Despite educational efforts to prevent occupational skin diseases in the hairdressing schools, Danish apprentices are still at increased risk for hand eczema and contact urticaria. Both diseases develop after only a few years of work in hairdressing. Further preventive strategies are warranted.

Occupational allergic contact eczema and asthma caused by bleaching agents is seen in hairdressers. Bleaching agents contain persulfate salts, which are known to induce immediate reactions such as rhinitis, asthma, contact urticaria, and anaphylaxis. The immunologic mechanism is not, however, fully understood. The specific inhalation challenge test is considered to be the gold standard for diagnosing occupational asthma and rhinitis. However, this test is not always accessible. Therefore, the diagnosis of occupational allergic asthma caused by persulfate salts is made by combining a clinical history, a diagnosis of asthma, and a positive skin prick test (SPT). Standardized methods for performing SPT with persulfate salts are warranted. A case of a young hairdresser with occupational asthma and hand eczema caused by persulfate salts is presented, and the procedure for performing the SPT with ammonium persulfate and potassium persulfate is described in detail.

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Our findings suggest that FLG mutations alone are insufficient to cause secondary sensitization to allergens. The positive association seen in patients must be explained by a combination of further barrier abnormality caused by dermatitis as well as increased allergen exposure.