Patch Testing to Paraphenylenediamine: The North American Contact Dermatitis Group Experience (1994-2018).

Abstract

Background/Objectives: Paraphenylenediamine (PPD) is an aromatic amine dye that may cause allergic contact dermatitis. This study examines the epidemiology of allergic patch test reactions to PPD. Methods: This retrospective analysis characterizes individuals tested to PPD (1% petrolatum) by the North American Contact Dermatitis Group (1994-2018). Demographics and dermatitis site(s) were compared between PPD-allergic and PPD-negative patients. PPD reactions were analyzed by reaction strength, clinical relevance, occupational relatedness, and source as well as coreactivity with structurally related compounds. Results: Of 54,917 patients tested to PPD, 3095 (5.6%) had an allergic patch test reaction. Compared with PPD-negative patients, PPD-allergic patients had significantly greater odds of age >40 years (odds ratio [OR] 1.55 [95% confidence interval; CI 1.43-1.69]) and female gender (OR 1.52 [95% CI 1.41-1.66]), but lower odds of being White (OR 0.66 [95% CI 0.60-0.71]). The most common primary anatomic sites of dermatitis were face (25.5%), hands (21.9%), and scattered/generalized pattern (15.5%). Over half (55.3%) of PPD reactions were ++ or +++ at the final reading and 60.9% were currently relevant. Common exposure sources included hair dye (73.5%) and clothing/shoes/apparel (3.9%). Occupationally related reactions occurred in 8.3%, most commonly in hairdressers/cosmetologists (72.8%). The most common coreactions were benzocaine (11.3%), N-isopropyl-N'-phenyl-p-phenylenediamine (6.7%), disperse dye mix (6.5%), and black rubber mix (5.1%). Conclusions: The 24-year percentage of allergic reactions to PPD was 5.6%. PPD allergy was associated with female gender and age >40 years. PPD allergic patients were less likely to be White. Allergic reactions were usually clinically relevant and hair dye was the most frequently identified source.

• Authors: Erin M Warshaw, Malina Yamashita Peterson, Amber R Atwater, Joel G DeKoven, Melanie D Pratt, James S Taylor, Donald V Belsito, Jonathan I Silverberg, Margo J Reeder, Vincent A DeLeo, Marie-Claude Houle, Cory A Dunnick, Jiade Yu, Brandon Adler, Christen Mowad, Nina C Botto
• Journal: Dermatitis : contact, atopic, occupational, drug (Dermatitis) 2023 Nov-Dec Vol. 34 Issue 6 Pg. 536-546 ISSN: 2162-5220 [Electronic] United States
• PMID: 37523239 (Publication Type: Journal Article)

Chemical References

• 4-phenylenediamine
• Hair Dyes
• Phenylenediamines
• N-isopropyl-N-phenyl-4-phenylenediamine

Topics

• Humans
• Female
• Adult
• Patch Tests (adverse effects)
• Hair Dyes (adverse effects)
• Retrospective Studies
• Dermatitis, Allergic Contact (diagnosis, epidemiology, etiology)
• Phenylenediamines (adverse effects)
• North America