Intermittent exposure to low-concentration paraphenylenediamine can be equivalent to single, higher-dose exposure

Hair dye allergy is an important and increasingly common cause of allergic contact dermatitis. The role of repeated exposure in elicitation of allergy has not previously been extensively studied. We have therefore compared elicitation between single and intermittent exposure to paraphenylenediamine (PPD). 23 subjects known to be allergic to PPD from positive patch tests were exposed to 0.3% and 0.03% PPD, both in petrolatum and water, for 5 min at the same site every day for up to 8 D. In the same subjects, single exposures were also performed at different sites, from 5 to 40 min. Other experiments exposed rat skin to radiolabelled PPD as one‐off application or multiple exposures. There were 8 reactions in the cumulative exposure site using 0.3% PPD in aqueous solution. In 7 of these, there was an exact correlation with reaction to the cumulative time needed for repeat exposures to elicit a reaction and the time needed for a reaction to the single exposure. There were no reactions to 0.03% PPD in water or pet under either type of exposure condition. There was also a positive correlation between grade of original reaction in clinic (+++, ++, +) and appearance/intensity of elicitation reactions. In the animal study, cumulative time and single exposure time sites correlated with regards to retention of radiolabelled substance within the skin. This study therefore demonstrates for the first time that, over the time period tested, the allergenic component of PPD accumulates in the skin. Hence, intermittent exposure to lower concentrations of PPD may be equivalent to higher concentration, one‐off exposure.