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Rezaeian M, Mohamadi M, Ahmadinia H, Mohammadi H, Ghaffarian-Bahraman A. Lead and arsenic contamination in henna samples marketed in Iran. ENVIRONMENTAL MONITORING AND ASSESSMENT 2023; 195:913. [PMID: 37395865 DOI: 10.1007/s10661-023-11532-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/17/2023] [Indexed: 07/04/2023]
Abstract
Since ancient times, people around the world have used natural cosmetics to improve or change the appearance of their nails, skin, and hair. Henna is a plant-based dye that has been used over the centuries for medical and cosmetic purposes. The present work was aimed to investigate the presence of lead (Pb) and arsenic (As) in various types of commonly consumed henna samples in Iran. A total of thirty-nine henna samples from both local and imported products (3 colors in 13 brands) were randomly collected from popular and herbal medicine markets. The atomic absorption spectrometry (AAS) technique was used for the analysis of the samples. The amount of Pb and As in 100% samples was higher than the calculated limit of quantitation (LOQ). The concentrations of Pb and As in the samples were at the ranges of 9.56-16.94 μg/g and 0.25-1.12 μg/g, respectively. The mean level of Pb was higher in black and red products, compared with the green henna. The levels of Pb and As in 53.85% and 7.7% of the henna samples exceeded the permissible limits recommended by the World Health Organization (WHO), respectively. In addition, the mean levels of Pb and As contamination in the imported samples were significantly higher, in comparison to the local henna samples. To our knowledge, this is the first study assessing Pb and As contamination in the henna samples consumed in Iran. Our study demonstrated that there is a potential risk of exposure to Pb through henna in the Iranian consumers.
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Affiliation(s)
- Mohsen Rezaeian
- Department of Epidemiology and Biostatistics, Medical School, Occupational Environment Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Maryam Mohamadi
- Occupational Safety and Health Research Center, NICICO, World Safety Organization and Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Hassan Ahmadinia
- Department of Epidemiology and Biostatistics, Medical School, Occupational Environment Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Hamidreza Mohammadi
- Department of Toxicology, Faculty of Pharmacy, Razi Herbal Medicine Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Ali Ghaffarian-Bahraman
- Occupational Environment Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
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Nachimuthu S, Thangavel S, Kannan K, Selvakumar V, Muthusamy K, Raza Siddiqui M, Mohammad Wabaidur S, Parvathiraja C. Lawsonia inermis mediated synthesis of ZnO/Fe2O3 nanorods for photocatalysis – Biological treatment for the enhanced effluent treatment, antibacterial and antioxidant activities. Chem Phys Lett 2022. [DOI: 10.1016/j.cplett.2022.139907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Subburaj K, Vinay K, Bishnoi A, Kumaran MS, Parsad D. Pigmented contact dermatitis: A brief review. COSMODERMA 2022; 2:43. [DOI: 10.25259/csdm_45_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Hyperpigmentation is one of the common pigmentary complaints that brings the patient to dermatology services. Though there are multiple etiologies for hyperpigmentation, pigmented contact dermatitis (PCD) remains a common diagnosis. The cosmetics containing dyes, preservatives, fragrances, bactericidal, emulsifiers/surfactants, and vehicles are the potential sources, and paraphenylenediamine, benzyl salicylate, brilliant lake red R, thiomersal and gallate mix are some of the most commonly implicated allergens.
The clinical manifestation includes diffuse or patchy brown to blue-black pigmentation of the cheeks, the outer surface of ears, preauricular region, temporal area, nape of the neck, and upper back. Patch testing plays a pivotal role in the diagnosis of PCD and the testing series has to be selected according to the representative population. Given the chronicity of the disease, counseling patients against the use of cosmetics is challenging as the pigmentation tends to persist for longer durations inspite of stopping cosmetics. The pillars of treatment in PCD include recognition of the culprit allergen and preventing further exposure along with pharmacological therapy. This review provides a brief overview and an insight into the etiopathogenesis and management of PCD.
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Affiliation(s)
- Kiruthika Subburaj
- Department of Dermatology, Venereology & Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology & Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
| | - Anuradha Bishnoi
- Department of Dermatology, Venereology & Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
| | - Muthu Sendhil Kumaran
- Department of Dermatology, Venereology & Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
| | - Davinder Parsad
- Department of Dermatology, Venereology & Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
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Bobaker AM, Alakili I, Sarmani SB, Al-Ansari N, Yaseen ZM. Determination and Assessment of the Toxic Heavy Metal Elements Abstracted from the Traditional Plant Cosmetics and Medical Remedies: Case Study of Libya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111957. [PMID: 31159472 PMCID: PMC6603917 DOI: 10.3390/ijerph16111957] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 01/14/2023]
Abstract
Henna and walnut tree bark are widely used by Libyan women as cosmetics. They may contain lead (Pb), cadmium (Cd) and arsenic (As), which, in turn, pose a high risk to their health. This study aims to determine the levels of Pb, Cd and As in henna and walnut tree bark products sold in Libyan markets. The products were analyzed for their Pb, Cd and As content by using inductively coupled plasma mass spectrometry (ICP-MS) after a microwave acid digestion. The results showed a significant difference between the henna and walnut tree bark samples in terms of their heavy metals content (p < 0.05). The highest heavy metal concentrations were observed in the walnut tree bark samples whereas the lowest was observed in the henna samples. In addition, 60% of the henna and 90% of the walnut tree bark samples contained Pb levels and approximately 80% of the henna and 90% the walnut tree bark samples contained Cd levels, which are much higher than the tolerance limit. However, As concentrations in all the samples were lower. The results indicated that such cosmetics expose consumers to high levels of Pb and Cd and hence, to potential health risks. Thus, studying the sources and effects of heavy metals in such cosmetics is strongly recommended.
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Affiliation(s)
- Aiman M Bobaker
- Chemistry Department, Faculty of Science, University of Benghazi, 16063 Benghazi, Libya.
| | - Intisar Alakili
- Chemistry Department, Faculty of Science, University of Benghazi, 16063 Benghazi, Libya.
| | - Sukiman B Sarmani
- School of Chemical Sciences and Food Technology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, 43600 Bandar Baru Bangi, Malaysia.
| | - Nadhir Al-Ansari
- Civil, Environmental and Natural Resources Engineering, Lulea University of Technology, 97187 Lulea, Sweden.
| | - Zaher Mundher Yaseen
- Sustainable Developments in Civil Engineering Research Group, Faculty of Civil Engineering, Ton Duc Thang University, Ho Chi Minh City, Vietnam.
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Pai V, Prabhu HS, Khalekhan F, Mathai RT, Shivashankara AR, Jakribettu RP, Bala N, Simon P, Baliga MS. Audit of toxic effects of body paint in the tiger dancers (Hulivesha) of Mangalore, India: an investigational study. Cutan Ocul Toxicol 2018; 38:118-124. [PMID: 30501442 DOI: 10.1080/15569527.2018.1529036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Tiger dancing or Hulivesha, where the volunteers paint their bare body like a tiger and dance in a ritual during the Navarathri festival in Mangalore, India. There are no scientific studies done with the Hulivesha dancers at all, and therefore, we investigated the adverse effects of painting body like a tiger and dancing in the volunteers. OBJECTIVE/AIM In this study, we investigated the clinico-haematological effects of topical application of lead-containing paint and dancing for three consecutive days in these dancers to ascertain the toxic effects of whole body painting and dancing. MATERIALS AND METHODS This was a case-control study and was conducted during the Dasara festival in 2013 in the Huliveshadaris (study group) and the accompanying drummers (controls). Clinical, dermatological, and musculoskeletal examination were done before (day 0) and after the three days of the function (day 3). Blood was also collected and examined for alterations in the hematological parameters, lead, antioxidant glutathione, and lipid peroxidation levels. RESULTS The results indicated that the all Hulivesha volunteers had severe musculoskeletal pain, while few also complained of skin reactions (61.6%), headache (25%) and nausea, and vomiting (18.75%). The results also indicated that topical application increased the levels of blood lead, caused a change in the haematological profile, decreased glutathione and increased lipid peroxidation (p < 0.03-0.0001). CONCLUSIONS The results from this study clearly shows that topical application of the acrylic paint increases lead, changes haematological parameters and imparts adverse skin reactions.
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Affiliation(s)
- Varun Pai
- a Departments of Forensic Medicine and Toxicology , Father Muller Medical College, Mangalore , India
| | | | - Faizan Khalekhan
- c Father Muller Research Centre, Father Muller Charitable Institutions , Mangalore , India
| | - Rashmi Theresa Mathai
- d Department of General Medicine , Father Muller Medical College , Mangalore , India
| | | | | | - Nandakishore Bala
- g Department of Dermatology and Venerology , Father Muller Medical College , Mangalore , India
| | - Paul Simon
- c Father Muller Research Centre, Father Muller Charitable Institutions , Mangalore , India
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Panfili E, Esposito S, Di Cara G. Temporary Black Henna Tattoos and Sensitization to para-Phenylenediamine (PPD): Two Paediatric Case Reports and a Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E421. [PMID: 28420106 PMCID: PMC5409622 DOI: 10.3390/ijerph14040421] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 03/15/2017] [Accepted: 03/15/2017] [Indexed: 01/07/2023]
Abstract
Background: The use of temporary henna tattoos has increased dramatically in recent years, especially in children and adolescents. To obtain a darker colour and prolong the life of the tattoo, red henna, a plant-derived substance, is typically added to para-phenylenediamine (PPD). The mixture is called temporary black henna tattoo (TBHT). Because of its molecular characteristics, PPD can induce skin sensitization that may cause various clinical manifestations with successive exposures, among which the most common is allergic contact dermatitis (ACD). This report describes two paediatric cases of PPD sensitization and ACD after the exposure to TBHT and summarizes the literature on this emerging clinical problem. Case Presentation: We describe two cases of childhood-onset ACD that occurred 2 and 10 days, respectively, after the application of a TBHT during the summer holidays. Patch tests showed an evident positive response to 1% PPD in both cases. Sensitization to PPD occurred in the first case because a previous henna tattoo did not result in overt symptoms; in the second case, the reaction occurred after the same tattoo was retouched. In both cases, hypopigmentation persisted and both the patients and their families were advised to avoid further contact with PPD-containing materials and substances that could lead to cross-reactions. Conclusions: Sensitization to PPD is a growing phenomenon in children. The most common cause appears to be exposure to TBHT in which PPD might be present at unknown or high concentrations. Once sensitization occurs, patients may experience severe clinical symptoms which can present with a persistent hypopigmentation when they are re-exposed to substances that contain or cross-react with PPD. Given the widespread use of PPD, TBHT could adversely affect the daily life of paediatric patients; thus, for this reason, this practice as a fashion accessory must be discouraged. In addition, it is extremely important to provide scientific information on the risks of TBHT to consumers, especially to adolescents and to the parents of younger children to prevent PPD sensitization.
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Affiliation(s)
- Elisa Panfili
- Pediatric Clinic, Università degli Studi di Perugia, 06129 Perugia, Italy.
| | - Susanna Esposito
- Pediatric Clinic, Università degli Studi di Perugia, 06129 Perugia, Italy.
| | - Giuseppe Di Cara
- Pediatric Clinic, Università degli Studi di Perugia, 06129 Perugia, Italy.
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7
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Calogiuri G, Di Leo E, Butani L, Pizzimenti S, Incorvaia C, Macchia L, Nettis E. Hypersensitivity reactions due to black henna tattoos and their components: are the clinical pictures related to the immune pathomechanism? Clin Mol Allergy 2017; 15:8. [PMID: 28400706 PMCID: PMC5385600 DOI: 10.1186/s12948-017-0063-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 03/02/2017] [Indexed: 12/14/2022] Open
Abstract
Hypersensitivity to para-phenylenediamine (PPD) and related compounds induced by temporary black henna tattoos has become a serious health problem worldwide. Different patterns of sensitization with various clinical aspects are described in literature due to PPD associated to henna tattoo and these manifestations are likely correlated with the immunological and dermatological pathomechanisms involved. Henna is the Persian name of the plant Lawsonia inermis, Fam. Lythraceae. It is a woody shrub that grow in regions of North Africa, South Asia, India and Sri Lanka. Nowadays it is rather frequent to see temporary "tattoos" performed with henna. To make tattoos darker and long-lasting PPD has been associated to henna in tattoo drawings mixtures, so obtaining "black henna". In these years there has been a rise of contact sensitization to PPD and in medical literature an increased number of cases have been reported on temporary henna tattoo application. Here we review the various clinical patterns related to PPD and henna tattoo, to investigate the possible link between clinic-morphological pictures and the immunological response to PPD and henna. The literature underlines that different clinical manifestations are related to black henna containing PPD, and its derivative products may cause delayed-type as well as immediate-type reactions. Further studies are needed to investigate the relationship between clinical and morphological aspects of PPD contact dermatitis and the T cell subsets predominance.
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Affiliation(s)
- Gianfranco Calogiuri
- Pneumology and Allergy Department, Hospital Sacro Cuore, Gallipoli, Lecce, Italy
| | - Elisabetta Di Leo
- Section of Allergy and Clinical Immunology, Unit of Internal Medicine-“F. Miulli” Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Lavjay Butani
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, USA
| | - Stefano Pizzimenti
- Allergy Outpatients’ Clinic, ASL-TO3, Ospedale Civile “E. Agnelli”, Pinerolo, Turin, Italy
| | | | - Luigi Macchia
- Section of Allergy and Clinical Immunology, Department of Internal Medicine and Infectious Diseases, University of Bari Medical School, Bari, Italy
| | - Eustachio Nettis
- Section of Allergy and Clinical Immunology, Department of Internal Medicine and Infectious Diseases, University of Bari Medical School, Bari, Italy
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8
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Aktas Sukuroglu A, Battal D, Burgaz S. Monitoring of Lawsone,p-phenylenediamine and heavy metals in commercial temporary black henna tattoos sold in Turkey. Contact Dermatitis 2016; 76:89-95. [DOI: 10.1111/cod.12702] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/02/2016] [Accepted: 09/05/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Ayca Aktas Sukuroglu
- Faculty of Pharmacy, Department of Toxicology; Mersin University; 33169 Mersin Turkey
- Faculty of Pharmacy, Department of Toxicology; Gazi University; 06330 Ankara Turkey
| | - Dilek Battal
- Faculty of Pharmacy, Department of Toxicology; Mersin University; 33169 Mersin Turkey
- Advanced Technology Education Research and Application Center; Mersin University; 33343 Mersin Turkey
- Faculty of Pharmacy, Department of Toxicology; Near East University; 99138 Nicosia Republic of Cyprus
| | - Sema Burgaz
- Faculty of Pharmacy, Department of Toxicology; Gazi University; 06330 Ankara Turkey
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Abstract
A large list of foreign substances may penetrate the skin and induce a foreign body granulomatous reaction. These particles can enter the skin by voluntary reasons or be caused by accidental inclusion of external substances secondary to cutaneous trauma. In these cases, foreign body granulomas are formed around such disparate substances as starch, cactus bristles, wood splinters, suture material, pencil lead, artificial hair, or insect mouthparts. The purpose of this article is to update dermatologists, pathologists, and other physicians on the most recent etiopathogenesis, clinical presentations, systemic associations, evaluation, and evidence-based management concerning foreign body granulomatous reactions of skin.
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Affiliation(s)
- Ana M Molina-Ruiz
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Avda. Reyes Católicos 2, Madrid 28040, Spain.
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Avda. Reyes Católicos 2, Madrid 28040, Spain
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10
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Abstract
Henna, derived from a combination of natural leaves and coloring additives, is a common decorative dye traditionally used in many Islamic religious celebrations. Para-phenylenediamine (PPD), a major component of black henna tattoo, is a strong sensitizer and common allergen. We report a case of severe connubial allergic contact dermatitis after black henna heterotransfer in a girl.
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Affiliation(s)
- Alina Goldenberg
- School of Medicine, University of California, San Diego, San Diego, California
| | - Catalina Matiz
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital San Diego, University of California, San Diego, San Diego, California
| | - Lawrence F Eichenfield
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital San Diego, University of California, San Diego, San Diego, California
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Gupta A, Bonde SR, Gaikwad S, Ingle A, Gade AK, Rai M. Lawsonia inermis‐
mediated synthesis of silver nanoparticles: activity against human pathogenic fungi and bacteria with special reference to formulation of an antimicrobial nanogel. IET Nanobiotechnol 2014; 8:172-8. [DOI: 10.1049/iet-nbt.2013.0015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Arpita Gupta
- Department of BiotechnologySant Gadge Baba Amravati UniversityAmravati 444 602MaharashtraIndia
| | - Shital R. Bonde
- Department of BiotechnologySant Gadge Baba Amravati UniversityAmravati 444 602MaharashtraIndia
| | - Swapnil Gaikwad
- Department of BiotechnologySant Gadge Baba Amravati UniversityAmravati 444 602MaharashtraIndia
| | - Avinash Ingle
- Department of BiotechnologySant Gadge Baba Amravati UniversityAmravati 444 602MaharashtraIndia
| | - Aniket K. Gade
- Department of BiologyUtah State UniversityLoganUT 84322‐5305USA
| | - Mahendra Rai
- Department of BiotechnologySant Gadge Baba Amravati UniversityAmravati 444 602MaharashtraIndia
- Laboratório de Química BiológicaInstituto de Química – Unicamp Cidade Universitária ‘Zefferino Vaz’Barão Geraldo‐CEP 13083‐970, Caixa Postal 6150 CampinasSPBrazil
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12
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de Groot AC. Side-effects of henna and semi-permanent 'black henna' tattoos: a full review. Contact Dermatitis 2014; 69:1-25. [PMID: 23782354 DOI: 10.1111/cod.12074] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 02/06/2013] [Accepted: 02/09/2013] [Indexed: 11/29/2022]
Abstract
Henna, the dried and powdered leaf of Lawsonia inermis, is widely used as a dye for the skin, hair, and nails, and as an expression of body art, especially in Islamic and Hindu cultures. As it stains the skin reddish-brown, it is also called red henna. Black henna is the combination of red henna with p-phenylenediamine (PPD), and is used for temporary 'black henna tattoos'. This article provides a full review of the side-effects of topical application of red and black henna, both cutaneous (allergic and non-allergic) and systemic. Red henna appears to be generally safe, with rare instances of contact allergy and type I hypersensitivity reactions. In children with glucose-6-phosphate dehydrogenase deficiency, topical application of henna may cause life-threatening haemolysis. Black henna tattoos will induce contact allergy to its ingredient PPD at an estimated frequency of 2.5%. Once sensitized, the patients may experience allergic contact dermatitis from the use of hair dyes containing PPD. There are often cross-reactions to other hair dyes, dyes used in textiles, local anaesthetics, and rubber chemicals. The sensitization of children to PPD may have important consequences for health and later career prospects. Systemic toxicity of black henna has been reported in certain African countries.
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Kind F, Hofmeier KS, Bircher AJ. Irritant contact dermatitis from a black henna tattoo without sensitization to para-phenylendiamine. Pediatrics 2013; 131:e1974-6. [PMID: 23690526 DOI: 10.1542/peds.2012-2938] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Allergic contact dermatitis from nonpermanent black henna tattoos has been frequently reported, particularly in children. Contamination or adulteration of the dyes with para-phenylendiamine has been identified as major cause of active sensitization and elicitation of severe allergic contact dermatitis. Sequelae include permanent sensitization, hyper- or hypopigmentation, scarring, keloids, and hypertrichosis. We report a rare case of irritant dermatitis to an unknown ingredient in a black henna tattoo with consecutive hypopigmentation. Sensitization to para-phenylendiamine and other para-compounds was excluded by patch test evaluation. This is relevant for future exposure to consumer products such as hair dyes or in occupational settings. Generally, black henna tattoos, particularly if done with dyes of unknown composition, should be strongly discouraged.
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Affiliation(s)
- Fabiola Kind
- Department of Dermatology, University Hospital, Basel, Switzerland
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14
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Niño Azcárate C, Cabrera Vélez R. ¡Ojo con los tatuajes temporales! Semergen 2012. [DOI: 10.1016/j.semerg.2011.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Kind F, Scherer K, Bircher AJ. Contact dermatitis to para-phenylenediamine in hair dye following sensitization to black henna tattoos - an ongoing problem. J Dtsch Dermatol Ges 2012; 10:572-8. [PMID: 22299643 DOI: 10.1111/j.1610-0387.2011.07882.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The increased frequency of case reports of allergic contact dermatitis from non-permanent black henna tattoos in recent years shows the popularity of this form of body painting. PATIENTS AND METHODS Seven patients presented with allergic contact dermatitis after initial hair or eyelash dyeing. They all had a history of a previous reaction from a black henna tattoo. All were patch tested with the European standard patch test series and the standard supplemental series, as well as special series for dyes and hairdressers. RESULTS All seven patients showed a positive reaction in patch testing with para-phenylenediamine (PPD) (0.3 % and/or 1.0 % in pet.). Five patients also had positive reactions to other dyes such as aminophenol, para-toluene diamine, disperse orange and yellow and four patients reacted to benzocaine. These were interpreted as cross-reactions. The time from sensitization by the black henna tattoo to the onset of allergic contact dermatitis after hair dyeing was an average of 6.2 years. CONCLUSIONS The most common cause of allergic contact dermatitis after black henna tattoos is PPD. Both the long skin contact and the high concentrations of PPD increase the risk of sensitization. Allergic contact dermatitis may be followed by post-inflammatory hyper- or hypopigmentation, scarring and lifelong sensitization, which can have occupational impact, especially for hair dressers and cosmeticians.
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Affiliation(s)
- Fabiola Kind
- Allergy Unit, Department of Dermatology, University Hospital, Basel, Switzerland
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16
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Lousicidal activity of synthesized silver nanoparticles using Lawsonia inermis leaf aqueous extract against Pediculus humanus capitis and Bovicola ovis. Parasitol Res 2011; 111:2023-33. [DOI: 10.1007/s00436-011-2667-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 09/27/2011] [Indexed: 10/16/2022]
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Almeida PJ, Borrego L, Pulido-Melián E, González-Díaz O. Quantification of p-phenylenediamine and 2-hydroxy-1,4-naphthoquinone in henna tattoos. Contact Dermatitis 2011; 66:33-7. [DOI: 10.1111/j.1600-0536.2011.01992.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Effect of Lawsonia inermis on tumor expression induced by Dalton's lymphoma ascites in Swiss albino mice. Saudi J Biol Sci 2011; 18:353-9. [PMID: 23961147 DOI: 10.1016/j.sjbs.2011.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 02/24/2011] [Accepted: 04/11/2011] [Indexed: 11/20/2022] Open
Abstract
The purpose of this study was investigating experimentally the possible antitumor effect of ethanol extract of root of Lawsonia inermis against Dalton's lymphoma ascites (DLA) bearing mice. Mice were administered with L. inermis at a dosage of 180 mg/kg of body weight for 15 days after 24 h of DLA inoculation. The ethanolic root extract of L. inermis reverted the increased number of the WBC count, platelets and lymphocytes and decreased the number of the RBC count, hemoglobin content and monocytes. The effect of root extract of L. inermis also increased the pathophysiological marker enzyme, lipid profile and decreased the enzymic and non enzymic antioxidants. A histopathological result shows the loss of liver hepatocytes and kidney architecture in DLA bearing mice. However, mice treatment with L. inermis extract improves the liver and kidney function and rearranges more or less normal architecture. The present work indicates that the ethanol extract of L. inermis exhibited significant antitumor activity.
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Al-Suwaidi A, Ahmed H. Determination of para-phenylenediamine (PPD) in henna in the United Arab Emirates. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2010; 7:1681-93. [PMID: 20617053 PMCID: PMC2872353 DOI: 10.3390/ijerph7041681] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 04/04/2010] [Accepted: 04/07/2010] [Indexed: 11/16/2022]
Abstract
Henna is very popular in the United Arab Emirates (UAE); it is part of the culture and traditions. Allergy to natural henna is not usual; however the addition of para-phenylenediamine (PPD) to the natural henna increases the risk of allergic contact dermatitis. The objectives of the study were to identify the presence and concentration of PPD in henna available in UAE. Fifteen henna salons were selected randomly from three cities in UAE. Twenty five henna samples were acquired from these selected salons. The presence of PPD in henna samples was determined qualitatively and quantitatively using High Performance Liquid Chromatography (HPLC). The study showed that PPD was present in all of the black henna samples at concentrations ranging between 0.4% and 29.5% and higher than that recommended for hair dyes in most of the black henna samples. The presence of PPD in the black henna increases the risk of allergic contact dermatitis among users of black henna and a number of cases have already been reported in UAE.
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Affiliation(s)
- Ayesha Al-Suwaidi
- Environment Management Sector, Environment Agency-Abu Dhabi, UAE; E-Mail:
| | - Hafiz Ahmed
- Department of Environmental Health, College of Health Sciences, University of Sharjah, P.O. Box 27272, UAE
- Author to whom correspondence should be addressed; E-Mail:
; Tel.: +97-165-057-507; Mobile: +97-150-493-2075; Fax: +97-165-057-502
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Durmazlar SPK, Tatlican S, Eskioglu F. Localized hypertrichosis due to temporary henna tattoos: report of three cases. J DERMATOL TREAT 2010; 20:371-3. [PMID: 19954396 DOI: 10.3109/09546630802691945] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Temporary henna tattoos have become increasingly widespread. Although reactions to henna tattoo are becoming progressively more common, only one case of a henna pseudotattoo resulting in temporary hypertrichosis has been reported so far. We report three patients who received paint-on henna tattoos on their right upper arm. Approximately 1 week later, localized hypertrichosis was observed over the same area as the tattoo, which resolved spontaneously within 3-4 months. Clinicians should be aware of this complication and it should be noted that treatment is not necessary as hypertrichosis resolves spontaneously.
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Affiliation(s)
- Selda Pelin Kartal Durmazlar
- Department of Dermatology, Ministry of Health Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey.
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21
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Abstract
PURPOSE OF REVIEW The following study reviews the recent literature pertaining to allergic contact dermatitis (ACD) in the pediatric population. This study also provides an overview of the most common allergens and discusses various therapeutic modalities. RECENT FINDINGS The pathophysiology of ACD is intricate and multifaceted, resulting in a characteristic, delayed inflammatory response. Although commonly recognized in adults, its existence in the pediatric population was questioned. Recent literature suggests that pediatric ACD exists and is more common than previously recognized. The diagnosis relies on the clinical presentation combined with appropriate use and interpretation of a patch test. Although many studies have investigated ACD in children, few have documented the relevance of positive patch test reactions until recently. The most current prevalence estimates of positive patch test reactions range from 14 to 70% of children patch tested. Although that range is broad, these studies have demonstrated the relevance of positive reactions and confirmed ACD as a disease entity in children. SUMMARY ACD is a previously underrecognized disease process in the pediatric population that can manifest as a serious dermatologic challenge for both patients and physicians. This review will address the prevalence, diagnostic methods, frequent allergens and treatment options in pediatric ACD.
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23
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Kluger N, Raison-Peyron N, Guillot B. Tatouages temporaires au henné : des effets indésirables parfois graves. Presse Med 2008; 37:1138-42. [DOI: 10.1016/j.lpm.2007.09.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Accepted: 09/26/2007] [Indexed: 10/22/2022] Open
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24
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Wollina U, Gruner M, Schönlebe J. Granulomatous tattoo reaction and erythema nodosum in a young woman: common cause or coincidence? J Cosmet Dermatol 2008; 7:84-8. [DOI: 10.1111/j.1473-2165.2008.00368.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Abstract
Today, temporary henna tattoos drawn on the skin are very fashionable and have become more and more popular. At the same time, allergic reactions following these tattoos has increased worldwide. Actually, henna has a very low allergic potential. In most cases, allergic reactions are caused by the mixtures used by the so-called "artists" which contain not only natural henna but also many chemical coloring agents such as diaminotoluenes and diaminobenzenes. The long duration of skin contact, the high concentrations of sensitizing materials, and the lack of a neutralizing agent dramatically increases the risk of skin sensitization. We summarized 31 of our own cases with allergic contact dermatitis due to temporary henna tattoos and outlined the main characteristics for this peculiar contact dermatitis.
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Affiliation(s)
- Jana Kazandjieva
- Department of Dermatology, Medical University-Sofia, 1431 Sofia, Bulgaria.
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26
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Tomlinson JE, Winterton RIS, Liddington MI. Henna reaction. J Plast Reconstr Aesthet Surg 2007; 60:1164-5. [PMID: 17481976 DOI: 10.1016/j.bjps.2007.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Accepted: 03/16/2007] [Indexed: 11/22/2022]
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Affiliation(s)
- E Tan
- Department of Dermatology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, UK.
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Ramírez-Andreo A, Hernández-Gil A, Brufau C, Marín N, Jiménez N, Hernández-Gil J, Tercedor J, Soria C. Dermatitis de contacto alérgica a tatuajes temporales de henna. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s0001-7310(07)70021-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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29
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Corrente S, Moschese V, Chianca M, Graziani S, Iannini R, La Rocca M, Chini L. Temporary henna tattoo is unsafe in atopic children. Acta Paediatr 2007; 96:469-71. [PMID: 17407484 DOI: 10.1111/j.1651-2227.2007.00143.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
UNLABELLED Temporary henna tattoos have become increasingly popular as a safe alternative to permanent tattoos among American and European children and teenagers during the summer holidays. Currently, temporary henna tattoos contain not only henna, but also other additives such as para-phemylenediamine (PPD), which is considered to be the chemical agent that most frequently causes skin reactions associated with the use of commercial black henna. In this report, we describe an 11-year-old boy who applied a temporary black henna tattoo on his right arm during the summer holidays in Greece and developed a severe contact dermatitis at the tattoo site with residual hypopigmentation. He had no previous history of contact dermatitis, however he did suffer from seasonal allergic rhinitis and atopic dermatitis. Patch testing revealed a strong reaction to PPD, a substance commonly contained in temporary henna tattoo preparations. CONCLUSION Henna tattoos are an increasing problem worldwide since they carry an increased risk of severe skin reactions; therefore we suggest that the use of temporary henna tattoos in children be discouraged.
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Affiliation(s)
- Stefania Corrente
- Pediatric Allergology and Immunology Center, Azienda Ospedaliera Universitaria Policlinico Tor Vergata, University of Rome Tor Vergata, Italy.
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Ramírez-Andreo A, Hernández-Gil A, Brufau C, Marín N, Jiménez N, Hernández-Gil J, Tercedor J, Soria C. Allergic Contact Dermatitis To Temporary Henna Tattoos. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s1578-2190(07)70402-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Hardwicke J, Azad S. Temporary henna tattooing in siblings—An unusual chemical burn. Burns 2006; 32:1064-5. [PMID: 17010525 DOI: 10.1016/j.burns.2006.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Accepted: 04/06/2006] [Indexed: 11/21/2022]
Affiliation(s)
- J Hardwicke
- Department of Plastic and Reconstructive Surgery, Lancashire Teaching Hospitals NHS Trust, Royal Preston Hospital, Sharoe Green Lane, Preston PR2 9HT, UK.
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32
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Abstract
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.
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Affiliation(s)
- Jacqueline Matulich
- Skin and Cancer Foundation Australia, 7 Ashley Lane, Westmead, NSW 2145, Australia
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Abstract
Transferable picture tattoos for the skin are popular among children. There is however very little knowledge about the colourants that may be present in the picture tattoos and thus of the risk of contact allergic reactions. In the present investigation, 36 picture tattoos were analysed for the content of 129 organic colourants listed in the Cosmetic Directive, to which these products should comply as they are used on the skin. Only 11 of the cosmetic colourants could be identified in the analysed samples. Allergenic potential of 7 of these colourants (CI 15850, CI 11920, CI 45220, CI 75300, CI 13015, CI 45100 and CI 15525, maximum concentration 35-4479 p.p.m.) was evaluated on the basis of published scientific data. Only scarce information regarding contact allergy to these substances was found in the available literature. Most information in the literature regarding contact allergy has concerned CI 75300, curcumin, which is reported to have caused a few cases of contact allergy as a colourant in food or in disinfectants used prior to surgery. In no case, allergic reactions to any of the colourants have been verified from transferable picture tattoos. On the basis of this investigation, the risk of allergic reactions from the colourants in the transferable picture tattoos seems to be limited.
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Affiliation(s)
- Suresh Chandra Rastogi
- Department of Environmental Chemistry and Microbiology, National Environmental Research Institute, Denmark.
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Di Landro A, Valsecchi R, Marchesi L. Allergic reaction with persistent hypopigmentation due to temporary tattoing with henna in a baby. Contact Dermatitis 2005; 52:338-9. [PMID: 15932586 DOI: 10.1111/j.0105-1873.2005.0612a.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A Di Landro
- Clinica Dermatologica, Università degli Studi Milano-Bicocca, Ospedali Riuniti di Bergamo, Bergamo, Italy.
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Søsted H, Hesse U, Menné T, Andersen KE, Johansen JD. Contact dermatitis to hair dyes in a Danish adult population: an interview-based study. Br J Dermatol 2005; 153:132-5. [PMID: 16029338 DOI: 10.1111/j.1365-2133.2005.06588.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Contact allergy to hair dye ingredients is a well-known entity seen both in consumers using hair dyes and among hairdressers with occupational contact dermatitis. Surveys show that consumers with even severe adverse skin reactions to hair dyes only rarely contact the healthcare services. The frequency of hair dye-induced skin reactions in the consumer population is unknown. OBJECTIVES An epidemiological investigation with the aim of establishing the proportion of hair dye-induced skin reactions was performed in a population-based sample. METHODS A representative random sample (n = 4000) was taken of the Danish adult population. Personal interview questions were asked regarding adverse skin reactions to hair dyes, either compatible with a classical allergic eczematous reaction with redness, scaling and itching or a severe allergic reaction with oedema of the forehead and face. The response rate was 65.2%. RESULTS A total of 18.4% of the male respondents and 74.9% of the female respondents had at some point dyed their hair. The median age at first hair dyeing was 16 years (range 1-80). Adverse skin reactions to hair dyes compatible with an allergic reaction were reported in 5.3% of individuals who had ever used hair dye. Of these, only 15.6% had been in contact with healthcare services after the hair dye reaction. Having had a temporary tattoo was not a significant risk factor for an adverse reaction to hair dyes. CONCLUSIONS The rate of adverse allergic skin reactions to hair dyes was higher than expected from patch-test studies. Only by studying the clinical types of adverse reactions to hair dyes will it be possible to gather a complete epidemiological picture of the nature and extent of the problems related to hair dye ingredients.
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Affiliation(s)
- H Søsted
- The National Allergy Research Centre, Department of Dermatology, University of Copenhagen, Gentofte Hospital, Copenhagen, Denmark.
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36
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Martin JA, Hughes TM, Stone NM. 'Black henna' tattoos: an occult source of natural rubber latex allergy? Contact Dermatitis 2005; 52:145-6. [PMID: 15811029 DOI: 10.1111/j.0105-1873.2005.00547.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Temporary 'black henna' tattoos are an increasingly popular body decoration with a growing incidence of associated adverse events. We report the case of a 14 year old girl presenting with an acute allergic contact dermatitis to hair dyes. Some years previously she had a 'black henna' tattoo with prior application of a tacky transfer to the skin to outline the design followed some days later by an acute localised blistering reaction. Patch testing to an extended British Contact Dermatitis Society standard series showed relevant positive reactions to paraphenlyenediamine (PPD) and thiuram mix, as well as to several of the azo disperse dyes. We went on to perform prick testing to natural rubber latex (NRL), showing a positive reaction to the commercial HEP 100 concentration. We propose that through the initial acute reaction caused by PPD in the 'black henna' our patient was not only sensitized to PPD, but also to thiuram and natural rubber latex which may have been present in the tacky transfer applied prior to 'tattooing.' We would add that temporary 'black henna' tattoos may have more important consequences than previously thought on patients' future health by sensitization to NRL.
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Affiliation(s)
- J A Martin
- Department of Occupational Dermatology, Royal Gwent Hospital, Newport, South Wales, UK.
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37
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Jindal M, Davis B. Temporary henna tattooing--a risky procedure. Case report and literature review. Burns 2003; 29:866-7. [PMID: 14636768 DOI: 10.1016/s0305-4179(03)00163-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- M Jindal
- 7 Rangeley View, Whitebridge Manor, Stone, ST15 8YZ, Staffordshire, UK.
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38
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Le Coz CJ, Tromp G. Skin Paints (Pseudo-Tattoos) with ‘Black Henna’: Hazards and Long-Term Risks. ACTA ACUST UNITED AC 2003. [DOI: 10.1159/000068795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Arroyo MP. Black henna tattoo reaction in a person with sulfonamide and benzocaine drug allergies. J Am Acad Dermatol 2003; 48:301-2. [PMID: 12582412 DOI: 10.1067/mjd.2003.56] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Søsted H, Agner T, Andersen KE, Menné T. 55 cases of allergic reactions to hair dye: a descriptive, consumer complaint-based study. Contact Dermatitis 2002; 47:299-303. [PMID: 12534535 DOI: 10.1034/j.1600-0536.2002.470508.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Severe facial and scalp dermatitis following the use of permanent hair dyes has been reported in several cases. Para-phenylenediamine (PPD) is known as a potent contact allergen, and PPD is allowed in hair dye at a concentration of 6%. Hair dye reactions are usually diagnosed by the patients themselves, and adverse reactions to hair dye may not necessarily be recorded by the health care system, unless the reactions are especially severe. Based on this assumption, we suspected that hair dye dermatitis was occurring more frequently than reported in the literature. Consumer complaint-based data were obtained by advertising for persons with adverse reactions to hair dye. Among those responding to the advertisement, 55 cases of severe, acute allergic contact dermatitis were identified. The main symptoms were severe oedema of the face, scalp and ears, and clinically this was often mistaken for angio-oedema. The 55 cases comprised a total of 75 visits to the health service and 5 admissions to hospital. 18 persons had sick leave, which supports the impression of very severe dermatitis reactions. 60% were treated with antihistamine, while 52% were treated with corticosteroids. 29% of the cases were patch tested and all were found positive to PPD. Our data presented here clearly show that PPD and its derivatives in hair dye at the present concentrations presents a significant health risk for the population. Furthermore, the severe acute allergic skin reactions are often misdiagnosed in the health care system. The frequency of allergic contact dermatitis resulting from hair dye is likely to be underestimated. New methods to survey the frequency of adverse reactions should be considered.
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Affiliation(s)
- H Søsted
- The National Allergy Research Centre for Consumer Products, Department of Dermatology, University of Copenhagen, Gentofte Hospital, Denmark
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Avnstorp C, Rastogi SC, Menné T. Acute fingertip dermatitis from temporary tattoo and quantitative chemical analysis of the product. Contact Dermatitis 2002; 47:119-20. [PMID: 12455547 DOI: 10.1034/j.1600-0536.2002.470210_11.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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