The Association between Prolonged Occupational Exposure to Paraphenylenediamine (Hair-dye) and Renal Impairment

Introduction: Paraphenylenediamine (PPD) is widely used in hair dyes and cosmetic skin application. PPD intoxication following oral ingestion could be an important cause of ARF in Sudan, Morocco and the Indian Subcontinent. Repeated and prolonged exposure to PPD may also be associated with Chronic Kidney Disease (CKD). Methods: This is a cross-sectional study that covered six conveniently-chosen hairdressing saloons in Khartoum, Sudan. Hairdressers with regular professional exposure to PPD were evaluated for the presence of renal impairment (serum creatinine ≥ 2 mg/dl) and other markers of kidney damage. Results: The study included seventy-two females with a mean age of 40±8 years and a median duration of exposure to PPD of 6 years. Renal impairment, proteinuria and hematuria were observed in 14%, 26.4% and 41.1% of hair dressers, respectively. Hypertension, skin changes and bronchospasm were found in 19.4%, 38.9% and 22% of participants, respectively. Using pure forms of PPD significantly increased the risk of having elevated serum creatinine (OR 5.9; P = 0.02) and proteinuria (OR 9.8; P = 0.002) compared to manufactured forms with lower concentrations. Each additional year of exposure to PPD significantly increased the risk of having elevated serum creatinine (OR 1.3; P = 0.01), proteinuria (OR 1.4; P = 0.001) and hematuria (OR 1.1; P = 0.04). Conclusion: In this group of hairdressers with regular exposure to PPD, we observed high prevalence of renal impairment, proteinuria and hematuria. These findings were significantly associated with the use of pure forms of PPD and longer duration of exposure.