CCJ's Monday Media:
Recently published articles on Henna and PPD Black Henna

Abstract from Blackwell:    Serious adverse skin reactions to permanent hair dyes and temporary black tattoos have been reported. As temporary tattoos have become fashionable among adolescents, the risk profile for p-phenylenediamine (PPD) sensitization of the population has changed simultaneously with an increasing use of hair dyes in this age group. This investigation reports PPD sensitization in children with regard to cause of sensitization, clinical presentation and consequences. Clinical history and patch test results for consecutive children below 16 years of age with suspected hair dye allergic reactions and positive patch tests to PPD were collected over 2 years in 2 Danish dermatology clinics. 8 children aged 12–15 years were collected, and they all reacted to several hair dye ingredients. 5 of the patients were hospitalized, 1 in the intensive care unit. 6 of the patients gave a history of prior reaction to temporary black tattoos. These children showed simultaneous positive patch reactions to N-isopropyl- N-phenyl- p-phenylenediamine and local anaesthetics, while such reaction patterns were not seen in children with hair dye reactions only. The clinical consequences of these reactions are unknown. A re-evaluation of the risk assessment/risk management for hair dyes is required.

Abstract:    The article presents information on the harmful effects of henna tattoos. With increased popularity of body art such as body piercing and tattooing, an increase in temporary henna tattoos has also occurred. Although the appeal of non-permanence exists for henna tattoos, dermatologists have begun to see numerous cases of allergic contact dermatitis linked with a certain type of henna. There have been rare reports of sensitivity occurrence with ordinary henna tattoos; however, henna containing paraphenylene diamine, a popular chemical for use in black henna to darken the tattoo and reduce fixation time, increases skin sensitivities.

Abstract by Blackwell: Presents the case a 51-year-old woman who had walking difficulties due to an allergic reaction to henna tattoos on both feet. Results of patch testing; Suggestion that contact allergic reactions to temporary henna tattoos are, in general, not due to henna itself, but due to the additives which may be p-phenylenediamine, p-toluenediamine and various essential oils; Severity of the symptoms.

(HP note: temporary tattoos were applied in Mexico, and the stain was black, not red/brown.  The woman's feet were extremely swollen and had blisters 3 cm across.)

Abstract:    Temporary henna tattoos are a popular fashion accessory in recent years. The tattoo dye consists of henna extract from the plant Lawsonia, and p-phenylenediamine to create a darker shade to the tattoo. Increasingly, emergency departments are seeing children with atopic reactions to these tattoos. The p-phenylenediamine component can cause a spongiotic dermatitis with lympho-histiocytic infiltrates. I present two cases of reactions to temporary tattoos in children attending the emergency department. The acute management of these cases and the possible future consequences of sensitization to p-phenylenediamine are discussed.

Abstract by Blackwell:    Contact dermatitis following the application of temporary paint-on henna tattoos indicates a potentially serious problem of active sensitization. We describe 2 cases involving sisters who travelled to Bali together and acquired a temporary black henna tattoo to the lower back region. Both sisters subsequently developed a contact dermatitis at the tattoo site, the dermatitis disseminating in one sister. There was persistent hyperpigmentation at the tattoo site in both sisters several months after the application. Patch testing revealed a positive reaction to para-phenylenediamine (PPD) in both sisters. One sister also showed reactions to other hair dyes and to multiple organic dyes. Allergic contact dermatitis to PPD contained in temporary henna tattoos is an increasing problem worldwide, with cross-reaction to related compounds and permanent skin changes, a frequent consequence of sensitization to this significant allergen.

Abstract by Blackwell: The article presents the case study of a 4-year-old girl suffering from allergic contact dermatitis. The disease occurred due to temporary paint-on tattoos with a persistent hypopigmentation after the resolution of the eczematous lesions. Allergic contact dermatitis to tattoos has been reported in adults and also in children, although rarely. In this case, the allergic contact dermatitis developed 1 month after the application of a henna tattoo, and it was followed by hypopigmentation reproducing the tattoo design. The case represents the youngest patient reported with an eczematous reaction followed by the persistent hypopigmentation'

HP Note: This damage was done with PPD "Black Henna" on the Italian Riviera.  The article's author states, "Holiday henna tattoos are becoming increasingly fashionable, but they should be discouraged especially in children, because they are not free of risk, such as a sensitization to such a strong contact allergen as PPD."

Abstract by Blackwell: Presents a case of a boy with facial redness after having a permanent hair dye and black henna tattoos on his skin in Great Britain. Assessment on the response of the immune system from steroids and antibiotics; Increase on the risks of contact dermatitis; Description on the physical condition of the patient.

HP note: Author states, "We would like to draw attention to the potential serious implications that children are being sensitized to PPD and might develop a severe allergic response. Paraphenylene diamine also cross-reacts with permanent hair dyes and rubber,which can affect future work prospects. Legislation might be needed to prevent the occurrence of similar cases."