan Hair cosmetics

Table 2: Surfactants and hair types Additives

Various additional agents are added to shampoos to
Problem Surfactant
either give better conditioning or to term them as a
Dry hair Amphoterics, anionics
Oily hair Anionic
‘natural’ or a herbal shampoo.
Colored hair Cationic
Treated hair Cationic, amphoteric Depending upon the nature of the detergent used,
Baby hair Amphoteric shampoos are targeted for various hair types. Proper
Menopausal hair Amphoteric shampooing involves wetting the hair completely,
taking a good amount of shampoo in the palm and
laurel/laureth sulfates, ammonium lauryl/laureth then applying it along the head and length of hair.
sulfates, triethanol amine lauryl sulfate, diethanol Hair should not be piled up on top of the head before
lauryl sulfate, and sodium olefin sulfate. Also, a applying the shampoo as this can lead to matting of
detergent, to be very effective in cleansing the hair, hair.[10]
would also strip the hair of sebum, leaving them dry.
Conditioners
Foaming agents Conditioners fulfill the need for hair shaft protection
These are very popular in shampoos, as historically, and are agents either incorporated into shampoos or
people equate efficacy with foaming of the shampoo. used after cleansing, on slightly damp hair. After a
Greasy hair will require repeated washing with shampoo wash, the cuticles get slightly lifted, and
shampoo, until the shampoo foams properly. the hair develops a negative charge causing the hair
to repel each other and appear rough and uncombed.
Conditioners
Conditioners flatten the cuticles and seal the gaps that
An effective cleanser will strip the hair of all grease,
could expose the important cortex to environmental
thus leaving it dry and dull. Hence, shampoos
damage. Conditioning agents incorporated into
incorporate various ingredients that can coat the
shampoos (labeled as conditioning shampoos/
cuticle to improve shine, slip, and easy combability.
dry hair shampoos/hair fall shampoos) include
mineral oils, vegetable oils, fatty alcohols/esters,
Thickeners and opacifiers
humectants, hydrolyzed animal proteins, glycerine,
These appeal to the aesthetic sensibilities of
stearalkonium chloride, propylene glycol,
the user, but do not add to the cleansing effect.
silicones (dimethicone, simethicone), and natural
They have to be compatible with the surfactants.
products like bees honey (an emulsion of proteins
Although alkanolamides were the early agents used,
sugars and lipids), vinegar, wheat germ oil,
they have been replaced with various aqueous and
panthenol, collagen, and placenta. Silicones have
non-aqueous agents. The consumer equates thickness
with a better aesthetic look and efficacy. Betaines become very popular as they provide good ‘slip’ and
combine with the anionic surfactants to make luster, and retain moisture in the hair, but silicone
large micelles, and also contribute electrolyte salt that oil is hydrophobic and it does not get absorbed onto
increases the viscosity of the product. the hair very easily.

Sequestering agents Sebum is a natural conditioner for the hair. By

A detergent, when used with hard water, leaves a capillary action, the excreted sebum, coats only the
sticky residue on the surface. This scum renders the proximal 1.5 inch of the hair shaft. It is the process
hair dull and unmanageable. This is often seen when of combing that helps to distribute the sebum distally
soap is used to cleanse the hair. Sequestering agents and coat the hair evenly. An ideal conditioner, if it
prevent the formation of this scum by chelating the did exist, would need to match the components and
calcium and magnesium ions from hard water. natural properties of sebum. Hence, they would need
to have a combination of free saturated/unsaturated
pH adjusters fatty acids, squalene, cholesterol, and triglycerides.
Damaged hair can swell with alkaline detergents. The practice of using hair oil in India since ancient
Hence, when formulating suitable shampoos for such times is akin to using conditioners today. Coconut oil,
hair, an acidic pH adjustment is done. The substances but not sunflower or mineral oil, can penetrate the
used includes citric and lactic acid. hair shaft and reduce protein loss.[11] Commercially,

Indian Journal of Dermatology, Venereology, and Leprology | September-October 2013 | Vol 79 | Issue 5 657
Madnani and Khan Hair cosmetics

conditioners are available as rinses, instant, leave-on, The popular products are hair sprays, gels, waxes,
serums, and professional conditioners. pomades, and mousses.

Rinses or instant conditioners are applied to washed Hair sprays/fixatives

and towel-dried hair, left on for two to five minutes, These are products in aerosol form, which when
and rinsed off. They serve only to improve the sprayed, create stiffness and ‘hold’ between hair.
combability of the hair. They are employed after styling the hair to ‘hold’ the
style for an extended period. The main constituent
Leave-on conditioners are applied to washed and is polyvinylpyrrolidone, which is water washable.
dried hair, and remain on till the next shampoo. An addition of vinyl acetate make the sprays longer
They smoothen down the cuticle and protect the hair lasting (high-hold), but difficult to shampoo off.
from weathering. They are convenient and popular. Newer softer hair sprays contain methacrylate
They contain cationic detergents, water, lipids, and copolymers.
thickeners. They may be available in thin or thick
formulations. Their effect is short-lived. Hair gels
These are useful products for individuals with diffuse
Leave-in conditioners hair thinning, as when applied to the damp hair, can be
These are products used for curly or unmanageable styled to give a lift from the scalp, giving a semblance
hair prior to styling or blow drying and on hair that has of volume. They also give a gloss to the hair. The
been damaged by chemical processes. As they contain constituents are similar to hair sprays and can be used
mineral and vegetable oils, petrolatum, and silicone, for ‘styling’ or ‘sculpting’ the hair [Figure 2].
they impart gloss to the hair and trap in moisture.
These are not suitable for fine hair. Hair waxes
These are available as a wax containing copolymers,
Deep conditioners which are softer and can be evenly spread over dry
Popular as a parlor procedure, these are creams or hair for styling and can give an ‘oily’ look.
oils applied and left on for 20 to 30 minutes, with or
Hair mousses
without a steamer, and then rinsed off. They contain
These are very popular because of their ease of use.
concentrated conditioning agents (protein, quaternary
Available as a foam in aerosolized cans, they contain
ammonium salts). They provide more smoothening of
a soft copolymer that gives a more natural look, with
the cuticle, and hence, better gloss.
less ‘hold’.
Anti-hair loss conditioners
Pomades and brilliantine
These actually contain deep conditioning agents that
Very popular with African-American people as a
seal the split or frayed ends to reduce damage and
styling aid. These are products that contain vegetable/
brittleness, and thus, indirectly reduce hair fall.

Generally considered safe for regular use, few cases

of adverse events like contact dermatitis have been
reported with the use of both shampoos[12,13] and
conditioners[14-16] Shampoos can cause a flare-up of
childhood eczemas.[17]

Hair styling products

The hair industry has provided us with numerous
products to use before or after a physical hair
styling procedure like curling with rollers, ironing,
back-combing, and the like. These products help in
changing the texture of the hair or in holding the hair
in a particular style for long wear. Most of them can
be washed off with a shampoo or even with water. Figure 2: Hair styled with hair gel

658 Indian Journal of Dermatology, Venereology, and Leprology | September-October 2013 | Vol 79 | Issue 5
Madnani and Khan Hair cosmetics

mineral oils, petrolatum, lanolin and waxes, and Hair colors

help in styling, moisturizing and conditioning the Youth is represented by absence of gray hair. Graying
hair. They are comedogenic. Brilliantines are liquid becomes obvious when at least 20% of hair loses
pomades and newer formulations have better slip, as pigment. In the quest for looking young, research
they contain silicones. has focused on providing us with several options for
covering gray hair/changing hair color temporarily
‘Shine’ sprays or permanently. Hair coloring molecules are of
These contain silicones, hydrolyzed animal proteins, different sizes, with the larger molecules mainly
and cationic amino acid derivatives, and leave a shine getting deposited on the hair shaft as a temporary or
when sprayed on damaged hair. These are very useful semi-permanent color. In order for a hair dye to be
for hair that has become dry and lusterless. termed ‘permanent’ the molecules should be capable
of penetrating into the cortex and remaining there.
‘Heat protective’ products
Hair styling treatments using thermal energy can easily Gradual hair dyes
damage the hair, especially when wet. Specialized These are home-use products, which give the desired
products have been designed to address this particular color after several days of use. The product has to
problem. They contain conditioning polymers such as be applied daily on the hair till the desired shade is
silicon, petrolatum, and mineral oil, which function reached. The patient then stops the applications, but
primarily by forming light-weight films. These act as would need to restart once the shade starts fading
thermal barriers and offer some degree of protection. off. The gradual hair colors contain salts of metals
(lead, silver or bismuth) in a liquid form, which when
‘Camouflage’ products applied to the hair, leave behind the metallic salts as
Patients with hair loss have a decreased quality of sulfides, oxides, and suboxides. Compliance is not
life (QoL) and as treating physicians, dermatologists very good because of the messiness of application,
should address this aspect of hair loss.[18] Several but these are useful for individuals who are allergic
cosmetic products are available to be used by the to para-phenylenediamine (PPD). The end result is
individual to conceal the alopecia, for example, dull hair with a ‘not-perfect’ shade of color, which
Toppik (keratin fibers) and Hairouse (cellulose fibers). fades off faster and requires constant reapplication. In
These come in various shades of brown and black, and addition, hair that has been colored with these gradual
can be sprinkled on the bald areas. Static electricity dyes cannot be subjected to chemical perming or
make the fibers adhere to each other and the hair on straightening procedures. Some examples of gradual
the scalp, thus effectively concealing the bald area. hair dyes available in the Indian market are ‘Vegetal’
Similarly, ‘cover sticks’ made of waxes and pigment can (non-PPD) and ‘Godrej Kesh Kala’ (PPD-containing).
be used by individuals who wish to conceal the ‘gray
show’ between two sessions of hair coloring [Figure 3]. Temporary hair dyes
These are useful to brighten the original hair shade,
Category 2 to add a tint, or enhance dyed hair. They get washed
These include hair cosmetics that work on the cortex
or alter the structural integrity of the hair shaft and
include hair colors, bleaching agents, straightening,
and perming agents.

a b c
Figure 4: Depth of penetration of hair dyes a. Larger molecules
of temporary hair dyes are unable to penetrate into the cortex b.
Smaller molecules of semi-permanent hair dyes easily penetrate
into the cortex, but diffuse out easily in the subsequent washes
c. Smaller dye precursors penetrate into the cortex and undergo
Figure 3: (a and b) Cosmetic camouflage with a cover-stick: Before oxidation to form large colored molecules that remain within the
and immediately after application cortex and are unable to diffuse out

Indian Journal of Dermatology, Venereology, and Leprology | September-October 2013 | Vol 79 | Issue 5 659
Madnani and Khan Hair cosmetics

off with water and barely last till the next hair wash. Table 3: Concentration of Hydrogen peroxide used as a
They use textile acid dyes (FDC and DC dyes). Their developer in hair colors
large molecular size, keeps them outside the cuticle, Concentration Effectivity
keeping the cortex and medulla unaffected [Figure 4]. (in volumes)
10 vol Used to darken hair for same level of color
‘Silver shampoo’ is an example of a temporary dye used 20 vol To lighten hair color up to two levels
by women with all gray hair to give a silver hair look. 30 vol To lighten hair color up to three levels

The purple and blue dye colors in the silver shampoo,

camouflage the dull yellow stain, which these hair which are aniline dyes, to produce the required color
develop when combined with sebum and sweat. molecules. As these color molecules are large, they
cannot pass out through the cuticle, and remain firmly
Semi-permanent hair dyes bound in the cortex. A change of shade from dark to
These are water soluble, non-ionic, low molecular light and the reverse is possible. The color remains in
mixtures of pre-formed dyes,[19] the numbers of the hair, and a touch-up of roots may be required after
which vary depending on the shade required. six to eight weeks depending on the rate of growth. It
These do not require hydrogen peroxide. They is important for the ‘touch-up’ process to treat only the
are usually anthraquinone, aromatic amines or new growth, as the older hair shaft color may darken
aminonitrobenzenes, and may contain up to due to re-application. As PPD derivatives can cause
18 component dyes to obtain the required shade. The allergic reactions, a patch test is necessary before
product is applied to shampooed and towel-dried hair, using a permanent hair dye. Of late, PPD is being
left on for 20 minutes and then rinsed off. A conditioner incorporated into henna to give a deeper color and is
is used post-shampooing. The color gets reduced with marketed as black henna (kali mehendi). Permanent
each shampoo and is completely washed off in six to hair colors are available as liquids, gels, and creams.
eight shampoos. A patch test is required prior to the A home-use pack contains two bottles that contain
use of these dyes. colorless liquids (hydrogen peroxide and a primary
intermediary in combination with surfactants,
Demi-permanent hair colors conditioner, and so on). The two are mixed in equal
These are gentler on the hair than the permanent proportion and applied immediately to the hair. Any
colors as they do not contain ammonia, and have a left-over mixture must be discarded. The proportion of
lower concentration of hydrogen peroxide (2%) as combination is 1:1. Some home-use packs are available
compared to permanent hair dyes (6%).[20] Hence, the in powder form, which has to be reconstituted with
irritation to the scalp and damage to the hair shaft is water. Here, the oxidizing agent is either sodium or
reduced. They are effective in covering gray hair, but potassium perborate in powdered form. The final pH
not in lightening the hair shade. achieved is 8-9.

Permanent hair dyes Patch test for semi-permanent and permanent hair
Permanent hair colors are the most commonly used colors
hair colors, because of their longevity, ease of use, The hair dye test can be an ‘open’ test or one using the
and ability to have a range of color shades. These are epicutaneous patch test.
also superior for gray cover, as the result is permanent
and does not get washed off. This is an oxidation Open test: On a clean area behind the ear or on the
reaction that requires the combination of para forearm just below the elbow, the dye mix is applied
dyes (para-phenylenediamine, para-toluenediamine, with a cotton swab and allowed to dry. If there is no
and para-aminophenol, known as the primary reaction in 48 to 72 hours, the dye mix can be safely
intermediaries) with hydrogen peroxide [Table 3] used on the scalp.
to liberate oxygen. This process takes place inside
the cortex and the entry is facilitated by ammonia. The epicutaneous patch test is the gold standard.
In ammonia-free hair dyes this work is performed This is done with 2% PPD in petrolatum. The result is
by other alkaline agents like sodium carbonate and read at 24 hours. A 1+ to 3+ indicates allergy to PPD.
ethanolamine. The primary intermediaries are smaller Recently, an in vitro assay using patient’s peripheral
molecules that can pass through the cuticular cells. blood mononuclear cells has been developed with a
Once inside the cortex, they combine with couplers, sensitivity of 100%.[21]

660 Indian Journal of Dermatology, Venereology, and Leprology | September-October 2013 | Vol 79 | Issue 5
Madnani and Khan Hair cosmetics

Cross reactions restrictions on the manufacturing process. After the US

Patients sensitive to PPD may possibly cross react with Food and Drug Administration (FDA) placed regulatory
compounds listed in Table 4. guidelines on hair dye formulation in 1980, there has
been a significant change in hair dye composition.
Safety regulations for para-phenylenediamine Most recent studies and reviews of the meta-analysis
The European Commission Directive 2009 regulation do not support a causal relationship between personal
directs that the maximum concentration of hair dye hair dye use and bladder malignancies.[31,32] However,
substances in oxidative hair dyes should not exceed hairdressers still remain at a higher risk.[33] Few reports
2%.[22] This may be true for hair dye regulations, but link an increased incidence of Follicular Lymphoma (a
studies attempting to quantify the percentage of PPD variant of Non-Hodgkin’s Lymphoma (NHL)) in
in decorative henna tattoos have shown alarming patients using permanent hair dyes, but this is again
levels varying between 1-64%.[23,24] true for those using hair dyes prior to 1980.[34,35] Also, it
has been proposed that a possible genetic variation in
Side-effects of hair dyes the N-acetyltranfeferase enzyme may be an underlying
Most reactions to hair dye are due to the PPD predisposing factor for development of NHL in
content. The role of ammonia is to facilitate dye certain groups of patients applying hair dyes.[36] Use
penetration, and ammonia-free dyes, although gentler of hair colors does not appear to increase the risk of
to the hair shaft, do not prevent PPD reactions. Hair development of breast cancer.[37]
dye reactions most commonly present as allergic
or irritant contact dermatitis. Some patients may Indian hair dyes
experience photoallergic dermatitis.[21] Dye-induced Several hair dyes are available in India for home
depigmentation is not uncommon[25] and tends to run use, for example, Bigen, Godrej Hair Color, L’Oreal
along the hairline. With subsequent exposures, there excellence, Garnier ammonia-free, and for salon use,
may be a more widespread presentation. Hair dyes Wella, Majirel, Inoa, and so on. Most of these have
change the texture of the hair by stripping off the PPD as an active ingredient and sensitivity testing
18-MEA layer, and thus, making it coarse and dull. is recommended for most of then before every use.
PPD in permanent hair dyes induces apoptosis of Bigen contains 2-nitro-P-phenylenediamine Sulfate
cells and thus contributes to hair fall.[26,27] Uncommon and 4-nitro-O-phenylenediamine sulfate as PPD
reactions include lymphomatoid reaction, erythema derivatives, with sodium perborate as the oxidizing
multiforme,[28] and even anaphylaxis[29] following hair agent. It is mixed with water and then applied. The
dye application. percentage of PPD is not more than 0.98% when mixed.
Various home-use formulations (containing PPD) are
Hair dye and cancer risk available, some as surfactant-based and some are with
There is considerable debate on the association additional conditioning agents. The Godrej hair color
between the use of hair dye and development of although labeled as ‘herbal-based’, recommends a
cancer. It started in the 1970s, with the observation that skin sensitivity test. It is a powder formulation, which
permanent hair dyes contain certain chemicals that when mixed with water, has a PPD content of not more
were structurally similar to aromatic amines known to than 1.5%. In this case, herbs are added for improving
cause bladder cancer.[30] This was especially true for hair
the quality of the hair [Figure 5].
dyes manufactured before 1980, when there were no
Vegetable dyes
Table 4: Cross-reactivity with PPD A number of herbal and Ayurvedic dyes are available
Benzocaine, procaine Local anesthetics in India under various trade names such as Black Rose
Para-aminobenzoic Found in sunscreens, shampoos, and hair dye herbal (claims herbal, but advocates sensitivity
acid (PABA) cosmetic products
test), Optima Hair dye (PPD and ammonia-free,
Para-aminosalicylic Anti-tuberculosis drug
acid (PAS) but contains para-toluenediamine sulfate), Khadi
Azo dyes Food and medication colorant, dye (contains henna), Vegetal (contains henna and
semi-permanent and permanent dyes, other herbs), and Indus Valley hair color, among others.
gasoline and diesel oil, ballpoint pen ink
Henna (Lawsonia alba), is a natural organic substance,
Sulfonamides, Drugs
sulfones, sulfa drugs which is popular in India for decorative temporary
PPD: para-phenylenediamine tattoos and for coloring gray hair. The active ingredient

Indian Journal of Dermatology, Venereology, and Leprology | September-October 2013 | Vol 79 | Issue 5 661
Madnani and Khan Hair cosmetics

Options for individuals allergic to

para-phenylenediamine
Semi-permanent dyes may be an alternative, but
10% may be allergic to them too. A patch test is
recommended. Dyes containing para-toluenediamine
sulfate (PTDS) may be an option found in newer
semi-permanent and permanent dyes and upto 50%
may be able to tolerate it.[41] Metallic dyes and pure
henna are other options. These are not very popular
because of the final color obtained.

Figure 5: Locally available herbal-based permanent hair dye Hair bleaching

containing para-phenylenediamine. (a) (Inset) [close up image
showing the para-phenylenediamine content declaration] This is a process used when the individual is unhappy
with the existing hair color, and wants to go lighter (all
is 2-hydroxy 1,4 napthaquinone. The active ingredient scalp hair), or wants to get hair highlighted in
is obtained by treating the leaves with sodium streaks (small sections of hair). It involves two steps,
bicarbonate. It is available as a powder that is mixed namely, stripping hair of all eumelanin, and then using
a toner to get the required shade. This process is capable
with coffee powder, and made into a paste with black
of only bleaching eumelanin and not pheomelanin.
tea water, allowed to stand for a couple of hours, and
A mix of hydrogen peroxide and ammonia (with/
then applied to the hair. The contact time is a couple of without ammonium/potassium persulfate as a booster)
hours, after which the hair is washed and shampooed. is used for opening up the cuticle and stripping the
This process is useful for people allergic to para dyes. eumelanin from the cortex. When extreme color
It is a messy process, and the henna leaves a strong change is done, that is, from black or dark brown to
odor in the hair that lasts several days. The end result blonde, the process requires boosters that can result
is dry hair with an orange-red tint. The color fades in severe damage to the hair shaft. Hair bleaching is
gradually with shampooing and has to be reapplied as a time-bound process where the hairdresser checks
and when required. Although relatively inert, bullous the color of the hair every 10 to 15 minutes. The total
allergic contact dermatitis (ACD) has been reported in duration depends on the final color required. The hair
a three-year-old child.[38] A locally available black hair is then washed with a specialized shampoo. The next
step is the application of the hair color that may be a
dye by Godrej is marketed as completely natural and
semi-permanent or a permanent dye. This is left on
contains reetha (soapnut), shikakai (Acacia concinna),
for half an hour and the hair is rinsed with water to
bhringraj (Eclipta prostrata), mehendi (henna) and remove all color. Conditioning is necessary as the hair
aamla (Indian gooseberry). Shikakai and reetha act structure is now damaged and brittle. This process is
as natural cleansing agents, mehendi as a natural called ‘toning’.[42]
colorant/conditioner, and aamla as a natural hair
darkener. Over the last few years, ‘black henna’ is Hair highlighting
being used for decorative, ‘instant’ tattoos at events Highlighting is a process by which isolated sections
and tourist attraction spots. These contain, in addition of hair are either lightened or darkened. This is
to the henna, a para dye, and thus, can cause allergic done by the ‘foil method,’ where strands of hair are
reactions. Several such cases have been reported.[39] separated by a comb and laid over an aluminum foil
sheet, and then painted with a mixture of hydrogen
peroxide and pigment [Figure 6a]. The foil is then
Indigofera tinctoria is a natural dye that is available
folded, and the contact time depends upon the shade
for commercial use as a green powder. It is mixed
required. Every 10 to 15 minutes, the foil is unfolded
with water and applied the same way as henna; When
to check the degree of lightening. The remaining steps
mixed with henna, the color results are superior. are as mentioned earlier. The result is an enhanced
Interestingly, the indigo dye in Morocco is used for esthetic appearance [Figure 6b]. Peters reported a
coloring Moroccan handicrafts blue. A case of fatal burn following hair highlighting using foil.[43] Often
poisoning has been reported following administration darker hair has to be bleached first and then colored.
of indigo to a child for therapeutic purposes.[40] This highlighting can also be done with a brush or
662 Indian Journal of Dermatology, Venereology, and Leprology | September-October 2013 | Vol 79 | Issue 5
Madnani and Khan Hair cosmetics

spray, which contains semi-permanent or permanent shaded color [Figure 8]. Chan and Maibach reviewed
color. Various coloring styles are used to enhance the reports of eight cases with adverse reactions (chemical
overall aesthetic appeal. Dip dyeing [Figure 7] is a burns) caused by hair highlighting. The event was due
process where only the hair ends are colored with a to caustic chemical, thermal burn, or toxic reaction to
dye different from the base hair color. Ombré (French: the dye.[44]
Shaded) is a new trend where hair is dyed to give a
Hair bleaching products may cause severe systemic
reactions or anaphylaxis[45] and can aggravate
eczematous dermatitis especially in hairdressers.[46]

Fading of artificial hair color

Artificially colored hair is prone to fading when
exposed to sunlight, shampooing, and chlorine
exposure while swimming. Locke and Jachowicz
simulated the actual usage conditions and
demonstrated that the hair color maximally faded
when exposed to both irradiation and shampooing.
They also showed the photoprotective effects of
Figure 6: (a) Silver foil used to isolate strands of hair for UVA and UVB absorbers.[47] Such photoprotectors
highlighting / bleaching (b) End result of the ‘highlighting’ process are incorporated in color-protect shampoo and
conditioners. Schlosser tested the effect of various
silicones directly incorporated into semi-permanent
and permanent hair dyes for reducing the fading of
colored hair or color change with UV exposure. The
results indicated that dimethicone and dimethiconol
prevented the color from fading, while propyl-phenyl
silsesquioxane and trimethylsiloxysilicate decreased
UV-exposure color change.[48,49]

Hair straightening/perming
Hair perming and straightening are procedures that
change the physical appearance of hair. By breaking
down the di-sulfide bonds between the keratin
filaments, both these processes alter the structural
integrity and affect the cystine content of the hair.
Figure 7: Dip - dyeing is a new trend for hair color among the youth
The bonds are then rearranged and reformed to give
the desired shape of the hair. The process has to be
repeated after three to four months. The important
hydrophobic layer 18-MEA is permanently lost and
is irreplaceable. Such hair becomes porous to water,
swells easily, and loses its tensile strength.

Straightening (lanthionization) is a chemical process

popular in people with frizzy or unmanageable hair,
which results in at least 35% of the cysteine bonds
changing to lanthionine. There is swelling of the
shaft with lifting of the cuticles as the first step of the
procedure. This is achieved with the use of strongly
alkaline agents like 1.5 to 3.5% sodium/potassium
hydroxide (lye-based), or guanidine/lithium hydroxide,
Figure 8: Ombre is another popular hair dyeing style (no-lye). As the lye-based straighteners cause great

Indian Journal of Dermatology, Venereology, and Leprology | September-October 2013 | Vol 79 | Issue 5 663
Madnani and Khan Hair cosmetics

irritation, petrolatum needs to be applied to the scalp there is a need to use specialized hair care products,
and hairline as protection, prior to the procedure. including shampoos and conditioners, post the
This is not required (except to the hairline) in non-lye procedure, to ensure minimal damage to the hair.[53]
based procedures. The pH of these straighteners Just like with permanent hair dyes, there is a need to
varies between 12.5 and 14. This strong alkaline pH ‘touch up’ the growing roots especially if the inherent
is caustic to the skin, scalp, and eyes,[50] and hence, hair are extremely curly. It is best to avoid repeated
should be handled only by professionals in a salon. and frequent sessions, as damage by successive
Thioglycolic acid salts are increasingly being used as straightening is additive. It is advisable to perform
an alternative to ammonia, as reducing agents. They deep conditioning of the hair every fortnight to protect
have a pH of 9-9.5 and are less caustic and provide good the damaged hair. Hair straightening products may
curling/straightening results. Home-use straightening contain formaldehyde, which can cause skin and
products contain ammonium bisulfite + sulfite, have mucosal irritation. Newer products are available that
less alkaline pH (less than 9), and are safe to use, but are formaldehyde–free, and thus, safer for both the
their hair straightening ability is mild and the results hair care professionals and patients.
are short-lived.
Perming or permanent waving is a process by which
The hair is washed, hair protector spray applied, hair straight hair is chemically treated to give long-lasting
is partitioned in sections, and the softening agent curls. The process is similar to that of straightening,
applied by rubbing it in, and left on for half an hour, with a few exceptions, and involves chemical softening,
during which time the hair is constantly checked for rearranging, and refixing the bonds. Mercaptans are
the degree of softening. When the desired softening is used to soften the hair. Washed hair is first wound
achieved, the hair is rinsed and conditioner applied. around rollers of the required diameter. The waving
The hair is then ‘ironed’ between specialized tongs, lotion is carefully applied to cover all the hair, and left
and then a neutralizer is applied and kept on for
on for 20 minutes to complete the softening process,
20 minutes. The hair is once again rinsed and dried.
where the disulfide bonds are broken. This process is
The next shampoo is advised after 24 hours, followed
then neutralized by applying an oxidizing agent for
by conditioning. The final outcome can be very
15 minutes on the hair that are still wound around
pleasing [Figure 9].
the rollers, and then for five more minutes with the
rollers removed. The hair is then rinsed. Shampooing
Hair straightening can be very damaging to the hair
is advised two days later. The curls usually open a bit
and even when performed correctly, can result in loss
in a few weeks. A touch-up is required for the newly
of up to 20% of the tensile strength of virgin hair. It
grown hair.
results in physical damage to the hair with loss of
proteins and moisture resulting in dry, brittle hair.
The use of hair oils and perming agents in early
Many patients experience hair fall and breakage and
childhood have been shown to be associated with
may present to the clinic with alopecia.[51,52] Hence,
earlier menarche[54] and use of these hair products
should be avoided in pre-pubertal/very young children.

Hair cosmetics in pregnancy

Couto et al., studied mothers of children with acute
myeloid or lymphocytic leukemia (AML or ALL), and
found a probable correlation between the use of hair
dyes and hair straightening products during the first
trimester of pregnancy and the development of AML
or ALL.[55]

Although, no association was found in the pregnancy

outcome of women who underwent chemical
treatments such as straightening or curling the hair,[56]
it was inferred that it was best to avoid such treatments
Figure 9: Hair straightened with lanthionization during pregnancy.

664 Indian Journal of Dermatology, Venereology, and Leprology | September-October 2013 | Vol 79 | Issue 5
Madnani and Khan Hair cosmetics

Children with canites should not be encouraged to use

semi-permanent or permanent hair dyes as they have
a high risk of early sensitization.

Adverse effects in hairdressers

People working in salons as professional hair technicians
are exposed to a much higher concentration of chemicals,
increasing the risk of sensitization especially if use
of gloves for wet work is inconsistent.[57] Eczematous
hand dermatitis is their commonest complaint.[58]
But of greater concern is the possibility of fertility
disorders and adverse pregnancy outcomes.[59,60] Safety
recommendations for female hairdressers include
working for less than 35 hours per week, and a well
ventilated work place.[61] Hairdressers have a higher risk Figure 10: Hair care product containing lactic acid, which helps
to reduce pH
of respiratory complaints especially asthma. Ammonium
persulfate salts, which are present in bleaching agents,
An exciting innovation under development is the
have been implicated as the main etiological agents for
possibility of using dry thermal energy to transfer a
the respiratory distress.[62] Hairdressers also suffer from
powdered (azo) dye into the hair shaft as a method of
musculoskeletal problems including shoulder, wrist and
hair color.[67] The source of heat could be a hair dryer,
lower back pain which is work related.[63]
hot curling iron, or any other source. No more mess
associated with liquid hair dyes. The time required to
What is new in hair cosmetics?
develop the final color would be minimal. A recently
Newer methods and products are being developed
described delivery system, using non-ionic ethosomal
for improving the texture and softness of hair. The
use of glycylglycine has shown good promise in this vesicles, showed significantly better deposition
direction.[64] The use of silicon oil in a microemulsion of products on hair as compared to the traditional
preparation where the droplet size in ≤22.7 m has been delivery systems.[68]
seen to improve the stability and deposition of silicon oil
on the hair shaft.[65] Silicon oil-in-water nanoemulsions CONCLUSION
have shown to similarly improve silicon deposition on
the hair shaft.[66] Newer products have been developed, Newer products are in the pipeline, making the
which replenish the 18-MEA lost during various hair industry a continuously evolving one. As
cosmetic hair procedures and attempt to improve the dermatologists specialized in hair care, the need of the
texture and strength of the individual hair shaft. day is to keep abreast with these developments, and
keep a sharp eye out for adverse effects that may occur
Hair cosmetics containing Argan oil have hit the as a consequence of their usage.
market. These products claim to impart a nutritional
benefit to the hair. The commercial preparations ACKNOWLEDGMENT
contain in addition to Argan oil, linseed oil and
We would like to acknowledge the valuable practical inputs
silicones, which themselves promote ‘slip’ to the hair.
by Ms Annie Chen, hairstylist.

Alfa-hydroxy acids (e.g. glycolic and lactic acid) are

REFERENCES
being incorporated into hair care products (shampoos,
conditioners, hair balms) [Figure 10] to bring down 1. Sinclair RD. Healthy hair: What is it? J Investig Dermatol Symp
the alkaline pH resulting from various hair cosmetic Proc 2007;12:2-5.
procedures. This allows smoothening of the cuticular 2. Wolfram LJ. Human hair: A unique physicochemical composite.
J Am Acad Dermatol 2003;48:S106-40.
cells, making the hair appear smooth and glossy. 3. Kizawa K, Troxler H, Kleinert P, Inoue T, Toyoda M,
Morohashi M, et al. Characterization of the cysteine-rich
A lot more products to prevent hair ‘aging’ and color calcium-binding S100A3 protein from human hair cuticles.
Biochem Biophys Res Commun 2002;299:857-62.
protection are being developed with UV reflectors/ 4. Horvath AL. Solubility of structurally complicated materials: 3.
absorbers in their formulations. Hair. Sci World J 2009;9:255-71.

Indian Journal of Dermatology, Venereology, and Leprology | September-October 2013 | Vol 79 | Issue 5 665
Madnani and Khan Hair cosmetics

5. Dawber R. Cosmetic and medical causes of hair weathering. 31. Saitta P, Cook CE, Messina JL, Brancaccio R, Wu BC, Grekin SK,
J Cosmet Dermatol 2002;1:196-201. et al. Is There a true concern regarding the use of hair dye and
6. Trüeb RM. Aging of hair. J Cosmet Dermatol 2005;4:60-72. malignancy development?: A review of the epidemiological
7. Piérard-Franchimont C, Piérard GE. Hair weathering and evidence relating personal hair dye use to the risk of malignancy.
hair capacitance mapping: A pilot study. J Cosmet Dermatol J Clin Aesthet Dermatol 2013;6:39-46.
2012;11:179-82. 32. Bolt HM, Golka K. The debate on carcinogenicity of permanent
8. Hofbauer GF, Tsambaos D, Spycher MA, Trüeb RM. Acquired hair dyes: New insights. Crit Rev Toxicol 2007;37:521-36.
hair fragility in pili anulati: Causal relationship with 33. Harling M, Schablon A, Schedlbauer G, Dulon M, Nienhaus A.
androgenetic alopecia. Dermatology 2001;203:60-2. Bladder cancer among hairdressers: A meta-analysis. Occup
9. Draelos ZD. Essentials of hair care often neglected: Hair Environ Med 2010;67:351-8.
Cleansing. Int J Trichology 2010;2:24-9. 34. Sangrajrang S, Renard H, Kuhaprema T, Pornsopone P,
10. Zawar VP, Mhaskar ST. Matting of hair following use of a new Arpornwirat W, Brennan P. Personal use of hair dyes--increased
herbal shampoo. J Cosmet Dermatol 2003;2:42-4. risk of non-Hodgkin’s lymphoma in Thailand. Asian Pac J
11. Rele AS, Mohile RB. Effect of mineral oil, sunflower oil, Cancer Prev 2011;12:2393-6.
and coconut oil on prevention of hair damage. J Cosmet Sci 35. Zhang Y, Sanjose SD, Bracci PM, Morton LM, Wang R, Brennan P,
2003;54:175-92. et al. Personal use of hair dye and the risk of certain subtypes of
12. Stoll D, King LE Jr. Disulfiram-alcohol skin reaction to non-Hodgkin lymphoma. Am J Epidemiol 2008;167:1321-31.
beer-containing shampoo. JAMA 1980;244:2045. 36. Morton LM, Bernstein L, Wang SS, Hein DW, Rothman N, Colt JS,
13. Han H, Chen W, Li TS, Liu QS. Fetal death associated with et al. Hair dye use, genetic variation in N-acetyltransferase
ingestion of shampoo and development of hypotension and 1 (NAT1) and 2 (NAT2), and risk of non-Hodgkin lymphoma.
lactic acidosis. Clin Toxicol (Phila) 2012;50:793. Carcinogenesis 2007;28:1759-64.
14. Quertermous J, Fowler JF Jr. Allergic contact dermatitis from 37. Cook LS, Malone KE, Daling JR, Voigt LF, Weiss NS. Hair
carvone in hair conditioners. Dermatitis 2010;21:116-7. product use and the risk of breast cancer in young women.
15. Schalock PC, Storrs FJ, Morrison L. Contact urticaria from Cancer Causes Control 1999;10:551-9.
panthenol in hair conditioner. Contact Dermatitis 2000;43:223. 38. Belhadjali H, Akkari H, Youssef M, Mohamed M, Zili J. Bullous
16. Niinimäki A, Niinimäki M, Mäkinen-Kiljunen S, Hannuksela M. allergic contact dermatitis to pure henna in a 3-year-old girl.
Contact urticaria from protein hydrolysates in hair conditioners. Pediatr Dermatol 2011;28:580-1.
Allergy 1998;53:1078-82. 39. Rai VM, Shenoi S D. Pseudo-tattoo dermatitis. Indian J Dermatol
17. Langan SM. Flares in childhood eczema. Skin Ther Lett Venereol Leprol 2006;72:232-4.
2009;14:4-5. 40. Labib S, Berdai MA, Bendadi A, Achour S, Harandou M. Fatal
18. Han SH, Byun JW, Lee WS, Kang H, Kye YC, Kim KH, et al. poisoning due to Indigofera. Arch Pediatr 2012;19:59-61.
Quality of life assessment in male patients with androgenetic 41. Scheman A, Cha C, Bhinder M. Alternative hair-dye products
alopecia: Result of a prospective, multicenter study. Ann for persons allergic to para-phenylenediamine. Dermatitis
Dermatol 2012;24:311-8. 2011;22:189-92.
19. Corbett JF. Hair dyes – their chemistry and toxicology. Cosmet 42. Corbett JF. Hair coloring processes. Cosmet Toilet 1991;106:53-7.
Toilet 1976;91:21-28. 43. Peters W. The hair color-highlighting burn: A unique burn
20. Schlatter H, Neuser F. Hair dyes. In: Draelos Z, editor. Cosmetic injury. J Burn Care Rehabil 2000;21:96-8.
Dermatology. Products and Procedures. 1st ed. Singapore: 44. Chan HP, Maibach HI. Hair highlights and severe acute
Blackwell Publishing Ltd.; 2010. p. 227-35. irritant dermatitis (“burn”) of the scalp. Cutan Ocul Toxicol
21. Handa S, Mahajan R, De D. Contact dermatitis to hair dye: An 2010;29:229-33.
update. Indian J Dermatol Venereol Leprol 2012;78:583-90. 45. Hoekstra M, van der Heide S, Coenraads PJ, Schuttelaar ML.
22. Commission Directive 2009/130/EC of 12 October 2009 Anaphylaxis and severe systemic reactions caused by skin
amending Council Directive 76/768/EEC, concerning cosmetic contact with persulfates in hair-bleaching products. Contact
products, for the purpose of adapting Annex III thereto to Dermatitis 2012;66:317-22.
technical progress (Text with EEA relevance). 46. Hougaard MG, Menné T, Søsted H. Occupational eczema and
23. Almeida PJ, Borrego L, Pulido-Melián E, González-Díaz O. asthma in a hairdresser caused by hair-bleaching products.
Quantification of p-phenylenediamine and 2-hydroxy-1, Dermatitis 2012;23:284-7.
4-naphthoquinone in henna tattoos. Contact Dermatitis 47. Locke B, Jachowicz J. Fading of artificial hair color and its
2012;66:33-7. prevention by photofilters. Int J Cosmet Sci 2006;28:231-2.
24. Brancaccio RR, Brown LH, Chang YT, Fogelman JP, 48. Schlosser A. Silicones used in permanent and semi-permanent
Mafong EA, Cohen DE. Identification and quantification of hair dyes to reduce the fading and color change process of
para-phenylenediamine in a temporary black henna tattoo. Am dyed hair occurred by wash-out or UV radiation. J Cosmet Sci
J Contact Dermat 2002;13:15-8. 2004;55 Suppl: S123-31.
25. Ghosh S, Mukhopadhyay S. Chemical leucoderma: 49. Lee HY, Jeong YI, Choi KC. Hair dye-incorporated
A clinico-aetiological study of 864 cases in the perspective of a poly--glutamic acid/glycol chitosan nanoparticles based on
developing country. Br J Dermatol 2009;160:40-7. ion-complex formation. Int J Nanomedicine 2011;6:2879-88.
26. Chye SM, Tiong YL, Yip WK, Koh RY, Len YW, Seow HF, 50. Smith RS, Shear G. Corneal alkali burns arising from accidental
et al. Apoptosis induced by para-phenylenediamine involves instillation of a hair straightener. Am J Ophthalmol 1975;79:602-5.
formation of ROS and activation of p38 and JNK in chang liver 51. Swee W, Klontz KC, Lambert LA. A nationwide outbreak of
cells. Environ Toxicol 2012. [In press]. alopecia associated with the use of a hair-relaxing formulation.
27. Ishida W, Makino T, Shimizu T. Severe hair loss of the scalp Arch Dermatol 2000;136:1104-8.
due to a hair dye containing Para phenylenediamine. ISRN 52. Nicholson AG, Harland CC, Bull RH, Mortimer PS, Cook MG.
Dermatol 2011;2011:9472-84. Chemically induced cosmetic alopecia. Br J Dermatol
28. Koley S, Sarkar J, Choudhary S, Dhara S, Choudhury M. 1993;128:537-41.
Erythema multiforme following application of hair dye. Indian 53. Dias TC, Baby AR, Kaneko TM, Velasco MV. Protective effect
J Dermatol 2012;57:230-2. of conditioning agents on Afro-ethnic hair chemically treated
29. Mavroleon G, Begishvili B, Frew AJ. Anaphylaxis to hair dye: with thioglycolate-based straightening emulsion. J Cosmet
A case report. Clin Exp Allergy 1998;28:121-2. Dermatol 2008;7:120-6.
30. Shafer N, Shafer RW. Potential of carcinogenic effects of hair 54. James-Todd T, Terry MB, Rich-Edwards J, Deierlein A, Senie R.
dyes. N Y State J Med 1976;76:394-6. Childhood hair product use and earlier age at menarche in a

666 Indian Journal of Dermatology, Venereology, and Leprology | September-October 2013 | Vol 79 | Issue 5
Madnani and Khan Hair cosmetics

racially diverse study population: A pilot study. Ann Epidemiol 62. Pignatti P, Frossi B, Pala G, Negri S, Oman H, Perfetti L, et al.
2011;21:461-5. Oxidative activity of ammonium persulfate salt on mast cells
55. Couto AC, Ferreira JD, Rosa AC, Pombo-de-Oliveira MS, and basophils: Implication in hairdressers’ asthma. Int Arch
Koifman S; Brazilian Collaborative Study Group of Infant Acute Allergy Immunol 2013;160:409-19.
Leukemia. Pregnancy, maternal exposure to hair dyes and hair 63. Bradshaw L, Harris-Roberts J, Bowen J, Rahman S, Fishwick D.
straightening cosmetics and early age leukemia. Chem Biol Self-reported work-related symptoms in hairdressers. Occup
Interact 2013;205:46-52. Med (Lond) 2011;61:328-34.
56. Blackmore-Prince C, Harlow SD, Gargiullo P, Lee MA, 64. Breakspear S, Fukuhara M, Itou T, Hirano Y, Nojiri M,
Savitz DA. Chemical hair treatments and adverse pregnancy Kiyomine A, et al. Alignment control and softness creation in
outcome among Black women in central North Carolina. Am J hair with glycylglycine. J Cosmet Sci 2013;64:19-33.
Epidemiol 1999;149:712-6. 65. Nazir H, Lv P, Wang L, Lian G, Zhu S, Ma G. Uniform-sized
57. Lysdal SH, Johansen JD, Flyvholm MA, Søsted H. silicone oil microemulsions: Preparation, investigation of
A quantification of occupational skin exposures and the use stability and deposition on hair surface. J Colloid Interface Sci
of protective gloves among hairdressers in Denmark. Contact 2011;364:56-64.
Dermatitis 2012;66:323-34. 66. Hu Z, Liao M, Chen Y, Cai Y, Meng L, Liu Y, et al. A novel
58. Khumalo NP, Jessop S, Ehrlich R. Prevalence of cutaneous preparation method for silicone oil nanoemulsions and its
adverse effects of hairdressing: A systematic review. Arch application for coating hair with silicone. Int J Nanomedicine
Dermatol 2006;142:377-83. 2012;7:5719-24.
59. Peters C, Harling M, Dulon M, Schablon A, Torres Costa J, 67. US Patent Number US7722680 B2; Dyeing of human keratin
Nienhaus A. Fertility disorders and pregnancy complications in materials by dry thermal transfer of a direct dye, composition
hairdressers-A systematic review. J Occup Med Toxicol 2010;5:24. comprising the said dye and its method of preparation,
60. Rylander L, Källén B. Reproductive outcomes among 25 May 2010.
hairdressers. Scand J Work Environ Health 2005;31:212-7. 68. Yeh MI, Huang HC, Liaw JH, Huang MC, Wu TH, Huang KF,
61. Chua-Gocheco A, Bozzo P, Einarson A. Safety of hair products et al. Ethosomes in hair dye products as carriers of the
during pregnancy: Personal use and occupational exposure. major compounds of black tea extracts. Int J Dermatol 2013;
Can Fam Physician 2008;54:1386-8. 52:868-75.

Indian Journal of Dermatology, Venereology, and Leprology | September-October 2013 | Vol 79 | Issue 5 667