PPD Sensitization in Men: Unique Risks and Gendered Behavior

 

 

Introduction

Para-phenyelenediamine (PPD) is one of the most common allergens in cosmetics. While genetics can increase chances of allergy, anyone can develop a PPD allergy. High concentrations and repeated exposure increase the likelihood of becoming sensitized. Basic information about PPD is covered in an earlier article, What You Need to Know About Para-Phenylenediamine.

 Occupations that involve repeated exposure to PPD, such as hair stylists, and fur and textile workers, show higher rates of employees with PPD sensitization [13]. Outside of occupation-related sensitization, the average person is sensitized to PPD through a black henna tattoo, or through the use of hair dye. Prevalence rates of PPD sensitization are about 6.2% in North America, 4% in Europe, and 4.3% in Asia [1]. Overall, sensitization rates appear to be increasing over time [2]. Rates are higher in populations with darker hair, as dark hair dyes contain higher PPD concentrations.  Rates of sensitization are also higher in countries where “black henna” is commonly used in place of traditional henna.

 PPD sensitization rates also vary between genders. Both body art and the use of hair dye are gendered behaviors; more women participate than men. This leads some to presume that PPD sensitization is more of a concern for women. While it is true that, overall, a higher percentage of women have PPD sensitization than men, it is important to discuss issues specific to men’s self-grooming and help-seeking behaviors that put the male population at unique risks. Certain populations of men experience higher rates of facial dermatitis due to frequent beard dyeing. Men who work in industries involving frequent contact with products that contain PPD or cross-reacting allergens may be forced out of their jobs to avoid continual allergic reaction. Men show reluctance to seek medical attention; this puts them at risk for future complications which could be avoided. Understanding gendered behavior may lead to better education, prevention, and treatment of PPD sensitization in men.

 

 

This man will have permanent scarring from his “black henna” body art, and is now sensitized to PPD.

Source: https://shewhoseeks.blogspot.ca/2012_02_01_archive.html

 

 

Avenues of PPD Sensitization

Traditionally, self-grooming and concerns for beauty have been characterized as feminine behaviors. Men spend less time and money in the use and consumption of beauty products and services.  Gender-specific grooming practices will be explored further in the next section. About 30-40% of women and up to 10% of men in North America are regular hair dye users [2],[3]. Another study estimated that 70% of women and 20% of men have used hair dye at least once in their lifetime [4].

On the other hand, getting a “black henna” tattoo is much less gendered in western cultures, leading to a fairly even split in the numbers of males and females getting a temporary “black henna” tattoo. Traditional henna body art is highly gendered; it is used for decorating and beautifying women, especially for celebrations and social events. In contrast, “black henna,” when it is used in spaces of tourism, is used to mimic the look of true tattoos. It is not limited to a specific custom or style.black henna” is readily available on boardwalks and beaches, and in shopping malls, resorts, amusement parks, festivals, and fairs. Those who get “black henna” body art are usually children or young adults. [5], [6]. Children are attracted to body art that mimics tattoos because they like to imitate adult behavior. Parents who believe that “black henna” is harmless allow their children to have body art done, unaware of the risk of sensitization. Thus, both young boys and girls get “black henna” body art.

 

 

 

A young boy is scarred and sensitized by a “black henna” tattoo.

Source: Daily Mail

 

 

Of those who get a “black henna” tattoo, an estimated 50% will become sensitized [6], [7]. Some will experience a delayed contact dermatitis reaction following; some will not. A person can develop a sensitization even if they did not react to their first exposure. It is rare for consumers of “black henna” to understand the connection between the product used to create “black henna” body art, and hair dye. Children become sensitized to PPD through “black henna,” then later on may choose to dye their hair. The chances of a person previously sensitized by black henna having a severe (+++) reaction to PPD hair dye is about 40% [8]. A study found that 16% of adolescents in Manchester, England had a PPD allergy. Most of this was likely caused by the “black henna” they had gotten on holiday [8]. We will see a wave of hair dye reaction cases around 2030, when this population begins showing gray hair.

 

 

Source: Presentation to USFDA June 30, 2016: ‘‘Black Henna’ and the Epidemic of para-Phenylenediamine Sensitization: Awareness, Education and Policy, Catherine Cartwright-Jones PhD

 

 

 While girls and women favor delicate designs, boys and men are more likely to choose tribal-style patterns that cover large areas of the skin with a solid application of “black henna.” This larger surface area increases the amount of PPD to which the person is exposed, thus increasing the risk of sensitization. If the client experiences a delayed hypersensitivity reaction to the body art, a larger area of their body is subject to dermatitis symptoms such as blistering, permanent scarring, and hypopigmentation. This is only just one way gendered behavior creates unique variables in PPD sensitization.

If a parent sees that their child is suffering from a reaction to their “black henna” tattoo, they will probably take the child to a medical professional. Adults, especially men, may be less likely to seek medical attention for their own allergic reaction, especially if it is not severe. Neglecting to seek medical attention causes a person to remain uneducated about the nature of their allergy, putting them at risk for repeated exposures and reactions. Men’s help-seeking behaviors will be discussed later in this article.

 

 

Grooming Practices as Gendered Behavior

Conventional ideals for appearance differ greatly between those for men and those for women. Entire books are dedicated to the sociology behind gendered beauty norms; therefore, it is impossible to cover this subject in its entirety within this article. One salient feature is that feminine and masculine norms are often presented as binary, and in opposition with one another [9]. If one behavior is used in traditionally feminine self-grooming, it is avoided in traditionally masculine self-grooming [9], [10], [11]. This is particularly evident in the way we treat hair.  In western societies, most men keep their hair short, while most women have longer hair. Of course, there are many exceptions, and there are people and groups who intentionally choose to defy norms through their appearance. As societal constructs of masculine and feminine ideals shift, so do people’s choices in personal style. However, there is still an overall trend in gendered grooming behaviors. Cosmetics companies actively seek to maintain these norms in the sorts of images they use in marketing their products.