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Contact dermatitis from tertiary‐butylhydroquinone in a hair dye, with cross‐sensitivity to BHA and BHT

Case Report A 37-year-old woman, with no past history of allergy, consulted our Dermato-Allergy Unit. 1 day after the 2nd application of a new hair-colouring preparation (Excellence Chatain Clair, L’Oréal, Clichy, France), she had developed an itchy inflammatory oedema of her scalp and face, with occipital lymph node swelling. The lesions cleared after 5 days on oral corticosteroids. She had regularly used hair dyes for several years, but with transient local discomfort only. Patch testing was performed with the European standard series and a hairdressers series (TrolabA). As the tests were negative at D2 and D4, the patient was subsequently tested with the hair dye. Semi-open patch tests showed a weakly positive reaction at D2 to the colouring solution, but no reactions to the revealer or the neutralizing shampoo. Patch tests were then performed with the 20 ingredients of the hair dye, kindly provided by the manufacturer at their use concentration, monoethanolamine and pentasodium pentetate (pH±10) excepted. We observed a strongly positive reaction to tertiary-butylhydroquinone (TBHQ) 0.3% in a hydro-alcoholic (50/50) solution. Hydroquinone, butylated hydroxyanisole (BHA), and butylated hydroxytoluene (BHT) each 1% pet. (TrolabA), were finally tested, with positive reactions at D2 and D4 to both BHA and BHT (Table 1).