A rare case of retinopathy has been linked to the use of hair dye containing aromatic amines (para-phenylenediamine). Termed "retinopathy associated with hair dye aromatic amines," this condition was identified in three middle-aged women, including a detailed case report of a 61-year-old woman with primary bilateral serous retinal detachments. This type of retinopathy mimics mitogen-activated extracellular signal-regulated kinase inhibitor–associated retinopathy, suggesting the potential for systemic absorption of these chemicals through scalp lesions.

The 61-year-old woman, with no significant medical history, experienced bilateral blurry vision a few days after using a commercially available hair dye containing aromatic amines. Her visual acuity was 20/40 in the right eye and 20/20 in the left. Fundus examination and optical coherence tomography (OCT) imaging revealed multiple serous retinal detachments (SRDs) and diffuse thickening of the neurosensory retina. Fluorescein angiography and indocyanine green angiography showed no leakage points or vasculitis, and the SRDs did not stain during the angiographic sequence, according to the investigators' report in JAMA Ophthalmology.

Extensive diagnostic tests, including chest computed tomography, positron emission tomography scan, and interleukin 6/10 assay, ruled out other causes such as central serous chorioretinopathy, sarcoidosis, and oculocerebral lymphoma. The retinopathy resolved after discontinuation of the hair dye, supporting the diagnosis of retinopathy associated with hair dye aromatic amines" (RAHDAA).

Although no scalp wounds were observed in the described cases, the investigators hypothesized that lesions could facilitate systemic absorption of aromatic amines. RAHDAA is considered rare and possibly underdiagnosed. The mitogen-activated protein kinase pathway, involved in the survival and homeostasis of retinal pigment epithelial (RPE) cells, may be disrupted by aromatic amines, similar to the mechanism observed in mitogen-activated extracellular signal-regulated kinase inhibitor–associated retinopathy.

The patient’s visual acuity improved to 20/20 after four months, and fundus examination showed resolution of the SRDs. OCT revealed persistent subretinal deposits that were hyperautofluorescent. Four years later, the patient remained free of recurrence after switching to aromatic amines–free hair dye, though OCT continued to show hyperautofluorescent subretinal deposits and slow regression of the neurosensory retina thickening.

The findings indicate that para-phenylenediamine in hair dye is associated with long-term RPE dysfunction. Identifying RAHDAA and discontinuing exposure to aromatic amines may help limit further retinal damage. Though rare, RAHDAA should be considered when patients present with unexplained retinal detachment.

One author reported personal fees from Bayer, AbbVie, Novartis, Roche, and Horus Pharma. No other disclosures were reported.