Paraphenylene diamine hair dye poisoning in an adolescent

Suicide by poisoning in Pakistan: review of regional trends, toxicity and management of commonly used agents in the past three decades

BACKGROUND

Suicide is one of the leading mental health crises and takes one life every 40 seconds. Four out of every five suicides occur in low- and middle-income countries. Despite religion being a protective factor against suicide, the estimated number of suicides is rapidly increasing in Pakistan.

AIMS

Our review focuses on the trends of suicide and means of self-poisoning in the past three decades, and the management of commonly used poisons.

METHOD

We searched two electronic databases (PubMed and PakMediNet) for published English-language studies describing agents used for suicide in different regions of Pakistan. A total of 46 out of 85 papers (N = 54 747 cases) met our inclusion criteria.

RESULTS

Suicidal behaviour was more common among individuals younger than 30 years. Females comprised 60% of those who attempted suicide in our study sample, although the ratio of completed suicides favoured males. There were regional trends in the choice of agent for overdose. Organophosphate poisoning was reported across the nation, with a predominance of cases from the agricultural belt of South Punjab and interior Sindh. Aluminium phosphide ('wheat pills') was a preferred agent in North Punjab, whereas paraphenylenediamine ('kala pathar') was implicated in deaths by suicide from South Punjab. Urban areas had other means for suicide, including household chemicals, benzodiazepines, kerosene oil and rat poison.

CONCLUSIONS

Urgent steps are needed, including psychoeducational campaigns on mental health and suicide, staff training, medical resources for prompt treatment of self-poisoning and updated governmental policy to regulate pesticide sales.

Protective Effects of Cocos Nucifera Oil in Paraphenylene Diamine Toxicity

BACKGROUND

Paraphenylenediamine (PPD) is a highly toxic compound used for hair-dyeing worldwide. PPD self-poisoning had significantly increased in recent times with increased mortality rates.

OBJECTIVE

This study aims to evaluate the toxic effects of PPD and the protective potential of its prospective antidote Virgin Coconut Oil (Cocos nucifera).

METHODS

PPD was identified and validated by FT-IR and UV mass spectrometer. PPD toxicity was induced in-vivo by single intraperitoneal injection (40 mg/kg and 60 mg/kg). Single-injection of Virgin Coconut Oil (VCO) was administered in the presence of PPD at doses of 5 mg/kg and 10 mg/kg. Blood was analyzed for renal, hepatic and cardiac biomarkers. Relevant organs were collected, weighed and preserved for histopathological examination. Statistical analysis was carried out to note mortality rate, survival duration and serum biochemical parameter. Molecular docking studies were performed to assess attachment of PPD with histaminergic receptors.

RESULTS

PPD injection achieved 100% mortality rate with short survival span, and disturbed hepatic, renal, and cardiac serum markers with marked histopathological changes. VCO notably decreased mortality rate, raised treatment time window with marked adjustment in hepatic, renal, and cardiac markers. Docking studies proved that PPD attaches robustly with histaminergic receptors.

CONCLUSION

The study concludes that VCO possesses lifesaving protection against PPD toxicity and can be a suitable antidote.

Rhus semialata M. extract ameliorate para-phenylenediamine-induced toxicity in keratinocytes

para-Phenylediamine (PPD), a major component of hair dyeing ingredients, can induce allergenic sensitization and exert mutagenic, tumorigenic and cytotoxic effect. In this study, we determined the cytotoxic effect of PPD on human keratinocytes and evaluated the protective effect of Rhus semialata M. extracts (RSE) on PPD induced cytotoxicity for the first time. We observed that RSE is a strong inhibitory agent against PPD-induced toxicity in human keratinocytes. The results indicated that RSE pretreatment significantly could suppress PPD induced cytotoxic effects, including decrease of cell viability, accumulation in subG1 phase of cells, and relocation of phosphatidylserine on keratinocytes. Also, we found that PPD caused cytotoxicity was associated with mitochondrial membrane potential loss and subsequent activation of caspase and PARP degradation. However, pretreatment of RSE showed preventive activities against PPD induced mitochondrial membrane potential loss and ROS production in keratinocytes. In conclusion, the results of present study suggest that RSE was able to protect the skin from several cytotoxic effects of PPD and could be a meaningful material in many industries using PPD.

Hair Dye poisoning: "An early intervention"

The use of hair dye has been emerging worldwide however usage of Paraphenylenediamine (PPD) in making hair dye is generally restricted to underdeveloped and developing countries. In particular, prevalence of accidental and suicidal ingestion is more in low socioeconomic areas. The spectra of hair dye toxicity is wide, however, it presents more commonly with severe angioedema of face and neck leading to respiratory failure, rhabdomyolysis complicating into acute kidney injury, myocarditis and acute liver injury. Here we present a unique case of PPD poisoning in a young female presented with laryngeal edema and marked rhabdomyolysis. Preemptive shifting to Critical care unit and elective endotracheal intubation for air way patency obviated the need of tracheostomy and precluded its related complications. Moreover, aggressive intravenous hydration prevented from renal failure despite markedly raised Creatine phospho kinase (CPK) levels.

p-Phenylenediamine and other allergens in hair dye products in the United States: a consumer exposure study

BACKGROUND

Hair dye products constitute an important source of allergen exposure, and contribute importantly to allergic contact dermatitis in consumers and hairdressers.

OBJECTIVES

To evaluate the presence of potent contact sensitizers in oxidative hair dye products intended for home use on the US market.

METHODS

Ingredient labels of 107 hair dyes from 10 major brands were examined and used to assess the prevalence of hair dye substances known to be potent contact sensitizers.

RESULTS

One hundred and six of 107 (99%) products contained at least one potent sensitizer, and the average product contained six (range 0-11). p-Phenylenediamine (PPD) was found in 83 products (78%), but resorcinol (89%), m-aminophenol (75%), p-aminophenol (60%) and toluene-2,5-diamine (21%) were also frequently identified.

CONCLUSIONS

Potent contact sensitizers were almost universally included in the hair dyes investigated in the United States. Although PPD is a common allergen, resorcinol and m-aminophenol were found more frequently. In total, 30 potent sensitizers were found. Clinicians should consider other allergens in addition to PPD when evaluating patients with suspected hair dye allergy.

A case of severe methemoglobinemia caused by hair dye poisoning

Context:

Hair dyes are widely used and very popular xenobiotics. Most of these products contain paraphenylenediamine (PPD) that can cause methemoglobinemia. We here report a case of severe methemoglobinemia that we treated using large amounts of methylene blue.

Case details:

A 30-year-old man visited a regional hospital with cyanosis. He was congenitally blind and had autism. For several weeks, he had mistaken hair dye for toothpaste. When he arrived at a regional hospital, he was drowsy with cyanosis and his initial serum methemoglobin (MetHb) level was 59.5%. After being treated with 2 mg/kg methylene blue (1 mg/kg × 2 administrations), he was transferred to a tertiary university hospital. Upon presentation at the Emergency Department in the tertiary hospital, his MetHb level was found to be 49.4% and his oxygen saturation was 80%. He was then admitted to the intensive care unit. After treatment with 4 mg/kg methylene blue (1 mg/kg × 4 administrations), he successfully recovered.

Discussion:

Because PPD can result in serious methemoglobinemia, clinicians should test it in cyanotic patients who have been exposed to hair dye for an extended period.

Paraphenylene diamine poisoning

The commonest constituent of all hair dyes is paraphenylene diamine (PPD) being used by the people to color their hair all over the world. Hair dye poisoning is emerging as one of the emerging causes of intentional self-poisoning to commit suicide. In this article, the importance of clinical manifestations and of hair dye poisoning is discussed due to the lack of specific diagnostic tests. Since there is no specific antidote for PPD poisoning, the early supportive treatment modalities are discussed.

Paraphenylene diamine poisoning

The commonest constituent of all hair dyes is paraphenylene diamine (PPD). Hair dye poisoning is emerging as one of the emerging causes of intentional self-poisoning to commit suicide. In this article, we report a case of PPD poisoning and the importance of clinical of hair dye poisoning. The lack of specific diagnostic tests, a specific antidote for paraphenylene diamine poisoning and the importance of early supportive treatment modalities are also discussed.