IADVL
Indexed with PubMed and Science Citation Index (E) 
 
Users online: 513 
     Home | Feedback | Login 
About Current Issue Archive Ahead of print Search Instructions Online Submission Subscribe What's New Contact  
  Navigate here 
  Search
 
   Next article
   Previous article 
   Table of Contents
  
 Resource links
   Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
  Related articles
   Article in PDF (1,020 KB)
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
   Abstract
   Introduction
   Report
   Discussion
   Case Report
   References
   Article Figures

 Article Access Statistics
    Viewed5461    
    Printed126    
    Emailed4    
    PDF Downloaded145    
    Comments [Add]    
    Cited by others 7    

Recommend this journal

 


 
CASE REPORT
Year : 2010  |  Volume : 76  |  Issue : 2  |  Page : 165-167

Severe inflammatory and keloidal, allergic reaction due to para-phenylenediamine in temporary tattoos


Department of Dermatology, School of Medicine, University of Cukurova, Adana, Turkey

Date of Web Publication10-Mar-2010

Correspondence Address:
Suhan Gunasti
Çukurova University, Department of Dermatology, School of Medicine, Adana
Turkey
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0378-6323.60569

Rights and Permissions

  Abstract 

Hair coloring with henna has been popular in Turkey for years. In recent years since the tattoos are applied by the street vendors in most of the beach places in Turkey, skin coloring with henna has also increased. Henna can be used alone or in combination with other coloring agents. Henna alone can be safe but due to additives such as para-phenylenediamine (PPD), p-toluenediamine and various essential oils, allergic contact reactions may occur. We report a 22-year-old man who developed severe inflammatory and keloidal, moderately bullous allergic reaction after henna paint-on tattoo. We did a patch test separately with these painting products (henna powder, PPD) and with the European standard series. PPD was strongly positive (+++) on day 2 and remained positive for following days. After treating with topical clobetasol-17 butyrate, resolution was obtained in two weeks. But some keloidal reaction remained.


Keywords: Allergic contact dermatitis, henna, keloidal, para-phenylenediamine


How to cite this article:
Gunasti S, Aksungur VL. Severe inflammatory and keloidal, allergic reaction due to para-phenylenediamine in temporary tattoos. Indian J Dermatol Venereol Leprol 2010;76:165-7

How to cite this URL:
Gunasti S, Aksungur VL. Severe inflammatory and keloidal, allergic reaction due to para-phenylenediamine in temporary tattoos. Indian J Dermatol Venereol Leprol [serial online] 2010 [cited 2019 Sep 19];76:165-7. Available from: http://www.ijdvl.com/text.asp?2010/76/2/165/60569



  Introduction Top


Hair coloring with henna has been popular in Turkey for years. In recent years since the tattoos are applied by the street vendors in most of the beach places in Turkey, skin coloring with henna has also increased. Henna is a vegetable dye obtained from the dried leaves of Lawsonia inermis or Lawsonia alba (family Lythraceae).[1],[2] Henna can be used alone or in combination with other coloring agents, such as para-phenylenediamine (PPD), for speeding up dyeing, improving pattern definition, to darken its red color and to give the appearance of permanent tattoos.[1],[3] Henna alone can be safe but due to additives such as para-phenylenediamine (PPD), p-toluenediamine and various essential oils, allergic contact reactions may occur.[4] A review about tattoo-associated dermatoses showed three categories of conditions: 1) allergic, lichenoid, granulomatous; 2) inoculation, infection and 3) coincidental lesions.[5]

We report a case who developed severe inflammatory and keloidal, moderately bullous allergic reaction after henna paint-on tattoo.


  Case Report Top


A 22-year-old man had a henna tattoo on his left forearm while on holiday in July. Two weeks after painting with henna, he developed itchy, slightly painful and bullous, keloidal eruption at the application side [Figure 1]a,b. On henna painting only paste was used, needle was not used. His past medical history revealed that he had never used henna tattoo for painting his skin nor coloring his hair, he had no personal or family history of atopic eczema and allergic diseases. Patient also did not mention any keloidal reaction in his past medical history. On his dermatologic examination, there was no keloidal reaction on any part of his body. At the application side, there were severe inflammatory and keloidal, moderately bullous eruption [Figure 1]a,b. Patient brought us all the ingredients, which were used for the temporary tattoo. We did a patch test separately with these painting products (henna powder, PPD) [Figure 2]a and with the European standard series. Because of the severity of the allergic reaction, patch test with PPD was applied open and patient followed up everyday. PPD was strongly positive (+++) on day 2 [Figure 2]b and remained positive for the following days. Patch tests with pure henna powder and in alcohol solutions and with other allergens were negative. He was treated with topical clobetasol-17 butyrate and resolution was obtained in two weeks. But some keloidal reaction remained.


  Discussion Top


Natural henna paints the skin with a brownish-orange pigment. A variety of oils, powders and dyes are often added to henna to obtain various colors.[6] The combination of PPD and henna is marketed as 'black henna'. Skin reactions due to black henna tattoo has been reported from all over the world.[1],[3],[4],[7],[8],[9],[10] In all the reported cases dermatitis occurred due to PPD and not due to henna powder. There are various types of allergic reactions reported to PPD such as persistent leukoderma,[7] severe bullous contact dermatitis[8] and lichenoid reactions.[11] These patients developed strong positive patch test reaction to PPD as we observed in our patient. Our patient developed hypertrophic lesions in exact pattern of original skin painting. In addition to delayed type reactions, there are reports of immediate contact urticaria on the hands of hairdresser and doll makers exposed to the PPD containing dyes.[12],[13],[14] Systemic toxicity may be due to percutaneous absorption or to ingestion.[15] Contact anaphylaxis,[16] renal insufficiency[17] and acute respiratory failure[18] have been reported due to topical application of PPD-added dyes.

PPD is available in patch test material in white petrolatum in 1% concentration.[19] There is no upper limit of PPD concentration legally permitted in many countries.[15] The European Economic Community has permitted a concentration limit of 6% PPD.[15] Australia requires a warning label for PPD concentrations >5%.[6] It may be possible that to darken the shades, PPD is being used in higher concentration than the permitted usual dose. Black henna tattoo inks have been found to have PPD concentrations as high as 15 to 30%.[20] This may lead to severe and more frequent reactions. Kligman estimated that a single application of 1.0 mL of 10% solution would sensitize about 80% of the population.[21]

Coloring and tattooing with henna is maintaining its popularity. Also children and teenagers use of hair dyes and tattooing their body is increasing. Besides allergic contact dermatitis, immediate reactions such as contact urticaria and systemic toxicity due to the PPD may also occur. Some of these reactions are severe and necessitates hospitalization and acute treatment. To avoid severe and immediate reactions, it is advisable to do a patch test before the coloring procedure and/or use the PPD concentration in a permitted dose. In other words, PPD concentration in the henna products should be reevaluated. Clinicians should also be aware of the potential complications of PPD. To decrease these complications, there are attempts to substitute p-phenylenediamine in hair dyes with less sensitizing and cross-reactive chemicals.[22]

 
  References Top

1.Stante M, Giorgini S, Lotti T. Allergic contact dermatitis from henna temporary tattoo. J Eur Acad Dermatol Venereol 2006;20:484-6.  Back to cited text no. 1      
2.Mohamed M, Nixon R. Severe allergic contact dermatitis induced by paraphenylenediamine in paint-on temporary 'tattoos". Australas J Dermatol 2000;41:168-71.  Back to cited text no. 2      
3.Schultz E, Mahler V. Prolonged lichenoid reaction and cross-sensitivity to para-substituted amino-compounds due to temporary henna tattoo. Int J Dermatol 2002;41:301-3.  Back to cited text no. 3      
4.Van den Keybus C, Morren MA, Goossens A. Walking difficulties due to an allergic reaction to a temporary tattoo. Contact Dermatitis 2005;53:180-1.  Back to cited text no. 4      
5.Jacob CI. Tattoo-associated dermatoses: a case reports and review of the literature. Dermatol Surg 2002;28:962-5.  Back to cited text no. 5      
6.Sonnen G. Type IV hypersensitivity reaction to a temporary tattoo. Proc (Bayl Univ Med Cent) 2007;20:36-8.  Back to cited text no. 6      
7.Valsecchi R, Leghissa P, Di Landro A, Bartolozzi F, Riva M, Bancone C. Persistent leukoderma after henna tattoo. Contact Dermatitis 2007;56:108-9.  Back to cited text no. 7      
8.Jung P, Sesztak-Greinecker G, Wantke F, Götz M, Jarisch R, Hemmer W. A painful experience: black henna tattoo causing severe, bullous contact dermatitis. Contact Dermatitis 2006;54:219-20.  Back to cited text no. 8      
9.Läuchli S, Lautenschlager S. Contact dermatitis after temporary henna tattoos--an increasing phenomenon. Swiss Med Wkly 2001;7:131:199-202.   Back to cited text no. 9      
10.Jappe U, Hausen BM, Petzoldt D. Erythema-multiforme-like eruption and depigmentation following allergic contact dermatitis from a paint-on henna tattoo, due to para-phenylenediamine contact hypersensitivity. Contact Dermatitis 2001;45:249-50.   Back to cited text no. 10      
11.Rubegni P, Fimiani M, de Aloe G, Andreassi L. Lichenoid reaction to temporary tattoo. Contact Dermatitis 2000;42:117-8.  Back to cited text no. 11      
12.Edwards EK Jr, Edwards EK. Contact urticaria and allergic contact dermatitis caused by paraphenylenediamine. Cutis 1984;34:87-8.   Back to cited text no. 12      
13.Cronin E. Immediate-type hypersensitivity to henna. Contact Dermatitis 1979;5:198-9.  Back to cited text no. 13      
14.Majoie IM, Bruynzeel DP. Occupational immediate-type hypersensitivity to henna in a hairdresser. Am J Contact Dermat 1996;7:38-40.  Back to cited text no. 14      
15.Marcoux D, Couture-Trudel PM, Riboulet-Delmas G, Sasseville D. Sensitization to Para-Phenylenediamine from a Streetside Temporary Tattoo. Pediatr Dermatol 2002;19:498-502.  Back to cited text no. 15      
16.Le Coz CJ, Lefebvre C, Keller F, Grosshans E. Allergic contact dermatitis caused by skin painting (pseudotattooing) with black henna: a mixture of henna and p-phenylenediamine. Arch Dermatol 2000;136:1515-7.  Back to cited text no. 16      
17.Sir Hashim M, Hamza YO, Yahia B, Khogali FM, Sulieman GI. Poisoning from henna dye and para-phenylenediamine mixtures in children in Khartoum. Ann Trop Paediatr 1992;12:3-6.  Back to cited text no. 17      
18.Abdulla KA, Davidson NM. A woman who collapsed after painting her soles. Lancet 1996;7:348:658.  Back to cited text no. 18      
19.Sosted H, Menné T, Johansen JD. Patch test dose– response study of p-phenylenediamine: thresholds and anatomical regional differences. Contact Dermatitis 2006;54:145-9.  Back to cited text no. 19      
20.Gawkrodger DJ, English JS. How safe is patch testing to PPD? Br J Dermatol 2006;154:1025-7.  Back to cited text no. 20      
21.Kligman AM. The identification of contact allergens by human assay. J Invest Dermatol 1966;47:393-409.  Back to cited text no. 21      
22.Xie Z, Hayakawa R, Sugiura M, Kojima H, Konishi H, Ichihara G, et al. Experimental study on skin sensitization potencies and cross-reactivities of hair-dye-related chemicals in guinea pigs. Contact Dermatitis 2000;42:270-5.  Back to cited text no. 22      


    Figures

  [Figure 1], [Figure 2]

This article has been cited by
1 Les tatouages éphémères au henné noir : complications observées au Burkina Faso
Nina Korsaga-Somé,Fatou Barro-Traoré,Muriel S. Ouedraogo,Patrice Tapsoba,Pascal Niamba,Adama Traoré
La Presse Médicale. 2015; 44(7-8): 845
[Pubmed] | [DOI]
2 Side-effects of henna and semi-permanent ‘black henna’ tattoos: a full review
Anton C. de Groot
Contact Dermatitis. 2013; 69(1): 1
[Pubmed] | [DOI]
3 Allergic contact dermatitis mimicking angioedema due to paraphenylendiamine hypersensitivity: a case report
Gulsen Tukenmez Demirci,Ilknur Kivanc Altunay,Guldehan Atis,Asli Kucukunal
Cutaneous and Ocular Toxicology. 2012; 31(3): 250
[Pubmed] | [DOI]
4 Dermatoses secondary to Asian cultural practices
Lilly, E., Kundu, R.V.
International Journal of Dermatology. 2012; 51(4): 372-382
[Pubmed]
5 Dermatoses secondary to Asian cultural practices
Evelyn Lilly,Roopal V. Kundu
International Journal of Dermatology. 2012; 51(4): 372
[Pubmed] | [DOI]
6 The tattoo: From social outcast to genetic medicine
Mavridou, K.A., Bassukas, I.D.
Archives of Hellenic Medicine. 2011; 28(5): 583-595
[Pubmed]
7 Phytotherapy in skin diseases: The known effect and side effect of traditionally used plants in Turkey | [Türkiyeæde deri hastaliklarinda fitoterapi: Geleneksel kullanilan bitkilerin bilinen etki ve yan etkileri]
Tükenmez Demirci, G., Mertoǧlu, E., Kivanç Altunay, I.
Turkiye Klinikleri Dermatoloji. 2011; 21(3): 117-129
[Pubmed]



 

Top
Print this article  Email this article
Previous article Next article

    

Online since 15th March '04
Published by Wolters Kluwer - Medknow