Case Report: Autoimmune Disease Triggered by Exposure to Hair Straightening Treatment Containing Formaldehyde


Formaldehyde (FHO) is a multipurpose chemical that is an eye, nose, throat and skin irritant, sensitizer and allergen, as well as a class 1 human carcinogen. Brazilian hair treatments, containing high levels of FHO (up to 11%), have become regularly used that have the potential to expose clients to toxic levels in excess of current regulatory standards. We report on a patient who underwent a single hair treatment and subsequently developed an autoimmune disease. We review the relevant literature on autoimmune disease and formaldehyde exposure. Our case adds to existing knowledge and suggests that physicians ask their patients about commercial products that contain formaldehyde when diagnosing autoimmune conditions.

Share and Cite:

J. Dahlgren, R. Roback, M. Dominguez, V. Byers, D. Silver and E. Faeder, "Case Report: Autoimmune Disease Triggered by Exposure to Hair Straightening Treatment Containing Formaldehyde," Open Journal of Rheumatology and Autoimmune Diseases, Vol. 3 No. 1, 2013, pp. 1-6. doi: 10.4236/ojra.2013.31001.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] J. Winkelman “Absorption of formaldehyde in water,” University of Groningen, Groningen, 2003.
[2] N. Matubayasi, S. Morooka, M. Nakahara and H. Takahashi, “Chemical Equilibrium of Formaldehyde and Methanediol in Hot Water: Free-Energy Analysis of the Solvent Effect,” Journal of Molecular Liquids, Vol. 134, No. 1-3, 2007, pp. 58-63. doi:10.1016/j.molliq.2006.12.002
[3] National Toxicology Program, “Report on Carcinogens,” 12th Edition, US Department of Health and Human Services PHS, Research Triangle Park, 2011.
[4] International Agency for Research on Cancer, “Formaldehyde, 2-Butoxyethanol and 1-tert-Butoxypropan-2-ol,” IARC Monographs, Vol. 88, 2006, pp. 1-436.
[5] Agency for Toxic Substances and Disease Registry, “Toxicological Profile for Formaldehyde,” US Department of Health and Human Services PHS, Atlanta, 1999.
[6] Michigan Occupational Safety and Health Administration, “Hair Straightening Products and Formaldehyde (Fact Sheet #022),” Division GISH, Lansing, Michigan, 2011.
[7] Health Canada, “Several Professional Hair Smoothing Solutions Contain Excess Levels of Formaldehyde,” 2011.
[8] California Department of Public Health, “Q&A: Brazilian Blowout & Other Hair Smoothing Salon Treatments,” Branch CSCPOH, Sacramento, 2011.
[9] New York State Department of Health, “Consumer Health Alert: Hair Straightening Products and Formaldehyde,” Health CfE, Troy, 2011.
[10] Occupational Safety and Health Administration, “Hair Smoothing Products That Could Release Formaldehyde,” Labor UDo, 2011.
[11] European Union, “Eighth Commission Directive of 26 March 1986 adapting to technical progress Annexes II, IV and VI to Council Directive 76/768/EEC on the Approximation of the Laws of the Member States Relating to Cosmetic Products,” Official Journal of the European Communities, Vol. 15, 1986, p. 0150.
[12] J. S. Pierce, A. Abelmann, L. J. Spicer, R. E. Adams, M. E. Glynn, K. Neier, et al., “Characterization of Formaldehyde Exposure Resulting from the Use of Four Professional Hair Straightening Products,” Journal of Occupational and Environmental Hygiene, Vol. 8, No. 11, 2011, pp. 686-699. doi:10.1080/15459624.2011.626259
[13] National Institute of Occupational Safety and Health, “Formaldehyde Exposures during Brazilian Blowout Hair Smoothing Treatment at a Hair Salon-Ohio,” Control CfD, Cincinnati, 2011.
[14] K. M. D. McCarthy, D. Montgomery, P. Munsell, M. Schuster and M. Wood, “Keratin-Based Hair Smoothing Products and the Presence of Formaldehyde,” Oregon OSHA COHSU, Portland, 2010.
[15] P. A. Breysse, “The Immediate and Long-Term Effects of Formaldehyde,” Comments on Toxicology, Vol. 3, No. 2, 1988, pp. 135-153.
[16] M. P. Galiotte, P. Kohler, G. Mussi and G. J. Gatta, “Assessment of Occupational Genotoxic Risk among Brazilian Hairdressers,” The Annals of Occupational Hygiene, Vol. 52, No. 7, 2008, pp. 645-651. doi:10.1093/annhyg/men037
[17] J. L. Mazzei, E. V. Figueiredo, L. J. da Veiga, C. A. Aiub, P. I. Guimaraes and I. Felzenszwalb, “Mutagenic Risks Induced by Homemade Hair Straightening Creams with High Formaldehyde Content,” Journal of Applied Toxicology: JAT, Vol. 30, No. 1, 2010, pp. 8-14. doi:10.1002/jat.1464
[18] P. S. Burge, M. G. Harries, W. K. Lam, I. M. O’Brien and P. A. Patchett, “Occupational Asthma Due to Formaldehyde,” Thorax, Vol. 40, No. 4, 1985, pp. 255-260. doi:10.1136/thx.40.4.255
[19] D. J. Hendrick and D. J. Lane, “Formalin Asthma in Hospital Staff,” British Medical Journal, Vol. 1, No. 5958, 1975, pp. 607-608. doi:10.1136/bmj.1.5958.607
[20] C. W. Kim, J. S. Song, Y. S. Ahn, S. H. Park, J. W. Park, J. H. Noh, et al., “Occupational Asthma Due to Formaldehyde,” Yonsei Medical Journal, Vol. 42, No. , 2001, pp. 440-445.
[21] H. Nordman, H. Keskinen and M. Tuppurainen, “Formaldehyde Asthma—Rare or Overlooked?” The Journal of Allergy and Clinical Immunology, Vol. 75, No. , 1985, pp. 91-99. doi:10.1016/0091-6749(85)90018-1
[22] D. L. Jacobson, S. J. Gange, N. R. Rose and N. M. Graham, “Epidemiology and Estimated Population Burden of Selected Autoimmune Diseases in the United States,” Clinical Immunology and Immunopathology, Vol. 84, No. 3, 1997, pp. 223-243. doi:10.1006/clin.1997.4412
[23] G. S. Cooper, M. L. Bynum and E. C. Somers, “Recent Insights in the Epidemiology of Autoimmune Diseases: Improved Prevalence Estimates and Understanding of Clustering of Diseases,” Journal of Autoimmunity, Vol. 33, No. 3-4, 2009, pp. 197-207. doi:10.1016/j.jaut.2009.09.008
[24] M. E. B. N. Kammuller and W. Seinen, “Autoimmunity and Toxicology Immune Disregulation Induced by Drugs and Chemicals,” Elsevier, Amsterdam, 1989.
[25] E. V. Hess, “Environmental Chemicals and Autoimmune Disease: Cause and Effect,” Toxicology, Vol. 181-182, 2002, pp. 65-70. doi:10.1016/S0300-483X(02)00256-1
[26] California Air Resources Board, “Airborne Toxic Control Measure to Reduce Formaldehyde Emissions from Cposite Wood Products,” Agency CEP, Sacramento, 2008.
[27] California Office of Environmental Health Hazard Assessment, “All OEHHA Acute, 8-Hour and Chronic Reference Exposure Levels (chRELs) as on February 2012,” Agency CEP, Sacramento, 2012.
[28] Brazilian Blowout, “Brazilian Blowout Professional Smoothing Solution,” MSDS Revision 1.4, Tujunga Ave, North Hollywood, 2010.
[29] A. Tsigonia, A. Lagoudi, S. Chandrinou, A. Linos, N. Evlogias and E. C. Alexopoulos, “Indoor Air in Beauty Salons and Occupational Health Exposure of Cosmetologists to Chemical Substances,” International Journal of Environmental Research and Public Health, Vol. 7, No. 1, 2010, pp. 314-324. doi:10.3390/ijerph7010314
[30] E. Ronda, B. E. Hollund and B. E. Moen, “Airborne Exposure to Chemical Substances in Hairdresser Salons,” Environmental Monitoring and Assessment, Vol. 153, No. 1-4, 2009, pp. 83-93. doi:10.1007/s10661-008-0338-y
[31] B. Goodman, “Position Statement of the American Chemistry Council’s Formaldehyde Panel on the Formaldehyde Content of Certain Hair-Care Products,” Council AC, Washington, 2010.
[32] Environmental Working Group, “Adverse Reactions and Injuries,” Flat-Out Risky, Washington, 2011.
[33] P. Breysse, W. G. Couser, C. E. Alpers, K. Nelson, L. Gaur and R. J. Johnson, “Membranous Nephropathy and Formaldehyde Exposure,” Annals of Internal Medicine, Vol. 120, No. 120, 1994, pp. 396-397.
[34] W. Fassbinder and K. M. Koch, “A Specific Immunohaemolytic Anaemia Induced by Formaldehyde Sterilisation of Dialysers,” Contributions to Nephrology, Vol. 36, 1983, pp. 51-67.
[35] J. D. Thrasher, A. Broughton and R. Madison, “Immune Activation and Autoantibodies in Humans with Long-Term Inhalation Exposure to Formaldehyde,” Archives of Environmental Health, Vol. 45, No. 4, 1990, pp. 217-223. doi:10.1080/00039896.1990.9940805
[36] R. Patterson, V. Pateras, L. C. Grammer and K. E. Harris, “Human Antibodies against Formaldehyde-Human Serum Albumin Conjugates or Human Serum Albumin in Individuals Exposed to Formaldehyde,” International Archives of Allergy and Applied Immunology, Vol. 79, No. 1, 1986, pp. 53-59. doi:10.1159/000233942
[37] J. H. E. Arts, S. C. M. Droge, S. Spanhaak, N. Bloksma, A. Penninks and C. F. Kuper, “Local Lymph Node Activation and IgE Responses in Brown Norway and Wistar Rats after Dermal Application of Sensitizing and Non-Sensitizing Chemicals,” Toxicology, Vol. 117, No. 2-3, 1997, pp. 229-237. doi:10.1016/S0300-483X(96)03576-7
[38] H. Fujimaki, Y. Kurokawa, N. Kunugita, M. Kikuchi, F. Sato and K. Arashidani, “Differential Immunogenic and Neurogenic Inflammatory Responses in an Allergic Mouse Model Exposed to Low Levels of Formaldehyde,” Toxicology, Vol. 197, No. 1, 2004, pp. 1-13. doi:10.1016/j.tox.2003.11.015
[39] F. Riedel, E. Hasenauer, P. J. Barth, A. Koziorowski and C. H. L. Rieger, “Formaldehyde Exposure Enhances Inhalative Allergic Sensitization in the Guinea Pig,” Allergy, Vol. 51, No. 2, 1996, pp. 94-99.
[40] A. L. Swiecichowski, K. J. Long, M. L. Miller and G. D. Leikauf, “Formaldehyde-Induced Airway Hyperreactivity in Vivo and ex Vivo in Guinea Pigs,” Environmental Research, Vol. 61, No. 2, 1993, pp. 185-199. doi:10.1006/enrs.1993.1063
[41] H. D. Hosgood, L. Zhang, X. Tang, R. Vermeulen, Z. Hao, M. Shen, et al., “Occupational Exposure to Formaldehyde and Alterations in Lymphocyte Subsets,” American Journal of Industrial Medicine, Vol. 56, No. 2, 2013, pp. 252-257.

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.