A routine beauty treatment caused one woman permanent eye damage
Key Takeaways
RAHDAA, or retinopathy associated with the use of hair dye aromatic amines, is presumed rare, but the condition may be mis- or underdiagnosed.
A case report details RAHDAA in a woman whose visual disturbance resolved after switching to aromatic amine-free hair dye.
Still, aromatic amines may be responsible for long-lasting dysfunction of a fundamental component of the retina, the retinal pigment epithelium.
A woman presented with blurred vision in both eyes a few days after dyeing her hair with a box dye from the drug store. Eventually, she was diagnosed with RAHDAA, a rare condition attributed to an ingredient in the hair dye: aromatic amines.[][]
“RAHDAA may be rare or underdiagnosed,” wrote the authors of a case report in JAMA Ophthalmology.[] “However, identifying this pathology may allow prompt consideration to remove exposure to such hair dye in an attempt to limit persistent RPE [retinal pigment epithelium] damage.”
According to the case report, the woman’s vision symptoms resolved once she switched to using an aromatic amine-free hair dye—but the damage to the neurosensory retina was permanent. Let’s take a closer look at how box dye may contribute to vision loss.
The leading cause of preventable blindness
According to the American Diabetes Association, “Retinopathy is the leading cause of preventable blindness.”[]
Retinopathy is caused by damage to the blood vessels of the retina, the light-sensitive tissue at the back of the eye. While diabetes is the most common cause of retinopathy, hypertensive retinopathy—caused by acute or chronic episodes of hypertension—is also very prevalent. Retinopathy is also linked to low birth weight, age-related macular degeneration, and environmental and genetic factors.[][]
Individuals with retinopathy may experience blurred or fluctuating vision or see black specks, strings, or dark empty areas. Early diagnosis is critical to prevent long-term damage. Treatments may include injecting medications into the vitreous, or the use of focal or scatter laser therapy. Vitrectomy is a surgical procedure done to remove blood from the vitreous and scar tissue that is pulling on the retina.[]
Diagnosing the damage
The authors of the case report explained that RAHDAA presents similarly to MEK inhibitor-associated retinopathy, involving the mitogen-activated protein kinase enzymes MEK1 and MEK2. MEK inhibitors—agents used to treat some types of cancer—may disrupt the neurochemical pathway involved in RPE cell survival and self-regulation.
Para-phenylenediamine, an aromatic amine found in hair dyes, may also disturb this neurochemical pathway.
Clinicians should consider RAHDAA after ruling out other potential retinopathies, including central serous chorioretinopathy, according to the JAMA authors. They noted that systemic absorption of aromatic amines can occur through scalp lesions, thus possibly explaining why RAHDAA is presumably rare.
Toxic retinopathy related to the use of hair dye had been reported back in 2022, in a case report published in Retinal Cases & Brief Reports that followed three women (aged 32–66) with RAHDAA.[] Their symptoms included moderate to severe vision loss in both eyes. Slit-lamp examinations were normal, but fundus examinations showed multiple serous retinal detachments mainly in the posterior pole.
The examination results, together with those from optical coherence tomography (OCT), were suggestive of MEK-inhibitor retinopathy. The women’s vision improved as the retinal detachments resolved, and the time course was in proportion to the intensity of the aromatic amine exposure.
A warning to patients
The latest case, described by the JAMA authors, was a 61-year-old woman who presented with bilateral blurred vision a few days after using a commercially available hair dye that contained para-phenylenediamine.
Her visual acuity was 20/40 and 20/20 in the right and left eyes, respectively. Fundus examination and OCT revealed bilateral multiple serous retinal detachments mainly in the posterior pole, and OCT showed diffuse thickening of the neurosensory retina. The choroidal vessels were normally dilated, ruling out central serous chorioretinopathy.
The patient underwent several examinations, blood tests, and scans to exclude sarcoidosis, oculocerebral lymphoma, and acute exudative polymorphous vitelliform maculopathy. The results were normal.
“RAHDAA was diagnosed based on the temporal association between symptoms and hair dye exposure, consistent with the description including OCT appearance,” the JAMA Ophthalmology authors wrote.
At 4 months’ follow-up, the patient’s visual acuity had improved to 20/20. The retinal detachments had resolved, but OCT showed increased autofluorescent deposits below the retina. At 4 years follow-up, the patient reported switching to aromatic amine-free hair dye with no recurrence of blurred vision. Her 20/20 vision persisted. However, the subretinal deposits remained, and the neurosensory retina thickening resolved only slowly. The persistent thickening, wrote the authors, suggests that “aromatic amines could be responsible for long-lasting RPE dysfunction.”
What this means for you
Retinopathy, the leading cause of preventable blindness, has several causes including the use of hair dye containing aromatic amines. RAHDAA should be ruled out in patients presenting with retinopathy but, if diagnosed, patients should be advised to switch to aromatic amine-free products. As in this case report, visual disturbance may resolve after switching to aromatic amine-free hair dye, although RPE dysfunction may persist.