586 Scalp Burn Injury Associated with Hair Highlight Treatment

Introduction Hair highlighting treatment has become popular at salons across the country. The ubiquity of this beauty treatment gives many people the impression that it is safe. The process of changing hair color differs between hair salons and hair stylists. We describe the cases of two teenage patients who received third degree burns from hair highlighting treatments. Differences in highlighting technique and treatment modality will be compared and contrasted. Methods As part of a quality assurance project looking at variation in scalp burn treatment and outcome, two patients were identified who experienced scalp burn injury due to hair highlighting. Patient 1 received a hot foil hair lighting application. After 5 minutes, the patient experienced tingling in the scalp and removed heat lamp and foils from hair. The first two weeks of treatment were administered by her primary care provider before the patient admitted to our burn facility, where topical collagenase was initiated. Forty two days after initial injury the patient underwent first surgery for debridement, followed by subsequent excision and grafting of scalp. Patient returned for tissue expansion nine months later. Patient 2 received a hair highlighting treatment of bleach and water. Patient 2 complained of burning and immediately her hair was washed out by the hairdresser. The patient was seen two weeks later in our clinic, and treated conservatively with mineral oil and antibacterial topical application. Patient was offered tissue expansion surgery but declined. Results Table 1. compares injury type, treatment and outcome in these two patients. Both injuries required significant time to heal, ranging between 56–70 days. Although similar injuries, mode of treatment differed at this same institution. Both patients made decisions based on school activities and fear or surgery, which prolonged time of conservative treatment. Patient 1 received psychological support and anti-anxiety medication prior to all treatments. After tissue expansion Patient 1 no longer required medication and had no sign of alopecia. Patient 2 has area of alopecia 2x2 cm. Neither patient requires further follow up, however Patient 2 could return for tissue expansion if desired. Conclusions Hair highlighting is a risk for serious scalp burn injury. Conservative treatment (often per patient preference) is associated with prolonged days to healing. Surgical intervention which includes subsequent tissue expansion, combined with psychological support and anxiety management results in good outcome. Applicability of Research to Practice Results from this analysis will be used to develop treatment protocols and staff education on scalp burn injury.