Dyeing one's hair, because it is turning white or simply because it pleases us to see ourselves with a different look, is a human behaviour that dates back to the dawn of time and has always been very common among women and in recent decades is becoming more and more common among men as well.
Not everyone may be aware that this cosmetic treatment may involve risks to the eyes. Let's make it clear right away that the risks depend on the type of dyes used.
A clinical study, just published in Jama Ophthalmology, Retinopathy Associated With Hair Dye | reports cases of retinopathy occurring in three middle-aged women following the use of hair dyes containing aromatic amines.
Aromatic amines are chemicals used in the production of dyes and colour pigments for textiles, leather and paper, and in the rubber industry. The most important aromatic amines are benzidine, 4-aminobiphenyl, 2-naphthylamine and ortho-tolidine.
Retinopathy arising from the use of hair dyes containing aromatic amines manifests as a bilateral, multiple serous retinal detachment that mimics MEK (Mitogen-Activated Protein Kinases Kinase) inhibitor-associated retinopathy, a still poorly understood form of retinopathy in which the enzymes MEK1 and MEK2, or both, are involved.
The hair dye retinopathy resolved within months after discontinuing the use of the dye responsible for the ocular reaction.
One of the clinical cases concerned a 61-year-old woman with no clinical history who presented with blurred vision a few days after using a commercially available hair dye containing para-phenylenediamine.
Paraphenylenediamine (PPD) is the most important dye used in permanent hair colouring and is the third most common ingredient, after perfume essences and preservatives, capable of causing contact dermatitis in cosmetics.
On OCT examination, the patient had a bilateral multiple serous retinal detachment and diffuse neurosensory retinal thickening. Fundus autofluorescence also showed a hypofluorescent serous retinal detachment zone.
This form of retinopathy associated with the use of hair dyes is certainly a rare occurrence. Retinal toxicity is most likely favoured by the presence of head skin lesions, which favour the systemic absorption of aromatic amines and may be the reason for the rarity of this abnormal reaction.
These cases of retinopathy, although symptomatically resolved, on long-term follow-up revealed persistent OCT abnormalities, hyperfluorescent retinal deposits 4 years after discontinuation of dye use, and a slow regression of neurosensory retinal thickening. This thickening could be secondary to intermittent dysfunction of the retinal pigment epithelium, suggesting that persistent dye use responsible for the retinopathy could cause long-term dysfunction of the epithelium itself.
The absence of recurrences after discontinuing the use of dyes containing aromatic amines and replacing them with those without them strengthens the association between paraphenylenediamine and this type of retinopathy.
Although this is a rather rare manifestation, it is very important that it be diagnosed early, as the rapid identification of such an abnormal reaction allows an immediate discontinuation of the use of the harmful dye with the ultimate goal of preventing permanent damage to the retinal pigment epithelium.
On the subject of rare retinopathies see also:
X-linked retinopathies - Oculista Italiano
Risk of NAION and Semaglutide - Oculist Italiano
- Chirpaz N, Bricout M, Elbany S, et al. Retinopathy Associated With Hair Dye. JAMA Ophthalmol. Published online September 12, 2024. doi:10.1001/jamaophthalmol.2024.3453
- Faure C, Salamé N, Cahuzac A, Mauget-Faÿsse M, Scemama C. Hair dye-induced retinopathy mimicking MEK-inhibitor retinopathy. Retin Cases Brief Rep. 2022;16(3):329-332. doi:10.1097/ICB.0000000000000969
- Chong HP, Reena K, Ng KY, Koh RY, Ng CH, Chye SM. Para-phenylenediamine containing hair dye: an overview of mutagenicity, carcinogenicity and toxicity. J Environ Anal Toxicol. 2016;6. doi:10.4172/2161-0525.1000403