Reactions to hair dye, skin rashes raise questions of how COVID-19 impacts immune system

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TORONTO — It appears as a skin rash, almost like an allergic reaction or a really bad sunburn. For Josée Laroche, it is one of many life-changing symptoms she has been grappling with since catching COVID-19 more than a year ago. For a woman named Gemma, it was an unexpected reaction to hair dye.

Skin sensitivities or allergies that appear to be related to COVID-19 have been documented since the early days of the pandemic, adding to questions over how the disease may be impacting the immune system.

"We don’t have all the data yet to really know … it needs more study -- I think we’re really limited in our conclusions," Dr. Jeff Donovan, a dermatologist with the Canadian Dermatology Association and a clinical instructor at the University of British Columbia’s Department of Dermatology and Skin Science, told CTVNews.ca in a phone interview. The most common post-COVID-19 issue he deals with is hair loss.

"There’s certainly a lot of post-COVID issues that we are studying … Issues related to skin reactions and other issues are prevalent. They haven’t been well-mapped out yet in terms of how much more common are they than the general population? But there’s no doubt about it that COVID-19, the SARS-CoV-2 virus really heightens the immune system."

ALLERGY TO HAIR COLOURING?

The skin sensitivity issue specifically involving hair dye first garnered public attention recently when a U.K. woman shared her story with the BBC. The woman, identified as Gemma, experienced burns following a “patch test” her hairdresser conducted, even though she said she had been using the same dye product for the last decade.

"The following day, I felt a really hot burning sensation behind my ear, which progressively got worse to the point where it had taken layers of skin from behind my ear," Gemma told the BBC.

Patch testing is a process where a small amount of colouring solution is dabbed onto a discreet area, such as behind the ear 48 hours before dying your hair. It is standard advice in most hair dye products, but it is a step that is often skipped, according to Donovan.

A reaction to hair dyes can be quite varied, ranging from an uncomfortable skin rash to very serious anaphylactic reaction, he explained. Most will have reactions that affect the face including severe swelling, redness, and sometimes inflammation and redness in the neck. The scalp is often also affected, with patients experiencing itching, burning, redness, prickling, and scaling.

"It’s absolutely a miserable experience for so many people," Donovan said.

The National Hair and Beauty Federation (NHBF), the largest association of its kind in the U.K. posted a reminder to members on the importance of conducting allergy alert and skin sensitivity testing after lockdowns were lifted.

“I was picking up and seeing a lot of reports from stylists and salon owners saying that people were having these new reactions that weren’t having them before so it really alerted me to -- something is going on here,” Stacey, Gemma’s hairdresser, told the U.K. news outlet. She said other clients had experienced a similar issue so it was not an isolated incident.

With millions of people around the world colouring their hair multiple times a year, however, the handful of reported incidents remain low and difficult to assess without further study. Some scientists are investigating how the virus might reprogram our body’s immune response. While very little is known about this specific issue, Donovan said the scenario documented in the U.K. is “certainly possible.”

A member survey put out by BeautyCouncil following a query by CTVNews.ca found that among the 71 respondents who took the survey, 10 reported clients who had experienced an unexpected allergic reaction to hair colour this year. Among those, three said the client had previously contracted COVID-19.

"Thankfully, we have not received any reports of severe allergic reactions on clients. We strongly encourage all clients who have contracted COVID-19 to ask for a 48 hour patch test just to be safe," said Greg Robins, the executive director of BeautyCouncil, also known as the Cosmetology Association Western Canada, a B.C.-based association of salon, spa and barber professionals.

"In addition, in cases where a client has been vaccinated and may be prone to allergies, we encourage a 48 hour patch test."

Robins shared some of the member comments, noting there was no clear trend. One member who has been a colourist for 35 years said the virus had not resulted in any adverse skin reactions among clients, while others spoke of their own experiences.

"My mom and I had COVID-19. Post-COVID, we both coloured our hair and had weird reactions: My mom's did not take color properly, and her hair has been falling out like crazy. Mine went the lightest it had ever gone and lost its color very quickly," one member wrote.

Some reported reactions to hair dye after vaccination, but not from the infection itself.

"I have had four clients who were vaccinated have severe reactions to hair color after their second dose, but none from having COVID-19," another member shared.

Robins stressed that these were anecdotal. “There are always other factors at play, but for anybody who’s been doing hair for a certain amount of time, you kind of see an anomaly fairly quickly. Especially with hair colour, because hair colour is such an exact science in a way. When it fails, it can fail pretty badly.”

While there has been little documented about this issue, Donovan says it is still important to raise awareness among hairdressers, physicians, and the public, to better understand what may be happening.

"It may prove that it is a small number, it may prove that it’s a bigger number, but this is how really good observations come to life," he said.

"Last month it might have been a stubborn, itchy rash, but next month could be swelling of the face and hospitalization. So we need to take it seriously."

LIKE A REALLY BAD SUNBURN

It has been a long and difficult year for Josée Laroche, 53, who tested positive for COVID-19 in late September 2020. As a long-hauler, she is already grappling with severe exhausting, serious heart problems, neurological symptoms, and her doctor believes she may have developed diabetes as well. But on top of these health issues, she has had to deal with recurring skin rashes on her face, arm and legs.

'Most of the time, the rash is very itchy and very hot to touch. The other day it happened and my face was completely red, very, very hot, very uncomfortable," Laroche told CTVNews.ca in a phone interview. She caught the virus while taking care of an infected resident during a second wave outbreak at the long-term care home where she worked as a personal support worker, she said.

Her rashes appeared within the first month of contracting COVID-19 and have continued to flare up once or twice every two weeks or so since, each time with no signal or warning, Laroche said. And this past summer, she found she could not be in the sun at all. Her skin erupted in a severe rash that felt like a really bad sunburn despite wearing a shawl, she added.

"I saw the blisters on my arm and it was so painful. So that one lasted a few days. That was pretty bad." Bad enough that Laroche spent the entire summer indoors and avoided the sun as much as possible when she had to step outside.

IS IT AN ALLERGY OR A SENSITIVITY?

Sometimes, figuring out the reactions can be challenging because there can be a bit of a delay between the onset of the reaction and what caused it in the first place, Donovan noted. And for many of the skin reactions reported, “allergy” is often used as a catch-all term, even though it may be a skin irritation or sensitivity, he added.

When it comes to products like hair dye, a dermatologist will apply a very small amount of the chemical on the patient and leave it there for 48 hours. If the spot develops a red, scaly appearance, then that is a true allergic reaction, Donovan said.

If a reaction is an irritant, the product may cause redness and flaking, but will settle down very quickly when the product is removed.

"If the reaction continues to rumble along even when the chemical is gone … What you observe over the next days is that the redness increases and intensifies, the scaling and the inflammation intensifies even though the chemical’s been washed off -- that is a true allergy."

Laroche says she had heard stories from others in her Facebook group for COVID-19 long-haulers who had issues when they went to have their hair coloured and decided against the process herself after her infection.

"I wasn’t sure what was happening to me …I’ve seen many women that have issues when they went to dye their hair, so I’m glad that I never attempted to do it for myself. I have enough issues right now," she said.

For Laroche, it has been a "really bad roller coaster ride" over the past year. She went from working 40 hours a week to being bedridden on most days due to severe exhaustion.

"My life has completely changed … Still today, I’m in shock. It’s almost unbelievable that one virus can cause all of that," said Laroche.

"I got the worst of the COVID virus without being intubated at the hospital."