Hairdresser Eczema Risk Far Outweighs That of Consumers

Jim Kling

April 28, 2022

Hairdressers experience much more exposure to toxic agents than do consumers, putting them at much greater risk of hand eczema. That means that risk models based on consumer exposure frequency are not appropriate for hairdressers, according to a new review of seven observational and questionnaire-based studies.

"Hairdressers are in contact with many hazardous and toxic agents, which entails different occupational health risks, such as skin damage, respiratory problems, reproductive disorders, [and] various forms of cancer," said Cara Symanzik in an interview with Medscape Medical News. She was the lead author of the study, which appeared in the May issue of Contact Dermatitis.

Up to 70% of hairdressers experience work-related skin damage during their career, most often dermatitis. "The most important risk factors for developing occupational skin diseases are wet work and occupational contact to irritants and allergens," said Symanzik, who is head of the Skin Bioengineering Laboratory at the Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University (Osnabrück, Germany). Wet work can exacerbate risk by breaking down the epidermal barrier.

Not surprisingly, hairdressers are exposed to far more hair cosmetic products than consumers, up to 78 times as much, depending on the task, according to the results of the review. These products include shampoos, conditioners, oxidative and nonoxidative hair colors, and bleaching agents.

To estimate exposures, the researchers used mean procedure durations, frequency of procedure performance, and frequency of glove use, among other factors. They compared their estimates to similar estimates for consumer exposure. Some of the procedures with highest levels of exposure for hairdressers include permanent/oxidative hair coloring using 6% to 12% hydrogen peroxide (exposure factor, 32-fold to 78-fold higher than consumers), bleaching hair with most 6% to 9% hydrogen peroxide (exposure factor, 9-49), shampooing (exposure factor, 6-13), and deep conditioning of hair (exposure factor, 5-19).

The authors maintain that standards used for consumer exposure cannot be applied to hairdressers. "Consumer usage frequency does not appear to be appropriate for representing hairdresser exposure. The current standards do not effectively address the occupational risks associated with hairdressers' use of cosmetics. The findings of this study should cause current risk assessment procedures to be reconsidered," said Symanzik.

The study's findings match clinical experience, said Sonya Kenkare, MD, when asked by Medscape for independent comment. "Oh, my poor hairdresser patients. The ones with hand eczema are so uncomfortable," said Kenkare, who is an assistant professor of dermatology at Rush University, in Chicago, Illinois.

Hairdressers in the US generally wear gloves during chemical hair processing procedures, such as coloring or bleaching. "I actually try to talk to my patients with hand eczema who are hairdressers, chefs, caregivers to try to wear gloves as much as they can, because that occlusion with a glove will minimize the contact of their skin with water and with products," said Kenkare.

Protection should include three tiers, said Symanzik ― skin protection, skin cleansing, and skin care. "[These] should be coordinated in their entirety to maintain a good skin condition and should lead to an improvement in skin damage that has already occurred," she said. Protective measures include use of protective gloves, mild cleaning agents, and appropriate emollients. "A central point is that the barrier function of the skin should be protected, and its regeneration should be supported. It is important that hairdressers seek advice [or] dermatological help at an early stage in their careers when skin problems occur," said Symanzik.

However, it's not always easy to convince hairdressers to wear gloves, especially during procedures that require fine motor control. "When I can get a patient to wear petroleum jelly or Neutrogena and put on cotton gloves and then a plastic glove, I find that they're able to do the best. I get a lot of resistance on that from patients like hairdressers who are doing a lot of fine motor work, but it works," said Kenkare.

She also encouraged hairdressers to find the gentlest versions of products. "There's always a huge range of potential toxicity, but generally those [safer] products tend to be more expensive, so may not always be feasible," said Kenkare.

Symanzik and Kenkare report no relevant financial relationships.

Contact Dermatitis. 2022;86:333-343. Full text

Jim Kling is a science and medical writer in Bellingham, Washington.

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