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Heading Off Hair-Care Disasters:
Use Caution With Relaxers and Dyes
by Michelle Meadows

It's never a good sign when the hairdresser panics. That's what
happened to Barbara Cabrera-Avila, 38, when she returned to the salon
about six weeks after having her hair straightened a couple of years
ago. The cause for alarm: several bald spots in the back of her head.

The Adelphi, Maryland resident began having her curls straightened at the age of six so her hair would be easier to comb and style. She says
over-processed hair likely played a role in her hair loss, and stress
could have been a factor. What's certain is that three dermatologists
advised her to take a break from hair straighteners, also known as
relaxers.

Barbara says giving up the straight hair she had grown comfortable with
wasn't easy. After all, people's personal preferences about how they
want to look tie into self-esteem--a fact that makes for good sales in
the hair business. In addition to paying for trims and cuts to achieve
a certain look, consumers spend millions of dollars each year to get
hair that's different from what nature intended--whether it's to tame
tight curls, give flat hair a boost, or get rid of the gray.

According to the Food and Drug Administration's Office of Cosmetics and
Colors, hair straighteners and hair dyes are among its top consumer
complaint areas. Complaints range from hair breakage to symptoms
warranting an emergency room visit. Reporting such complaints is
voluntary, and the reported problem is often due to incorrect use of a
product rather than the product itself. FDA encourages consumers to
understand the risks that come with using hair chemicals, and to take a
proactive approach in ensuring their proper use. The agency doesn't
have authority under the Federal Food, Drug, and Cosmetic Act to
require premarket approval for cosmetics, but it can take action when
safety issues surface.

When the Product Is the Problem

When consumers notify FDA of problems with cosmetics, the agency
evaluates evidence on a case-by-case basis and determines if follow-up
is needed, says Allen Halper, an FDA consumer safety officer. FDA looks
for patterns of complaints or unusual or severe reactions. The agency
may conduct an investigation, and if the evidence supports regulatory
action, FDA may request removal of a cosmetic from the market.

Take the example of two popular hair relaxer products by World Rio
Corp.--the Rio Naturalizer System (Neutral Formula) and the Rio
Naturalizer System with Color Enhancer (Black/Licorice). After
receiving complaints about these products in November and December of
1994, FDA warned the public against using them. Consumers complained of hair loss, scalp irritation, and discolored hair.

In December 1994, the World Rio Corp., Inc. of Los Angeles, Calif.,
announced that it stopped sales and shipments of the product. But
reports indicated that the company continued to take orders, and the
California Department of Health also stepped in to stop sales. In
January of 1995, the U.S. Attorney's Office in Los Angeles filed a
seizure action against these products on behalf of FDA. By then, the
agency had received more than 3,000 complaints about the Rio products.

Although most relaxers are alkaline, this product was formulated to be
acidic. In the resulting consent decree of condemnation and permanent
injunction, FDA alleged that the products were potentially harmful or
injurious when used as intended, that they were more acidic than
declared in the labeling, and that the labeling described the products
as "chemical free" when "allegedly they contained ingredients commonly
understood to be 'chemicals.'"

Safer Straightening

FDA has received complaints about scalp irritation and hair breakage
related to both lye and "no lye" relaxers. Some consumers falsely
assume that compared to lye relaxers, "no lye" relaxers take all the
worry out of straightening.

"People may think because it says 'no lye' that it's not caustic," says
FDA biologist Lark Lambert. But both types of relaxers contain
ingredients that work by breaking chemical bonds of the hair, and both
can burn the scalp if used incorrectly. Lye relaxers contain sodium
hydroxide as the active ingredient. With "no lye" relaxers, calcium
hydroxide and guanidine carbonate are mixed to produce guanidine
hydroxide.

Research has shown that this combination in "no lye" relaxers results
in less scalp irritation than lye relaxers, but the same safety rules
apply for both. They should be used properly, left on no longer than
the prescribed time, carefully washed out with neutralizing shampoo,
and followed up with regular conditioning. For those who opt to
straighten their own hair, it's wise to enlist help simply because not
being able to see and reach the top and back of the head makes proper
application of the chemical and thorough rinsing more of a challenge.

Some stylists recommend applying a layer of petroleum jelly on the
scalp before applying a relaxer because it creates a protective barrier
between the chemical and the skin. Scratching, brushing, and combing
can make the scalp more susceptible to chemical damage and should be
avoided right before using a relaxer. Parents should be especially
cautious when applying chemicals to children's hair and should keep
relaxers out of children's reach. There have been reports of small
children ingesting straightening chemicals and suffering injuries that
include burns to the face, tongue, and esophagus.

How often to relax hair is a personal decision. According to Pearl
Freier, an instructor at the International Academy of Hair Design in
South Daytona, Fla., relaxing at intervals of six to eight weeks is
common, and the frequency depends on the rate of a person's hair
growth. Leslie F. Safer, MD, a dermatologist in Albany, Ga., who has
treated women with scalp irritation from relaxers, says straightening
every six weeks is too frequent, in his opinion. Relaxers can cause
hair breakage in the long term, he says, and blow drying and curling
can do more damage.

Consumers should be aware that applying more than one type of chemical treatment, such as coloring hair one week and then relaxing it the next, can increase the risk of hair damage. "The only color we
recommend for relaxed hair is semi-permanent because it has no ammonia and less peroxide," compared with permanent color, Freier says.

Hair Dye Reactions

As with hair relaxers, some consumers have reported hair loss, burning,
redness, and irritation from hair dyes. Allergic reactions to dyes
include itching, swelling of the face, and even difficulty breathing.

Coal tar hair dye ingredients are known to cause allergic reactions in
some people, FDA's Lambert says. Synthetic organic chemicals, including
hair dyes and other color additives, were originally manufactured from
coal tar, but today manufacturers primarily use materials derived from
petroleum. The use of the term "coal tar" continues because historically that language has been incorporated into the law and regulations.

The law does not require that coal tar hair dyes be approved by FDA, as
is required for other uses of color additives. In addition, the law does not allow FDA to take action against coal tar hair dyes that are shown to be harmful, if the product is labeled with the prescribed caution statement indicating that the product may cause irritation in certain individuals, that a patch test for skin sensitivity should be done, and that the product must not be used for dyeing the eyelashes or eyebrows. The patch test involves putting a dab of hair dye behind the ear or inside the elbow, leaving it there for two days, and looking for itching, burning, redness, or other reactions.

"The problem is that people can become sensitized--that is, develop an
allergy--to these ingredients," Lambert says. "They may do the patch
test once, and then use the product for 10 years" before having an
allergic reaction. "But you're supposed to do the patch test every
time," he says, even in salons.

And what about ending up with something other than the exact shade of
strawberry blonde on the shelf? "Don't think the color on the box is
the color you'll get," says Freier, the cosmetology instructor. "There
are so many variables, like what chemicals are already in your hair and
what your natural color is, that go into how your hair will turn out."

When using all hair chemicals, it's critical to keep them away from
children to prevent ingestion and other accidents, and to follow
product directions carefully. It sounds basic, but some people don't do
it, says FDA's Halper. "If it says leave on hair for five minutes,
seven minutes doesn't make it better," he says. "In fact, it could do
damage."
 

Michelle Meadows is a staff writer for FDA Consumer.

FDA encourages voluntary reporting of adverse reactions to hair
products to: FDA, Center for Food Safety and Applied Nutrition, Office
of Cosmetics and Colors, 200 C St. S.W., Washington, DC 20204,
202-205-4706.

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Look Out For Your Eyes

Whether applying hair chemicals at home or in a hair salon, consumers
and beauticians should be careful to keep them away from the eyes. FDA
has received reports of injuries from hair relaxers and hair dye accidentally getting into eyes. And while it may be tempting to match a
new hair color to eyebrows and eyelashes, consumers should resist the
urge. The use of permanent eyelash and eyebrow tinting and dyeing has
been known to cause serious eye injuries and even blindness. There are
no color additives approved by FDA for dyeing or tinting eyelashes and
eyebrows.

The law does not require that coal tar hair dyes be approved by FDA, as
is required for other uses of color additives. In addition, the law
does not allow FDA to take action against coal tar hair dyes that are
shown to be harmful, if the product is labeled with the following
caution statement:

"Caution-This product contains ingredients which may cause skin
irritation on certain individuals and a preliminary test according to
accompanying directions should first be made. This product must not be
used for dyeing the eyelashes or eyebrows; to do so may cause
blindness."

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Hair Color and Cancer

Over the years, some studies have indicated a possible link between
hair dye use and cancer, while others have not. In February 1994, FDA
and the American Cancer Society released an epidemiologic study
involving 573,000 women. Researchers found that women who had ever used permanent hair dyes showed decreased risk of all fatal cancers combined and also of urinary system cancers. The study also revealed that women who had ever used permanent hair dyes showed no increased risk of any type of hematopoietic cancer (cancer of the body's blood-forming systems).

This research, published in the Journal of the National Cancer Institute, did suggest that prolonged use (20 years or more of constant use) of black hair dye may slightly increase the occurrence of non-Hodgkin's lymphoma and multiple myeloma, but these cases represented a small fraction of hair dye users. This study followed previous NCI studies that raised concern about the use of hair dyes and higher rates of non-Hodgkin's lymphoma.

In another study, published in the October 5, 1994, issue of the Journal of the National Cancer Institute, researchers from Brigham and Women's Hospital in Boston followed 99,000 women and found no greater risk of cancers of the blood or lymph systems among women who had ever used permanent hair dyes.

Then in 1998, scientists at the University of California at San Francisco questioned 2,544 people about their use of hair-color products. After integrating the results of this study with those of animal and other epidemiologic studies, they concluded that there was little convincing evidence linking non-Hodgkin's lymphoma with normal use of hair-color products in humans. The study was published in the December 1998 issue of the American Journal of Public Health.

FDA continues to follow research in this field.
 

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‘Hereditary Hair Loss not always Genetic’

As a Trichologist* specialising in female hair loss I’ve seen thousands of women across the world for thinning scalp hair.

The trends I’ve observed in many women has led me to believe – despite prevailing medical opinion – there are two forms of so-called “genetic” thinning in women (female androgenetic alopecia). One is manageable but not presently curable, whilst the other may potentially be abolished.

It’s long been known that female patterned hair loss is a similar but clinically separate condition from that of male genetic balding. The hormonal conversion up to dihydrotestosterone (DHT), which has a miniaturising affect on the hair follicles across the top of the scalp, is different in males & females. So too the progression of the problem; androgen-sensitive (male hormones are termed androgens) hair follicles in women are randomly affected, thus thinning of the scalp hair occurs rather than complete baldness. Unlike males, afflicted women generally retain their frontal hairline margin as well.

True genetically inherited female androgenetic alopecia is an autosomal recessive hereditary trait affecting numbers of women within an extended family. The woman will recount a family history of her mother, grandmother/s, sisters, aunts or female cousins with a comparable thinning hair problem. These women tend to exhibit the condition after puberty or in their early twenties, particularly following childbirth. Other than low iron levels or poor dietary habits, they tend not to have any associated issues to their androgenetic alopecia.

The majority of women presenting with patterned hair thinning show (in my opinion), an acquired patterned alopecia due to the cascading affects of disordered hormonal pathways, frequently originating from problems such as oestrogen dominance, insulin resistance, or ‘leaky gut’ syndrome.

These women are 35 years + (but can be younger); mostly peri or early post-menopausal & relating a common history of menstrual difficulties, pre-menstrual mood disorders, weight gain, diminished libido, sleep disturbance or headaches. Their salivary hormone profiles (SHP) will be in imbalance - usually ‘oestrogen dominant relative to progesterone – even when the oestradiol level itself is low.

In the very complex way the body’s hormones influence each other, oestrogen dominance in women results in sub-optimal thyroid function. The adrenal glands respond to this by increasing testosterone output, with ensuing loss of scalp hair in an androgenetic pattern. Increased facial/body hair (hirsuitism) often accompanies patterned alopecia because follicles across the top of the scalp are androgen sensitive – causing follicle miniaturisation & hair shaft thinning (vellus hairs), whilst facial/body hair is male hormone (androgen) dependant – leading to increased growth.

Finally, stress as a cause for hair loss is often prematurely diagnosed by some practitioners, who are either unsure of what to look for or what to ask. Nevertheless severe or protracted stress from emotional, physical, chemical, or dietary causes can wreak havoc on many of the body’s vital hormones.

Adrenal gland production of cortisol is raised in times of acute stress. When this is prolonged, excess cortisol affects production of the hormones themselves & their target tissue sensitivity. Hormones that regulate ovarian/testicular function (gonadatrophins) in the respective sexes are decreased, resulting in lowered oestrogen & testosterone levels.

The pituitary gland’s production of growth & thyroid stimulating hormones are blocked by the indirect influences of excess cortisol, diminishing & disordering the conversion of the thyroid hormones from inactive to active.

Successfully treating women for hair loss problems requires careful review of their medical, nutritional, hormonal & lifestyle history undertaken in an organised & sequential way. Some specific baseline blood & SHP pathology (where appropriate) should be undertaken before deciding on a treatment regime. This will provide a clearer representation of what other areas are influencing the primary problem, & treating the cause of the condition rather than just the symptoms can then be undertaken.

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About the Author: Tony Pearce RN is a specialist trichologist and a registered nurse. He is a past chairperson for the International Association of Trichologists.

He has published numerous articles on trichology issues and provides a website and online consultation service for people seeking accurate information, diagnosis and treatment.

Tony has a clinical practice in Sutherland & Wollongong NSW, & Virginia USA (Hair Solutions of Virginia).

In Australia he can be contacted on (02) 9542 2700, or through his website at www.natrichology.com.au. Copyright Anthony Pearce 2005.
*References for this article available on request