Hair-care practices in African American women: potential for allergic contact dermatitis

Abstract

Allergic contact dermatitis (ACD) is a delayed hypersensitivity reaction that occurs when the skin is re-exposed to a substance to which it was previously sensitized. One significant source of exposure to sensitizing chemicals is through personal grooming and beauty products. While the role of cosmetics and hair-care products in the development of ACD is well-documented, there has been very little literature that specifically addresses the role of hair-care practices of patients with tightly curled hair, such as in patients of African descent, in the development of ACD in this population. This review provides an integrated summary of the hair-care practices of female African American patients and the potential for exposure to sensitizing agents at each stage. This review will also discuss the challenges faced in recognizing and assessing ACD in these patients.

Update on Contact Dermatitis and Patch Testing in Patients With Skin of Color

“…It also has been reported that scalp ACD can be mistaken for seborrheic dermatitis due to lack of erythema. 7 Without a high degree of clinical suspicion, a diagnosis of ACD can be missed in this patient population.…”

“…Moreover, multiple studies have shown that ACD can have different presentations in Black patients. 4,7,8 Lichenification and hyperpigmentation may be early signs of ACD in comparison to bright erythema and vesicles that can be seen in lighter skin types. It also has been reported that scalp ACD can be mistaken for seborrheic dermatitis due to lack of erythema.…”

“…An early papular or follicular eruption with minimal erythema can signal a positive reaction. 4,7 Because of these potentially subtle changes, patch testers should exercise care and attention when reading results for SOC populations. We recommend ample side lighting, palpation for adequate identification of positive reactions, and double-checking for positives that may have been overlooked on the initial review of findings.…”

“…We recommend ample side lighting, palpation for adequate identification of positive reactions, and double-checking for positives that may have been overlooked on the initial review of findings. 4,7 What health care disparities impact the evaluation and management of ACD?…”

Impact of trends in new and emerging contact allergens

“…Hair care regimens most commonly employed by skin of color patients emphasize reduction of hair dryness/fragility. 54 , 55 Multiple products may be used with the goal of providing moisture to the hair, but this can increase the risk of sensitization and subsequent development of ACD. 56 In 1 study examining the top 100 best-selling shampoos, conditioners, and styling products for ethnic and nonethnic hair products from 3 major online retailers, numerous important observations were noted.…”