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

Erin M. Warshaw, From the Department of Dermatology, Park Nicollet/Health Partners Health Services, Minneapolis, Minnesota, USA.
Malina Yamashita Peterson, From the Department of Dermatology, Park Nicollet/Health Partners Health Services, Minneapolis, Minnesota, USA.
Amber R. Atwater, Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA.
Joel G. DeKoven, Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
Melanie D. Pratt, Division of Dermatology, University of Ottawa, Ontario, Canada.
James S. Taylor, Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA.
Donald V. Belsito, Department of Dermatology, Columbia University Irving Medical School, New York, New York, USA.
Jonathan I. Silverberg, Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Margo J. Reeder, Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Vincent A. DeLeo, Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Marie-Claude Houle, Division of Dermatology, Centre Hospitalier Universitaire de Québec, Laval University, Québec, Canada.
Cory A. Dunnick, Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Jiade Yu, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Brandon Adler, Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Christen Mowad, Department of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA.
Nina C. Botto, Department of Dermatology, University of California San Francisco, San Francisco, California, USA.

Document Type

Journal Article

Publication Date

7-31-2023

Journal

Dermatitis : contact, atopic, occupational, drug

DOI

10.1089/derm.2023.0140

Abstract

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. 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. 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%), -isopropyl-'-phenyl--phenylenediamine (6.7%), disperse dye mix (6.5%), and black rubber mix (5.1%). 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.

Department

Dermatology

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