Pseudo Green Hair.

Green hair is due to insoluble copper deposits in the hair of blonde people. Although it is most frequently due to an increase in the copper content of algaecides in swimming pools, other causes have been recognized. Herewith, we present a case of a blonde girl who had previously commercially highlighted her hair and the hair had turned green following a swim in a pool with excess copper content in the water. Lifeguard swimming pool commented another previously affected blonde female swimmer 2 days ago. To date, <10 cases involving swimming pools with clearly increased copper concentrations have been published, and to the best of our knowledge, no similar case without traces of copper in X-ray microanalysis has been reported in the literature. Copyright:

INTRODUCTION

Green hair is a hair dyschromia characterized by green coloring of the hair due to insoluble copper deposits which fix to the cortex of the hair with “a priori” damage to the cuticle.[12] The most frequent origin of this condition is direct contact with domestic running water or swimming pool water with a high copper content. The use of copper-based algaecides in swimming pools also increases the presence of copper in water. In all cases, prior damage to the cuticle seems to be essential.[3] Other causes of green hair have been reported in association with metal workers or extravasation of serum containing dipyridamole.[245] We report a strange case of green hair in a blonde woman after swimming in a community pool.

CASE REPORT

A 20-year-old woman, with no previous pathologies, requested medical advice for heterogeneous bands of green discoloration of the hair, after swimming in an outdoor community swimming pool. Analytical controls of the pool revealed that pH and chlorine levels were appropriate. Nevertheless, copper concentrations were clearly increased at 3 ppm (normal concentrations cannot be >1.3 ppm). One-third of the whole pool water volume was changed, and a new copper concentration test showed a value of 1.1 ppm, being within the normal parameters.

Physical examination showed that her natural hair color was light brown, but wide strands of hair had turned green, especially of the distal third of the length which was more prominent at the back of the head [Figure 1]. The patient explained that she had self-highlighted the distal half-part of some strands of hair several days previously using a commercial hair dye (Garnier Color Sensation 110 extra blonde, containing hydrogen peroxide, resorcinol, phenylenediamines, and ammoniac) to achieve the so-called Californian highlights.

Figure 1

Wide strands of green hair especially on the distal third of its length

Complementary analysis with scanning electron microscopy showed hair detached from the cuticle with the cortex completely exposed [Figure 2, left image]. X-ray microanalysis found traces of silica (Si), aluminium (Al) and iron (Fe) [Figure 2, right image]. Surprisingly, copper (Cu) was not present. Two days later, the patient went to a hair salon for a haircut and new hair coloration, removing the green color. Finally, the natural hair color of the patient was recovered.

Figure 2

Left image; lack of cuticle in the hair shaft. Right image; traces of silica (Si), aluminium (Al) and iron (Fe) in the X-ray microanalysis. There was not increase in the copper (Cu) fraction

DISCUSSION

Green hair, sometimes referred to as chlorotrichosis, is an unusual dermatologic condition that has been associated with deposition of exogenous copper in swimming pool water after repeated additions of copper-based algaecides (copper sulfate) without adequate replacement of the water.[678] In the present case, the swimming pool had not undergone a whole water replacement for 7 years. In Catalunya (Spain), the control of chlorine (0.5–2 ppm) and pH levels (7-7.8) of swimming pools is mandatory,[9] whereas copper level testing is only “suggested” but not mandatory (<1.3 ppm). One previous publication concluded that hair that had been extensively damaged showed the highest degree of green coloration from absorbed copper: overall in patients with blonde hair.[3] These predisposed conditions for copper adsorption were present in our patient. Furthermore, electron microscopy showed a detached cuticle layer of the hair with the cortex completely exposed, reinforcing the suspicion of green hair due to elevated copper deposits in the swimming pool. However, while X-ray microanalysis of the green hair in our patient did not confirm an increase in the copper fraction, abnormal traces of Si, Al, and Fe were detected. Could it be that the cause of the green hair in the present case was due to a reaction of the excess of copper in the swimming pool with the components of the Californian highlights coloring (containing hydrogen peroxide, resorcinol, phenylenediamines, and ammonia)? The presentation of a strong green coloration only in some highlights supports this hypothesis. Was the partial green hair triggered by the cosmetic procedure? Was this a case of pseudo green hair? In summary, we present a case of green hair highlights, coinciding with the application of a cosmetic hair procedure (Californian highlights) prior to swimming in a pool with increased copper content. Since, conceptually, green hair is due to copper deposition on the hair, another cause of green hair should be named pseudo green hair, as in our case.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.