1. Challenges and threats for the beauty professions in Europe
The skin test
Challenges and threats for the beauty professions in Europe
Monday 16 November 2015
Stéphane Coigné – Board member of Coiffure EU
Cepec: The profession of beauticians and its contribution to the wellbeing
and to the work in Europe  

2. Context skin test
When dyeing hair, both hairdressers and customers come into contact with certain dye and colouring substances.
In order to find out whether consumers are allergic to the product, manufacturers of oxidative hair dyes recommend to carry out a self-test on the skin, before their products are used.

3. Situation in Ireland and the UK
People who are allergic go on purpose to the hairdresser to dye their hair.
After developing an allergic skin reaction, they submit claims for damages to the court.
As a result, several salons had to reduce staff numbers or had even been closed down.

4. Scientific research (2011) on 20 hair dye products
The hair dye products were sold in 7 countries:
Denmark
Sweden
Norway
France
Spain
Germany UK
The products of 16 different manufacturers were studied

5. Research (2011) on 20 hair dye products
Were investigated:
preparation procedure
anatomical site of application
duration of exposure
written recommendations
advised actions in case of a reaction
According to the lists of ingredients, 19/20 (95%) of the products contain:
PPD, PTD or PTDS

6. Findings from this research
Name for the self-test: 8 different names are used for the ‘self-test’.
Site of application of the self-test:
Sometimes in the elbow flexure,
Sometimes behind the ear
Sometimes on both locations
Composition of the product used for the self-test:
Sometimes a pure product is used
Sometimes the product is mixed with a developer
For 3 products, no instructions were given

7. Findings from this research
The amount of product to be applied during the self-test:
For 7 products, terms like ‘a small quantity’ or ‘a few drops’ were used
For 13 products, the size of the application area should be equivalent to 1 cm² or 1 euro coin and the applied amount was specified as
- enough to cover the area
- some amount
- a little amount
- a sufficient amount
Re-apply the test:
For 11 products, the consumer was instructed to re-apply the test up to 3 times.

8. Findings from this research
Rinsing
For 1 product, rinsing after 45 min was suggested
For 2 products, rinsing after 48 hr was suggested
For 13 products, rinsing was not suggested at all.
When to read the self-test?
For 19 products, test readings were recommended after 48 hours
For 1 product, test readings were recommended after 24 hours
Description of a skin reaction
No uniform description of skin reaction was given
For 3 products, the term ‘reaction’ was used but not defined.

9. Findings from this research
What to do in the case of a positive skin?
The consumer was advised to rinse the skin
For 3 products, the consumer was advised not to dye their hair
For 17 products, the consumer was advised not to use the product /or hair dye
When to contact a doctor ?
The consumer was advised to ‘contact a doctor if in doubt’,
‘in case a reaction develops’
and to ‘contact a dermatologist if in doubt’

10. Problems regarding the skin test
Problem 1:
Conclusions of this research:
the recommendations and instructions on how to perform the hair dye self-test vary greatly
even among products from the same company
It is our impression that most were not really ‘recommendations’

11. Problems regarding the skin test
Problems regarding the skin test
Problem 2:
it is not a screening test, but a diagnostic test
consumers without symptoms are screened
dermatitis patients are diagnosed
The study had been carried out on dermatitis patients and not on consumers without symptoms.
This means that the figures represent the self-test's performance as a ‘diagnostic’ test rather than as a ‘screening’ test.

12. Problems regarding the skin test:
Problem 3:
the test has not been validated according to basic criteria defined by scientists
The screening test must be performed in accordance with high methodological scientific standards. The test has critical limitations:
controls
an appropriate spectrum of participants
blinding
information on reproducibility
information on adverse effects

13. Problems regarding the skin test
the test has been evaluated in the wrong population group
The test must be validated in the target population, in this case: individuals from the general population who intend to dye their hair.
However, the self-test has been carried out on PPD-allergic patients.
Proper validation in the target population should lead to other results.

14. Problems regarding the skin test
skin reactions have been read by dermatologists and not by the targeted group (consumers and hairdressers)
The intention behind the self-test is that the ‘hairdresser or consumer’ should read and interpret the test reaction.
However, the self-test has been read and interpreted by ‘dermatologists’
No study has yet evaluated how well the hairdressers and consumers perform. A correct interpretation of the test is a prerequisite for correct validation of the self-test.

15. Problems regarding the skin test
hair dyes contain strong and extreme sensitizers that are left on the skin in high concentrations, potentially resulting in active sensitization
The self-test carries a significant risk of sensitization to hair dyes.
Studies have shown that the risk of sensitization increases with:
the allergen dose per unit area
the frequency of exposure
the duration of exposure
the occlusion
the presence of penetration-enhancing factors
the impairment of skin barrier function and the relation to anatomical site

16. Problems regarding the skin test
The used concentration of PPD can lead to sensitization
The dose of allergen per unit area
Application of an allergen to a small skin area does not diminish the risk of sensitization when compared with a larger skin area with the same dose per area.
Thus, repeated exposure to low doses of contact sensitizers, as occurs when the hair self-test is performed, may considerably increase the risk of sensitization.

17. Problems regarding the skin test:
Frequency of exposure
Besides the concentration, also frequency can cause active sensitization.
Study of Basketter:
repeated short-time exposure to hair dyes with a low concentration of PPD increases the risk of PPD sensitization more than prolonged exposure to a higher concentration of PPD, but with a longer time interval).

18. Problems regarding the skin test
The risk of developing a skin reaction and thus an allergy.
A contact allergy to hair dyes can also cause swelling of the neck and face, as well as obstruction of the respiratory tract.
The ideal self-test that doesn’t cause active sensitization has not yet been developed.
The number of studies are inadequate to make exact predictions.

19. Problems regarding the skin test
Other problems and/or difficulties
the responsibility of the manufacturer is shifted to the hairdresser/consumer
From a practical point of view, it is very difficult to carry out the self- test. It’s difficult to tell a client that he has to come back after 48 hours
Some sensitized individuals tend to keep dyeing their hair despite the risk of developing dermatitis and swelling
There is no standardized testing procedure, there is a lot of confusion
no information is given about unwanted side-effects, such as active sensitization, which is necessary knowledge for healthcare providers
No back-up system is available

20. Problems regarding the skin test
Other problems and/or difficulties
Nearly all tests may result in false-positive and false-negative results
The advantage of a screening is that one may detect and treat a condition at an early stage. The disadvantages include:
false-positive results: unnecessary investigations and treatments
false-negative results: positive test reactions may sometimes appear after several days. Hence, when restricting the test to 48 hours (2 days), false-negative readings are expected to appear to an unknown degree, resulting in a false sense of security.

21. General conclusions on the skin test
Problems regarding the self-test:
a lack of clear scientific evidence
the self-test increases the risk of developing an allergic reaction. An allergy will last all life. Once acquired it does not only mean that hair dye will elicit skin rashes, but also dyed leather clothing, black rubber and many other everyday products
Conclusion:
According to scientists, the test is not reliable and has harmful effects on human health.
Repeated hair dye application on the skin with the self-test may, in its current form, be compared with experimental human sensitization tests.

22. Economic consequences for hairdressers
If hairdressers follow the instructions of manufacturers, they may lose clients.
In the case of a positive skin test reaction, the hairdresser has to send the client away.
Clients simply go to another salon where no test is carried out. This stimulates the black economy!
If hairdressers don’t follow the instructions of manufacturers, they may be sentenced by court.

23. Provisional proposal of Coiffure EU for the skin test (to be validated during the meeting on 30 Nov)
Replace the self-test by scientific questionnaires
If in doubt, contact a dermatologist

24. Actions already taken by Coiffure EU regarding the skin test
Creation of an internal working group within CEU (22 March 2015) - 6 countries:
• Ireland • UK • Norway • Germany • Malta • Belgium (presidency)
Information collection, literature studies
Developing a draft version ‘Overview considerations concerning Skin testing’
Participation in the Working Group on Cosmetic Products (European Commission) (22 October 2015)
Planned actions:
Participation in the Cosmetic Forum (Ueapme) on 14 January 2016 to defend the interests of hairdressers.

25. Thank you for your attention!
Coiffure EU
Stéphane Coigné
Board member of Coiffure EU
Vijfwindgatenstraat 21 F
9000 Gent - Belgium