Shocking images show how a woman was left with a gaping wound on her head after getting her hair coloured at a salon.
The unnamed 21-year-old, from Seoul, South Korea, visited her local salon to get her hair lightened.
But, instead of giving her the colour she desired, the chemicals in the dye caused a deep open burn across the length of her head and made her hair fall out.
Doctors say she was exposed to persulfates and hydrogen peroxide – two potent chemicals found in dye – for too long.
The chemicals are the active ingredients in most highlighting products on the UK high street.
Shocking images show a woman’s scalp scalded open after she went to get her hair coloured at a salon (top left, after having her head shaved). B, C and D show the process of treating the wound, E shows the wound healing, and F shows the head two years later
After the wound had healed, the unnamed 21-year-old woman had a hair transplant which was able to recover most of her locks (pictured)
Doctors wrote about the incident in the journal Archives of Plastic Surgery, led by Dr Suk Joon Oh from the Department of Burn Reconstructive Surgery at Bestian Seoul Hospital.
The patient was treated with a mainstream colouring product in her local salon. The doctors don’t reveal the name of the product or how it was used.
But they suggest ‘prolonged exposure’ to the mixture may have caused the traumatising wounds, potentially because they contained particularly potent chemicals.
The doctors explained that the two of the chemicals – ammonium and potassium persulfates – are acidic and flammable.
And the dye contained hydrogen peroxide, a powerful chemical which can be found in high concentrations in hair formulas.
Dr Oh said: ‘[Hydrogen peroxide] is a clean, colorless, non-flammable liquid and is not well absorbed through intact skin.
‘At the concentrations used for household sterilization purposes, three to five per cent, it is slightly irritating to the skin.’
But at the concentration of 10 per cent that is found in many hair colouring materials, it is highly irritating and corrosive, and can therefore lead to skin blisters and burns, Dr Oh said.
WHAT IS A CHEMICAL BURN AND HOW CAN IT BE CAUSED BY HAIR DYE?
A chemical burn is the irritation and destruction of human tissue caused by exposure to a chemical.
Many cases occur due to accidental misuse of hair, skin and nail care products.
Most chemical burns are caused by strong acids that kill cells, which can lead to scarring and disabilities.
The extent of tissue damage depends on the strength of the chemical, the site of contact, whether it was swallowed, whether skin was intact and how long it was left on for.
- Redness, irritation or burning at the affected skin site
- Pain or numbness
- Vision changes if the eye is affected
- Cough or shortness of breath
In severe cases people may suffer a cardiac arrest, seizures or low blood pressure.
How can hair dye be dangerous?
The typical range of hydrogen peroxide concentration in hair colouring is three to six per cent.
In a concentration greater than ten per cent, it may induce blistering.
Under alkaline conditions, persulphates used in hair highlighting accelerate the bleaching process of peroxide hair treatment by making the hair ‘porous’, helping the hair absorb the dye.
Prolonged exposure to these oxidizing chemicals causes continued tissue necrosis, when the flesh dies.
In the worst outcomes, the injury resembles a full-thickness burn. Immediate skin reactions include contact dermatitis or hives, for example.
Delayed skin reactions may develop several days after exposure.
Sources: eMedicine Health and journal Annals of Burns and Fire Disasters
Hair dye formulations can contain a very high concentration of sulfates of up to 60 per cent.
In the UK, the maximum concentration of hydrogen peroxide allowed for use in hair products is 12 per cent. Persulfates do not have any specified concentration and hair lightening products may contain up concentrations up to 70 per cent, according to the Cosmetic, Toiletry and Perfumery Association (CTPA).
Over a prolonged time, a high-energy reaction, caused when the chemicals come in contact with skin tissue, can destroy human flesh.
This resulted in flesh on the woman’s scalp dying during process called coagulative necrosis, which is a form of cell death triggered by a lack of blood supply.
Dr Oh said: ‘Coagulation necrosis is caused by direct contact between the oxidising salt and the tissue.’
He continued: ‘As clinicians, we must educate people about the risk of burns caused by mixtures used for hair colouring, provide information on the safe use of these compounds, and join in current efforts to ban these chemicals from hair coloring products.’
The patient had a hair follicle transplantation afterwards, with images showing her hair’s recovery in the months after the event.
Dr Greg Willliams, a leading UK plastic surgeon in burn scar alopecia at the Farjo Hair Institute, said: ‘Incidents like this can be extremely traumatic for the patient.
‘The hair loss can have an equal or greater impact on the self-esteem and quality of life of patients than the scars themselves and act as a constant reminder of the causative traumatic incident.’
The woman’s hair was replaced using a ‘follicular extraction method’ transplant, available in the UK, which uses natural hair follicles from the patient.
Dr Williams, a former clinical director of the London’s Burn Centre at the Chelsea and Westminster Hospital NHS Foundation Trust, said: ‘Thankfully, technological advances now mean that it is possible to restore hair where it has been lost due to burns scars.’
Hair restoration on tissue once damaged by burns is complex and can take longer to achieve than typical hair transplant surgery.
Dr Bessam Farjo, founder and director of the Farjo Hair Institute clinics in Manchester and London, said: ‘With a hair transplant, we move follicles from a donor site which is usually at the back or sides of the head to the affected scarred area.
‘But the ability of the graft to take hold and thrive is not as reliable as it is in healthy non-scarred skin and may need repeating to achieve adequate density, which is important for a natural look.’
The surgeons see many people who suffer extreme hair dye burns who need transplants to correct the bald areas left behind.
Hair lightening products containing persulfates and hydrogen peroxide are permitted for use in the EU and UK only after being thoroughly checked for safety.
Dr Emma Meredith, a pharmacist and director at CTPA said: ‘Cosmetic products, including hair lightening products, are covered by robust, strict legislation, the EU Cosmetic Products Regulation 1223/2009 (CPR).
‘They are safe for use, provided of course the instructions for use are followed.’
Typically a salon would leave hair dye on for 30-45 minutes maximum, and ‘box dyes’ bought in stores vary.
A BBC investigation in 2017 warned many clinics don’t abide by industry guidelines stating hair dyes shouldn’t be used on under-16s.
Some components in hair dyes can cause symptoms of an allergic reaction, which is why manufacturers say a skin tolerance test must be carried out 48 hours before – for both home dye kits and those used by professionals in hair salons.
Most commonly the chemical paraphenylenediamine (PPD) causes reactions from mild skin irritation to swelling.
In November, teenager Riley O’Brien was temporarily blinded for two days and left with pus-filled scabs on her hairline after suffering an allergic reaction to hair dye.
The 18-year-old, from Colchester, used a cream-based permanent dye in dark brown but was left with chemical burns and a swollen face.
Reactions to PPD can range from mild irritation in the scalp to an allergic reaction that can potentially trigger serious symptoms throughout the body.
WHAT CHEMICALS IN HAIR DYE CAN CAUSE A REACTION?
Colouring products contain hundreds of chemicals.
PPD is the prime cause of allergic reaction to hair dye.
It is needed for most shades of permanent colour, especially dark shades.
There is a strict limit on the concentration of PPD at a maximum of two per cent in any substance applied to the hair.
You’re particularly at risk if you have (or have previously had) a black henna tattoo, which often illegally contains high levels of PPD.
These temporary tattoos should be avoided because the paste often contains high levels of PPD, which can increase the risk of an allergic reaction the next time you’re exposed to it.
This is used to ‘boost’ peroxide hair bleaches.
These persulfates can produce a variety of skin and respiratory responses, including dermatitis, localized edema, urticaria, rhinitis, asthma, and syncope.
Hydrogen peroxide removes hair’s pigment, allowing new colours to be absorbed.
Concentrated hydrogen peroxide is toxic if ingested or inhaled, and can cause tissue damage if it comes in contact with skin or eyes.
Even at diluted levels used in hair dye, repeated use can leave hair weaker.
Symptoms of a reaction
If you’re mildly irritated, you may find your scalp, neck, forehead, ears or eyelids become irritated.
The skin may become red, swollen, blistered, dry, thickened or cracked and you could feel a burning sensation.
If you’re allergic to the chemicals, your scalp and face may feel itchy and start to swell.
PPD may also trigger feeling generally ill. The symptoms may develop hours or even days later.
A severe reaction is called anaphylactic shock.
- Itchy, raised, or red skin
- Swollen eyes, lips, hands and feet
- Feeling lightheaded or faint
- Swelling of the mouth, throat or tongue which can cause breathing and swallowing difficulties
- Tummy pain, vomiting
Always carry out a patch test before using a permanent or semi-permanent hair dye.