Fundamentals
The skin, our body’s largest organ, acts as a diligent guardian, a living archive recording every interaction with the world around us. Its responses to external stimuli are as old as humanity itself, a dialogue between inner fortitude and outward encounters. Among these responses, a common condition that speaks volumes about this interaction is Contact Dermatitis. Simply put, Contact Dermatitis unfolds as a skin reaction, an observable manifestation of the skin’s defense system at work.
This condition manifests in two primary expressions ❉ Irritant Contact Dermatitis and Allergic Contact Dermatitis. While both ignite discomfort, their underlying mechanisms diverge, akin to two distinct dialects of the skin’s ancient language of complaint. The initial sensory experience often involves a symphony of symptoms ❉ an insistent itching, a flush of redness, a warmth to the touch, or a sensation of discomfort that settles upon the affected area. This is the skin communicating its distress, a primal signal that something applied externally has caused a disruption.
Consider our forebears, those who walked the earth long before scientific nomenclatures. They might not have articulated the terms “irritant” or “allergic” with clinical precision, yet their keen observations of cause and effect surely held an intuitive comprehension of skin upset. The elder noticing a rash after a new plant infusion was used to anoint the hair, or a sudden eruption following the application of a particular balm, understood a connection.
This ancestral knowledge, passed down through generations, represented a rudimentary yet profound understanding of what we now delineate as Contact Dermatitis. The wisdom of discerning which herbs soothed and which aggravated was woven into the very fabric of communal hair care, a practical dermatology practiced in the hearth-light of traditional homes.
The Skin’s Ancient Language
Long before the advent of microscopes and chemical analyses, human communities developed an intimate familiarity with the reactions of their bodies to the natural world. This awareness was particularly acute concerning ingredients applied to the hair and scalp, areas central to identity, spiritual belief, and communal well-being in many cultures. Skin, the visible boundary between self and environment, served as an immediate feedback system. When traditional preparations, perhaps a new blend of leaves for cleansing or a rich oil for conditioning, brought forth an unwelcome sensation — an unexpected prickle, a persistent itch, or a visible reddening — it signaled a discord.
Ancestral communities possessed an innate understanding of skin reactions, recognizing discomfort as a clear signal from the body.
These observations, often attributed to the inherent nature of the plant or substance, formed the bedrock of ancestral hair care practices. It was through repeated experience and communal sharing that discerning wisdom arose, guiding the selection of beneficial components and cautioning against those that provoked irritation. This unwritten pharmacopeia, rich with the heritage of observation, underpinned the tender care of textured hair long before modern chemistry illuminated the specific compounds at play.
Irritant Vs. Allergic ❉ A First Glimpse
The distinction between irritant and allergic responses, though scientifically codified later, had practical echoes in traditional knowledge. An Irritant Contact Dermatitis arose from substances that, by their very nature, were harsh enough to damage the skin’s protective barrier directly. Imagine a strong lye wash, historically derived from wood ash, used for cleansing. Its potent alkalinity would provoke an immediate, burning sensation for most individuals, a direct chemical assault on delicate skin.
The reaction was predictable across many people exposed to a sufficient concentration. This universal, dose-dependent reactivity was the ancestral understanding of irritation.
On the other hand, Allergic Contact Dermatitis presented a more puzzling phenomenon. It involved an individualized sensitivity, a reaction that occurred only in a select few, and often after repeated, seemingly benign exposures. A particular botanical dye, harmless to most, might inexplicably cause a severe rash in one person after years of peaceful use. This delayed, highly personal response defied immediate, universal explanation, often viewed as a unique constitution or a specific bodily “disagreement” with that particular plant.
Our ancestors recognized these different patterns of reactivity, even if the underlying immunology remained a mystery. They learned to discern between a universally harsh substance and a singular, idiosyncratic bodily response, informing their practices of preparing and applying hair remedies.
Intermediate
Deepening our exploration into Contact Dermatitis reveals the intricate dance between external agents and the body’s internal choreography. At an intermediate level of understanding, we move beyond surface observations to apprehend the underlying mechanisms that govern these skin responses. Irritant Contact Dermatitis unfolds when a substance directly damages the skin’s protective lipid barrier and cellular structures.
This damage can be immediate, as with a strong acid, or cumulative, appearing over time from repeated exposure to milder irritants like certain surfactants in shampoos or harsh styling gels. The skin’s innate defenses are overwhelmed, leading to inflammation.
Conversely, Allergic Contact Dermatitis signals a more personalized engagement with the immune system. This reaction is a delayed hypersensitivity, typically a Type IV response, where the body’s immune cells become “sensitized” to a particular substance (an allergen) upon initial or repeated contact. Once sensitized, subsequent exposures, even to minute quantities, trigger an inflammatory cascade, resulting in the characteristic rash. This response is not about inherent toxicity but about an individual’s unique immunological recognition of a compound as a threat.
Tracing the Reactive Path
The body’s defense mechanisms are remarkably complex, designed to safeguard its delicate internal environment. When an irritant encounters the skin, it breaches the stratum corneum, the outermost layer, disrupting cellular integrity. This prompts a cascade of chemical signals, recruiting inflammatory cells to the site. The visible symptoms – the redness, swelling, and itching – are merely the outward expressions of this protective response.
For allergic reactions, the path is more subtle. An allergen, often a small molecule, penetrates the skin and binds to native proteins, forming a complex that the immune system perceives as foreign. Specialized immune cells, notably T-lymphocytes, then recognize and remember this altered protein, standing ready to launch a more robust defense upon subsequent contact. This immunological memory explains why a product used without incident for years might suddenly provoke a dramatic allergic response.
Echoes in the Modern Regimen
The contemporary landscape of textured hair care, while offering a seemingly endless array of choices, also presents its own gallery of potential triggers for Contact Dermatitis. Common culprits found in formulations today include Fragrances, a pervasive group of chemicals designed to lend appealing scents; Preservatives, vital for product longevity but often potent sensitizers; and certain Dyes, particularly those used in permanent hair coloring. These modern components find an intriguing echo in ancestral practices. For instance, while contemporary hair dyes use complex chemical compounds like para-phenylenediamine (PPD), traditional communities often employed natural plant dyes.
Some indigenous plants, such as certain forms of henna, or concoctions using plant-derived pigments, could also elicit skin reactions. Similarly, traditional cleansing agents, which might have incorporated strong alkaline ashes from certain wood types, could certainly behave as irritants to the scalp, mirroring the harshness of some modern industrial detergents.
The difference, perhaps, lies in the ancestral capacity for immediate, firsthand observation of reactions within smaller, localized communities, allowing for quicker adaptation or avoidance of problematic ingredients. This collective wisdom, passed down through oral traditions and lived experience, represented a form of empirical risk assessment.
The journey of textured hair care, from ancient botanicals to modern chemical formulations, reveals a continuous interplay of innovation and inherent skin sensitivity.
A Tendered Heritage ❉ The Legacy of Early Relaxers
The mid-20th century marked a profound shift in textured hair care, particularly for Black women in the Western world, with the widespread introduction of chemical hair relaxers. Driven by societal pressures and evolving beauty standards that favored straightened hair, these products offered a potent, though often precarious, means of altering hair texture. These early relaxers, predominantly lye-based (containing sodium hydroxide), operated by chemically breaking down the hair’s disulfide bonds to permanently alter its structure. Their efficacy, however, often came at a considerable dermatological cost, giving rise to a prevalent form of Irritant Contact Dermatitis that scarred not only scalps but also aspects of collective memory.
Historical accounts and scholarly works, such as Ayana Byrd and Lori Tharps’ seminal text, Hair Story ❉ Untangling the Roots of Black Hair in America (2001), extensively document the pervasive incidence of scalp burns, scabbing, and intense irritation experienced by countless Black women and girls using these powerful chemical formulations. These reactions, while not always formally quantified with precise epidemiological statistics in early records, were a widely observed and deeply felt health burden within the community. The application process, often performed at home or in salons with varying levels of professional training, involved applying a highly alkaline substance directly to the scalp, often unprotected.
- Chemical Burns ❉ The primary and most visible consequence was the chemical burn, a direct tissue injury caused by the lye. This immediate, intense stinging and burning sensation frequently led to visible lesions, scabs, and even open sores on the scalp.
- Scalp Inflammation ❉ Chronic inflammation, a hallmark of irritant contact dermatitis, was common, contributing to persistent itching, tenderness, and discomfort for days after application.
- Hair Breakage and Loss ❉ Beyond the immediate skin reaction, the compromised scalp barrier and inflammatory response often contributed to hair weakening at the root, leading to significant breakage and, in severe cases, scarring alopecia, where hair follicles are permanently destroyed.
This historical reality underscores a poignant narrative within the textured hair heritage. The pursuit of a particular aesthetic, influenced by dominant societal norms, frequently led to physical suffering and long-term dermatological issues. The shared experiences of scalp pain and irritation formed a somber part of the communal dialogue around hair, a tender thread connecting generations through a history of both aspiration and unintended consequence. The resilience of those who navigated these challenges, seeking beauty and acceptance while enduring physical discomfort, offers a compelling testament to the complex interplay of cultural pressures and personal wellbeing in the story of Black hair.
These are not isolated incidents but a systemic pattern of skin reactions woven into the narrative of textured hair. While modern relaxer formulations have evolved, the historical prevalence of irritant contact dermatitis from earlier products serves as a powerful reminder of the profound impact of hair care choices on dermatological health within specific communities.
| Aspect of Care Primary Goal |
| Ancestral Practices (General) Nourishment, protection, spiritual adornment, communal identity. |
| Early Chemical Relaxers (Mid-20th Century) Hair straightening, conformity to Eurocentric beauty ideals. |
| Aspect of Care Typical Ingredients |
| Ancestral Practices (General) Natural oils (e.g. shea butter, palm oil), botanical extracts, clays, ash for cleansing. |
| Early Chemical Relaxers (Mid-20th Century) Highly alkaline compounds (e.g. sodium hydroxide/lye). |
| Aspect of Care Mechanism of Reaction |
| Ancestral Practices (General) Rare, individualized allergic sensitivities; occasional irritant effects from strong natural agents. |
| Early Chemical Relaxers (Mid-20th Century) Direct chemical damage to scalp and hair (irritant contact dermatitis). |
| Aspect of Care Observed Skin Reactions |
| Ancestral Practices (General) Localized irritation, occasional rashes, typically managed with soothing botanicals. |
| Early Chemical Relaxers (Mid-20th Century) Widespread scalp burns, persistent irritation, scabbing, hair breakage, scarring. |
| Aspect of Care Community Response |
| Ancestral Practices (General) Knowledge shared, problematic ingredients avoided, alternative remedies sought. |
| Early Chemical Relaxers (Mid-20th Century) Endured due to societal pressures, later led to calls for safer alternatives and natural hair movements. |
| Aspect of Care This comparison underscores the shift from inherently milder, though sometimes problematic, natural applications to highly aggressive chemical interventions that dramatically altered the dermatological landscape of textured hair care for generations. |
Academic
The precise meaning of Contact Dermatitis, from an academic and clinical perspective, delineates an inflammatory response of the skin triggered by direct interaction with an external substance. This encompasses two distinct pathophysiological pathways ❉ Irritant Contact Dermatitis (ICD) and Allergic Contact Dermatitis (ACD). ICD, the more prevalent form, results from a non-immunological, direct cytotoxic effect of a substance on epidermal cells, leading to a disruption of the skin’s protective barrier. This process is dose-dependent, meaning stronger or longer exposures to a given irritant will elicit a more pronounced reaction in nearly all exposed individuals.
Chemicals, harsh detergents, or even prolonged moisture can act as irritants. Conversely, ACD represents a delayed-type hypersensitivity reaction, specifically a Type IV immunologic response. This intricate process involves the initial sensitization of the immune system upon first exposure to an allergen (a hapten, which is a small molecule that becomes allergenic when it binds to a protein in the skin). Upon subsequent exposures, T-lymphocytes, having developed immunological memory, recognize the hapten-protein complex, initiating an inflammatory cascade that culminates in erythema, edema, papules, vesicles, and pruritus. This reaction is idiosyncratic, occurring only in sensitized individuals, irrespective of dose size once sensitization has occurred.
The profound impact of Contact Dermatitis, particularly allergic reactions to compounds like paraphenylenediamine (PPD) found in hair dyes, is not uniformly distributed across populations. Research indicates notable ethnic variations in sensitization patterns. For instance, studies have shown that individuals with darker hair, who often use darker shades of dye containing higher PPD concentrations, exhibit a greater propensity for PPD allergy (DermNet, n.d.).
This reality extends beyond mere individual sensitivity; it reflects a deeper interplay of cosmetic practices, societal pressures, and the accessibility of specific formulations, particularly within textured hair communities. The phenomenon is not merely a dermatological condition; it is a confluence of biological predisposition, cultural heritage, and commercial influence.
The Cellular Dialogue of Sensitivity
At a cellular level, the unfolding of allergic contact dermatitis involves a sophisticated immunological dialogue. When a hapten (such as PPD) penetrates the epidermis, it conjugates with endogenous skin proteins, forming a complete antigen. These complexes are then processed by antigen-presenting cells, primarily Langerhans cells residing in the epidermis. These Langerhans cells migrate to regional lymph nodes, where they present the antigen to naive T-lymphocytes.
This initial exposure leads to the clonal expansion of antigen-specific T-cells, which then differentiate into effector and memory T-cells. This sensitization phase, though symptomatically silent, establishes the immune system’s readiness for a robust response. Upon re-exposure to the same allergen, these memory T-cells are rapidly activated. They migrate to the site of contact, releasing a cascade of pro-inflammatory cytokines and chemokines, recruiting other immune cells, such as macrophages. This orchestrated cellular recruitment and cytokine release drive the clinical manifestations of eczema ❉ redness, swelling, blistering, and intense itching, typically appearing 24 to 72 hours post-exposure.
Understanding the precise molecular pathways and cellular players involved in both irritant and allergic forms of Contact Dermatitis allows for more targeted diagnostic approaches, such as patch testing for specific allergens, and the development of preventative strategies. It moves beyond the anecdotal observations of our ancestors, providing a scientific lexicon for their empirical wisdom.
Contact Dermatitis, at its most fundamental level, unveils the intricate immune responses of the body to specific chemical encounters, a silent conversation between external agent and internal defense.
A Historical Burden on Crown and Spirit ❉ The Legacy of Early Relaxers
The journey of textured hair in America has been deeply intertwined with social aspirations and external pressures, creating a unique historical context for dermatological conditions. The widespread adoption of chemical relaxers, particularly the potent lye-based formulations, during the 20th century represents a poignant chapter where the pursuit of a dominant aesthetic significantly impacted physical health. This period saw a pervasive and largely unquantified epidemic of Irritant Contact Dermatitis within the Black community.
Scholarship, such as Hair Story ❉ Untangling the Roots of Black Hair in America by Ayana D. Byrd and Lori L. Tharps (2001), provides a powerful, albeit qualitative, historical account of the profound physical consequences. They detail the widespread experiences of scalp burns, chronic irritation, and hair breakage that became an accepted, though painful, part of many Black women’s hair regimens.
While precise epidemiological data from that era defining the incidence of “contact dermatitis” directly attributable to relaxers is sparse by modern standards, medical observations and anecdotal reports from the mid-20th century consistently described severe scalp inflammation, blistering, and scabbing (Byrd & Tharps, 2001). The sheer volume of women and girls reporting such reactions, and the subsequent medical literature acknowledging “relaxer-induced scarring alopecia” and “chemical burns,” underscore a significant, community-wide dermatological burden. This widespread chemical exposure, often self-applied or administered by untrained individuals, inflicted direct cellular damage to the scalp, a clear manifestation of irritant contact dermatitis.
The long-term consequences of this historical exposure extend beyond immediate skin reactions. Chronic inflammation and repeated injury to the scalp compromised follicular health, contributing to conditions like Central Centrifugal Cicatricial Alopecia (CCCA), a scarring form of hair loss disproportionately affecting Black women. This historical narrative speaks to the sacrifices made in the quest for assimilation, highlighting a period where beauty practices, driven by external societal pressures, inadvertently became agents of physical harm.
The pain endured was not merely cosmetic; it was a physical manifestation of a deeper struggle for acceptance and self-definition. The experiences documented reflect a systemic health issue, deeply embedded in the cultural practices and historical context of textured hair care.
Dermatological Footprints Across the Diaspora
The global diaspora of African and mixed-race communities has given rise to diverse hair care traditions, each carrying its unique dermatological footprint. From the communal oiling rituals of certain West African communities to the intricate braiding practices found across the Caribbean and Americas, these traditions reflect a rich tapestry of care. Yet, with variations in climate, available botanicals, and commercial product access, so too vary the patterns of contact dermatitis. For instance, while certain traditional plant-based dyes or strong herbal concoctions might induce irritant reactions in some regions, the later introduction of synthetic chemical products, such as formaldehyde-releasing preservatives or specific allergens like methylchloroisothiazolinone, brought new challenges.
The prevalence of specific allergens, like PPD in hair dyes, also shows regional and ethnic variations. Studies suggest that individuals with darker hair, more commonly found within the African diaspora, tend to use darker shades of hair dye, which contain higher concentrations of PPD, contributing to a higher incidence of sensitization to this potent allergen in these populations. This highlights a complex interplay between cultural aesthetic preferences, product availability, and inherent dermatological risks.
- Regional Product Variation ❉ Different geographical regions have unique commercial product landscapes, leading to varied allergen exposures. For example, some regions might have a higher prevalence of products containing specific preservatives or fragrances.
- Traditional Ingredients Re-Evaluated ❉ Ancestral remedies, while often gentle, were not without potential for reactions. Certain indigenous plants used for cleansing, coloring, or styling, though natural, could contain compounds that act as irritants or allergens for sensitive individuals.
- Socioeconomic Disparities ❉ Access to professional dermatological care and patch testing, which is the gold standard for diagnosing allergic contact dermatitis, often remains a barrier in many communities within the diaspora, leading to underdiagnosis and prolonged suffering.
The Unbound Helix ❉ Reclaiming Agency and Wellbeing
Understanding Contact Dermatitis within the context of textured hair heritage is not an academic exercise alone; it is a profound step toward reclaiming agency and fostering holistic wellbeing. This understanding helps us move beyond inherited practices that might have been harmful, even if culturally significant, and toward informed choices that honor both ancestral wisdom and modern scientific understanding. The journey from the earliest recognition of skin sensitivities to the sophisticated immunological models we possess today allows for a dialogue between past and present. It provides the tools to discern which historical ingredients offered genuine benefit and which, perhaps, carried hidden risks.
For textured hair, this involves a conscious evaluation of product ingredients, a mindful approach to styling, and a celebration of natural hair patterns that may reduce reliance on chemical interventions that historically posed dermatological challenges. It is about fostering an environment where hair care is a source of joy and health, rather than a pathway to skin discomfort. This empowers individuals to make choices that align with their skin’s unique needs, recognizing that wellbeing is an interconnected experience of body, spirit, and heritage.
A deep understanding of Contact Dermatitis within the context of textured hair heritage empowers individuals to make informed choices that honor wellbeing.
| Agent/Category Paraphenylenediamine (PPD) |
| Primary Type of Dermatitis Allergic Contact Dermatitis |
| Relevance to Textured Hair Heritage A common allergen in darker hair dyes, historically used by many in textured hair communities. Higher incidence of sensitivity in some ethnic groups due to usage patterns. |
| Agent/Category Lye (Sodium Hydroxide) |
| Primary Type of Dermatitis Irritant Contact Dermatitis |
| Relevance to Textured Hair Heritage The primary active ingredient in early chemical relaxers, notoriously caused widespread scalp burns and irritation, shaping decades of textured hair care experiences. |
| Agent/Category Fragrances/Perfumes |
| Primary Type of Dermatitis Allergic Contact Dermatitis |
| Relevance to Textured Hair Heritage Ubiquitous in modern hair products, they are common sensitizers. Traditional hair care often relied on natural scents from botanicals, with varied allergenic potential. |
| Agent/Category Preservatives (e.g. Methylchloroisothiazolinone) |
| Primary Type of Dermatitis Allergic Contact Dermatitis |
| Relevance to Textured Hair Heritage Essential for product shelf-life, these are frequent allergens in modern shampoos and conditioners, a relatively new challenge compared to ancestral times. |
| Agent/Category Metallic Salts (e.g. Lead Acetate) |
| Primary Type of Dermatitis Irritant Contact Dermatitis (sometimes allergic) |
| Relevance to Textured Hair Heritage Found in some older or gradual hair darkening formulations. While less common now, their historical use could cause irritation. |
| Agent/Category Certain Plant Extracts/Botanicals |
| Primary Type of Dermatitis Irritant or Allergic Contact Dermatitis |
| Relevance to Textured Hair Heritage Some powerful natural ingredients used in ancestral remedies (e.g. certain strong cleansing herbs, dyes) could still cause reactions in susceptible individuals. |
| Agent/Category The evolution of hair care agents, from natural elements to complex synthetics, has continuously presented the skin with new challenges, requiring persistent vigilance and adaptation within communities. |
The conversation about Contact Dermatitis is not merely about symptoms and triggers; it extends to the very choices we make regarding our crowns, reflecting a commitment to ancestral reverence and personal wellbeing. It underscores the profound responsibility we hold for the care of our bodies, guided by the cumulative wisdom of generations and the clarifying lens of scientific inquiry.
Reflection on the Heritage of Contact Dermatitis
The journey through the intricate world of Contact Dermatitis, particularly when viewed through the profound lens of textured hair heritage, reveals a narrative far richer than mere clinical description. It is a story of resilience, adaptation, and the enduring connection between our bodies and the wisdom passed down through time. From the very first instinctual recoil from a harsh natural substance to the modern patch test pinpointing a subtle allergen, humanity, especially those within the Black and mixed-race diaspora, has cultivated a deep, embodied understanding of skin’s delicate responses.
The scalp, a sacred landscape in many ancestral traditions, has borne witness to generations of innovation, necessity, and sometimes, unintended consequence. We reflect upon the tender practices of our forebears, those who meticulously selected botanicals and oils, not always with a scientific taxonomy, but with an intuitive knowing of what brought soothing calm versus fiery protest. Their wisdom, whispered through generations, laid the groundwork for today’s dermatological inquiries. Consider the collective sigh of relief when a natural remedy brought comfort, or the shared understanding of a certain plant’s potency, which served as an early form of clinical observation.
The echoes from the source, the elemental biology of our skin’s reactivity, continues to shape our present. The tender thread of care, stretched across continents and centuries, connects those who once used ash-based lye for cleansing to those who later grappled with the intense irritancy of chemical relaxers. This historical continuum is not merely a record of suffering, but a testament to profound endurance and the unwavering human spirit’s quest for beauty, even when shadowed by discomfort. The stories of scalp burns and persistent irritation, though painful, served as a catalyst for a deeper interrogation of product safety and spurred movements towards embracing natural textures.
The unbound helix, the very DNA of our textured strands, carries within it not only the blueprint for our hair’s magnificent form but also the memory of its interactions with the world. It speaks to a future where understanding Contact Dermatitis is not just about avoiding triggers but about honoring the skin’s inherent sensitivity as part of our heritage. It calls for an informed approach to hair care, one that respects the ancestral remedies that healed and nurtured, while also discerning the scientific truths that protect and empower.
This is a continuous conversation, a living archive, where every choice about our hair is a reflection of reverence for our lineage, a commitment to wellbeing, and a step towards a future where our crowns are truly celebrated in their full, vibrant health. The sensitivity of our skin, far from being a weakness, becomes a powerful guide, reminding us of the profound intimacy between our bodies, our history, and our inherent beauty.
References
- Byrd, A. D. & Tharps, L. L. (2001). Hair Story ❉ Untangling the Roots of Black Hair in America. St. Martin’s Press.
- Khumalo, N. P. Pillay, K. & Ngwanya, R. M. (2007). Acute ‘relaxer’-associated scarring alopecia ❉ a report of five cases. British Journal of Dermatology, 156(6), 1394-1397.
- Richardson, V. Agidi, A. T. Eaddy, E. R. & Davis, L. S. (2017). Ten pearls every dermatologist should know about the appropriate use of relaxers. Journal of Cosmetic Dermatology, 16(1), 9-11.
- Vyas, S. Gupta, K. Modi, P. & Bhadee, A. (2018). Chemical relaxers and curlers ❉ Hidden danger. Journal of Clinical and Diagnostic Research, 12(11), ZC01-ZC03.
- Alonso, M. & Garcia, R. (2023). Allergic Contact Dermatitis Due to Paraphenylenediamine ❉ An Update. Actas Dermo-Sifiliográficas, 114(7), 543-550.
- DermNet. (n.d.). Paraphenylenediamine and hair dye contact allergy. Retrieved from DermNet website.
- Hillen, U. & Grabbe, S. (2010). Allergic contact dermatitis to hair dyes. Journal of German Society of Dermatology, 8(3), 169-174.
- Afrin, S. (2023). Dermatological adverse effects of hair dye use ❉ A narrative review. Journal of Skin and Sexually Transmitted Diseases, 45(3), 209-216.
- Kaur, B. J. Singh, H. & Lin-Greenberg, A. (2002). Irritant contact dermatitis complicated by deep-seated staphylococcal infection caused by a hair relaxer. Journal of the National Medical Association, 94(2), 121-123.
- Routh, D. & Patel, P. (2022). Afro-Ethnic Hairstyling Trends, Risks, and Recommendations. Cosmetics, 9(1), 16.
- Okereke, J. C. & Ezeani, M. C. (2015). Contemporary African-American Hair Care Practices. Skin & Aging, 23(5), 32-35.