Scalp Burn Post-Beauty Parlor Visit

Abstract: 54 yo woman with localized hair loss after a visit to the beauty parlor

HPI: The patient is a 54-year-old woman who was seen for evaluation of a localized hair loss and dermatitis of the scalp since she had her hair roots bleached 4 – 5 weeks ago.

She notes that the roots of her hair were left exposed to the chemical for about 4 hours after application.  On a next morning, her scalp was sore and burning, and somewhat swollen throughout the day. She was seen at ER  for evaluation that night and told that her scalp was probably burnt by the hair product; and was advised to wash her hair with cool water and was given a topical medication to apply, the name of which she cannot recall today. She has been using icepack and the medication that was given from ER, which helped. She has noticed that her hair was falling out in the mid parietal area since a few days after the insult.. She was reevaluated by her primary care physician two weeks ago for dryness and pruritus of the scalp and was prescribed another topical medication but does not remember the name.

Past medical history reveals bariatric surgery in  four years ago and had an episode of transient hair loss thereafter. She has been using hair products from the same store, JCP salon, since the episode, and has not had any problems until this recent hair dye/bleach treatment. She washes her hair once weekly, and takes multiple vitamins (including biotin) for her health in general.

The patient is quite upset, angry and tearful about the situation. Currently, she is seeing a therapist for the stress. She fears that the condition will be permanent.

O/E: The skin exam shows a healthy but distraught woman with a well-defined 9.5 x 1.3 cm alopecic patch with many scattered black short broken hairs on the mid parietal scalp to vertex region. There is mild erythema on the involved scalp without evidence of atrophy or cicatrix. Her roots of the surrounding hair are dark brown to blackish about 1 cm from the root.

Clinical Photos:

Impression: Irritant dermatitis with alopecia secondary to her recent hair dye/bleach process

Plan: We had a lengthy discussion of her recent hair damage. This is likely irritant dermatitis most likely secondary to the hair dye/bleach. There is no evidence of scarring today, and her hair will likely grow back although it will take some time. We reassured the patient that we will support her while she is recovering from the recent trauma. 

Follow-up Photo: Around 7 months after chemical burn.

Marked improvement, but patient still feels traumatized.

References:

1. Hair highlights and severe acute irritant dermatitis ("burn") of the scalp. Chan HP, Maibach HI. Cutan Ocul Toxicol. 2010 Dec;29(4):229-33. PubMed

2. Chemical burns to the scalp from hair bleach and dye.  Jensen CD, Sosted H.  Acta Derm Venereol. 2006;86(5):461-2.  Free Full Text

3. The hair color-highlighting burn: a unique burn injury.

Peters W. J Burn Care Rehabil. 2000 Mar-Apr;21(2):96-8.

Abstract: A unique, preventable, 2.8 x 3.7-cm, full-thickness scalp burn resulted after a woman underwent a professional color-highlighting procedure at a hair salon. The burn appeared to result from scalp contact with aluminum foil that had been overheated by a hair dryer during the procedure. The wound required debridement and skin grafting and 3 subsequent serial excisions to eliminate the resulting area of burn scar alopecia. The preventive aspects of this injury are discussed.

4.  Curling iron-related injuries presenting to U.S. emergency departments.

Qazi K et. al. Acad Emerg Med. 2001 Apr;8(4):395-7. PubMed.