A case of hair dye-induced contact anaphylaxis

Anaphylaxis is a sudden-onset life-threatening systemic hypersensitivity reaction. Allergens, such as foods, stinging insect venoms, and drugs, are the globally important causative factors for anaphylaxis. Para-phenylenediamine (PPD), an aromatic amine, is a well-known hair dye component that can act as a skin irritant and/or a skin sensitizer. As an allergen, PPD can induce various reactions; the most common being contact dermatitis, a delayed-type hypersensitivity reaction. Anaphylaxis or other immediate hypersensitivity reactions by hair dye contact is extremely rare, with only a few cases reported worldwide. Here, we report a case of a 63-year-old female who presented to the Emergency Department with dyspnea, rash, vomiting, and diarrhea within minutes after using a hair dye product containing PPD. Her past medical history includes urticaria of unknown cause. Her total IgE antibody level was increased to 630 kU/L. Skin prick and patch tests with the hair dye she applied at the time of anaphylaxis demonstrated an immediate reaction. An additional patch test with 25 common contact allergens showed positive reaction to PPD. This is the first case report of hair dye-induced contact anaphylaxis presenting sensitization to PPD in Korea.

Patch tests with commercial hair dye products in patients with allergic contact dermatitis to para‑phenylenediamine.

Background: Hair dye is one of the most common causes of allergic contact dermatitis. The main allergen has been identified as para‑phenylenediamine. To prevent the recurrence of contact dermatitis to para‑phenylenediamine, patients should discontinue the use of para‑phenylenediamine‑containing hair dye products. However, many patients are unable to discontinue their use for cosmetic or social reasons. Sometimes, they continue to have symptoms even after switching to so‑called “less allergenic” hair dyes. Objectives: To evaluate the safety of 15 commercially available hair dye products in patients with allergic contact dermatitis due to para‑phenylenediamine. Methods: We performed patch tests using 15 hair dyes that were advertised as “hypoallergenic,” “no para‑phenylenediamine” and “non‑allergenic” products in the market. Results: Twenty three patients completed the study and 20 (87.0%) patients had a positive patch test reaction to at least one product. While four (26.7%) hair dye products contained para‑phenylenediamine, 10 (66.7%) out of 15 contained m‑aminophenol and 7 (46.7%) contained toluene‑2,5‑diamine sulfate. Only one product did not elicit a positive reaction in any patient. Limitations: Small sample size and possibility of false‑positive reactions. Conclusions: Dermatologists should educate patients with allergic contact dermatitis to para‑phenylenediamine about the importance of performing sensitivity testing prior to the actual use of any hair dye product, irrespective of how it is advertised or labelled.

Reacción a un tatuaje de henna negra tratado con furoato de mometasona y gel de silicona: Caso clínico / Reaction to a black henna tattoo treated with mometasone furoate and silicone gel: case report

Black henna tattoos have paraphenylenediamine (PPD), which contains a product of herbal origin, which due to its molecular characteristics is capable of inducing, in susceptible individuals, a type IV hypersensitivity reaction. It clinically manifests as a contact dermatitis that usually when it disappears, scarring and hypopigmentation are left in the injured area. Objective: To describe the case of a patient with hypersensitivity to henna tattoo and to present the most relevant phenomena associated with this condition. Case report: The case of a 6 year-old patient with a black henna tattoo on his right leg, who was diagnosed with contact dermatitis probably attributed to PPD, is presented. Mometasone furoate and topical silicone gel treatment was started with good response. Conclusion: Mometasone furoate and silicone gel are a good possible therapeutic option for treating contact dermatitis caused by PPD as the dermatosis was resolved without residual lesions.

Los tatuajes de henna negra son aquellos que contienen parafenilendiamina (PPD), que contienen un producto de origen herbal, que por sus características moleculares es capaz de inducir, en individuos susceptibles, una reacción de hipersensibilidad tipo IV. Se manifiesta clínicamente como una dermatitis de contacto, que generalmente al desaparecer, persiste de manera residual una cicatriz hipertrófica e hipopigmentación en la zona lesionada. Objetivo: Describir el caso de un paciente con hipersensibilidad al tatuaje de henna, y presentar los fenómenos más relevantes asociados a esta patología. Caso clínico: Paciente de 6 años de edad, que se realizó un tatuaje con henna negra en la pierna derecha, en quien se diagnosticó posteriormente una dermatitis de contacto atribuida probablemente a la PPD. Se comenzó tratamiento con furoato de mometasona y gel de silicona con buena respuesta por vía tópica. Conclusión: El furoato de mometasona y gel de silicona son una posible opción terapéutica de utilidad para tratar la dermatitis de contacto causada por el PPD, debido a que la dermatosis se resolvió sin lesiones residuales.

Super Vasmol Hair Dye: An Emerging Fatal Poison.

Hair dye poisoning is not rare, but is an emerging poisoning in India. The main component of super vasmol hair dye causing toxicity is paraphenylenediamine (PPD) and can cause rhabdomyolysis, laryngeal edema, severe metabolic acidosis, acute renal failure (ARF) and myocarditis. There is no specific antidote for hair dye poisoning and treatment is mainly supportive. We report a case of suicidal ingestion of hair dye that presented with angioneurotic edema, rhabdomyolysis and ARF. Our patient improved completely with dialysis and symptomatic management. Various pathogenesis of its complications are also explained in this case report.

Contact dermatitis to hair dye: An update.

Exposure to hair dyes has long been known as a significant risk factor for development of allergic contact dermatitis among the exposed population as these lead to severe eczema of face and upper trunk in the consumer and hand eczema in hair-dressers. Currently, para-phenylenediamine (PPD) is the main ingredient used in permanent hair color products in the market and is the most important allergen. Prevalence of PPD sensitization is high in patients with contact dermatitis across all continents, with hair dye use being the commonest cause. In order to decrease the burden of disease, use of alternative natural dyeing agents among consumers and use of barrier neoprene gloves among hairdressers should be encouraged apart from stringent legislation to reduce the amount of PPD reaching the consumer.

An electromyographic and enzymatically confirmed case of inflammatory myopathy in hairdye poisoning.

Reports on electromyographic changes in poisoning with hairdye containing paraphenylenediamine are scant. In view of the number of cases of hairdye ingestion presenting with severe pain in the limbs, it was planned to record the electromyogram and observe the pattern. This is a report on electromyographically and enzymatically proved case of systemic poisoning with hairdye (paraphenylenediamine) ingestion, resulting in quadriparesis and acute renal failure.

Contact Vitiligo Associated with Allergic Contact Dermatitis to Para-phenylenediamine / 대한피부과학회지

Contact vitiligo with allergic contact dermatitis is a rare condition. Early diagnosis of contact vitiligo is imperative, as it could halt the progression of depigmentation, unlike idiopathic vitiligo. We herein report a case of contact vitiligo with allergic contact dermatitis due to para-phenylenediamine.

Allergic dermatitis to hair dyes: an analysis of 597 cases in Tianjin / 中华医学美学美容杂志

Objective To investigate the morbility and epidemic characteristics of hair dye dermatitis in individuals who dyed their hair in Tianjin.Methods Questionnaires were distributed to the outpatients in the Gerneral Hospital of Tianjin Medical University,students and teachers in Tianjin Medical University,residents in the community and customers in barber shop from Aug.2007 to Mar.2008.The personal data including the methods and site of coloring hair and something correlated to hair dyes were investigated.Results A total of 597 cases with the history of coloring hair were enrolled in the study,including 485 women and 112 men,with mean age of 41 years (ranged from 16- 74years).Among 597 cases,69 cases had allergic reactions to hair dye,including 51 women and 18 men,with mean age of 44 years (ranged from 19-65 years).The median age of the first coloring hair was 40 years (ranged from 3-50 years).The comparison between the sites of coloring hair had no statistic significance (P ＞0.05),but there was a significant difference between black dyed hairs and col or dyed hairs (P ＜0.05).Conclusions People with black hair dye are prone to be allergic.

Hair dye poisoning: An emerging epidemic.

In view of the increasing number of case reports of hair dye poisoning it is important to sensitise medical professionals and toxicologists about its potentially lethal toxicity, and guidelines pertaining to management. Most permanent hair dyes contain paraphenylenediamine, which is nephrotoxic. The main aim of this communication is to create awareness amongst the medical fraternity regarding hair dye poisoning, so that cases of accidental or deliberate ingestion can be readily diagnosed and effectively treated.

Incidence of suicides by poisoning with a popular indian brand of hair dye.

Hair dyes are being used extensively by the general populace in India, and several brands are available in the market. There are increasing reports of suicidal ingestion of hair dye from various parts of the country because of easy availability and high lethality. This autopsy study was conducted with reference to deaths resulting from suicidal exposure to one of the most popular brands of permanent hair dye (Super Vasmol 33) in this part of the country, in order to understand the incidence and implications. Results revealed a female preponderance, with the most common age group affected being 20–30 years.

Suicide by para-phenylenediamine poisoning.

Twenty three cases of acute para-phenylenediamine poisoning were examined clinically at emergency ward of Rama Medical College Hospital, Kanpur (Uttar Pradesh) irrespective of age, sex and socio-economic strata along with route and manner of administration of the poison. Albuminuria, anaemia, hypocalcemia, leucocytosis, thrombocytopenia, increased serum bilirubin, prolonged bleeding and clotting time alongwith increased levels of liver enzymes and serum creatinine were observed as significant bio-chemical parameters; on investigation in respect to complete haemogram, liver function test, renal function test, serum electrolytes, serum CPK levels and arterial blood gas analysis. The para-phenylenediamine is the ingredient of a traditional cosmetic hair dye available with the trade name Godrej expert powder hair dye, which is orally administered mainly with an intention to commit suicide, sometimes accidentally and very rarely as homicidal poison by hair dye users. The suicidal poisoning is more common in females as compared to males. The systemic toxicity of PPD has serious consequences which may eventually lead to death. The cases are reported with the advice “public education and strict control over the sale and distribution of para-phenylenediamine should be done to reduce poisoning by this agent”.

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

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.

Contact dermatitis with henna tattoo.

Allergic and irritant reactions to henna are rare. Para-phenylenediamine, which is sometimes added to obtain a dark, blackish henna, causes the majority of contact dermatitis reported related with tattoos. Allergic contact dermatitis due to temporary paint-on tattoo with black henna is described in two adolescents.

A Case of Allergic Contact Dermatitis due to Henna Tattooing / 대한피부과학회지

Tattooing and other forms of body art have recently become popular fashion accessories worldwide. Temporary henna tattooing has also become increasingly popular and is readily available. Henna, which is called Mehndi in Indian, is a plant that is commonly used as a temporary dyeing agent. Para-phenylenediamine (PPD) is added to the Henna tattooing process in most cases to hasten the drying process and enhance darkness. Since PPD is widely recognized as a sensitizer, the risk of allergic contact dermatitis from henna tattoo mixtures is increasing. We report a case of contact dermatitis from a henna tattoo mixture, which developed 2 weeks after henna tattooing.

Hair dye poisoning: A case report.

A case is reported of an 18 year-old female who ingested a toxic quantity of a hair dye containing paraphenylenediamine (PPD), and presented with severe metabolic acidosis, rhabdomyolysis leading to acute renal failure, and toxic myocarditis leading to myocardial dysfunction. Haemodialysis, cardiac supportive treatment, and ICU care resulted in complete recovery over a 1-month period.

Obstrucción aguda de la vía respiratoria superior y rabdomiolisis luego de intoxicación por tintura de cabello / Acute upper respiratory obstruction and rhabdomiolysis due to intoxication with a hair dye

Las intoxicaciones por tinturas para el cabello son infrecuentes en Antioquia; sin embargo, su toxicidad es potencialmente letal cuando ingresan al organismo por vía oral al producir un compromiso multiorgánico que puede llevar a la muerte del paciente. Se presenta el caso de una paciente de 2 años que ingirió una dosis de 125 mg/kg de parafenilendiamina, asociada a ácido bórico y perborato de sodio, compuestos que hacen parte de una presentación comercial de una tintura para el cabello; la intoxicación por parafenilendiamina tuvo como consecuencia principal la obstrucción de la vía aérea por angioedema que requirió intubación endotraqueal, soporte ventilatorio y administración de esteroides y antihistamínicos; secundario al compromiso aéreo la paciente presentó edema agudo de pulmón y posteriormente un cuadro neumónico que requirió tratamiento con antibióticos. Adicionalmente presentó rabdomiolisis severa que se trató con líquidos endovenosos para que no se comprometiera la función renal. Luego de una terapia durante 10 días en el hospital, la niña fue dada de alta con resolución completa del cuadro tóxico.Se revisan los posibles mecanismos fisiopatológicos, las manifestaciones clínicas y el tratamiento de la intoxicación por parafenilendiamina, dado que este fue el compuesto tóxico clínicamente importante en el contexto de este reporte de caso.

There have been few cases reported of intoxication by hair dyes in Antioquia; however, their toxicity may be potentially lethal when their components enter the organism by oral route inducing a multiorganic compromise that may lead to death. We report the case of a two year old girl who ingested 125mg/kg of paraphenylenediamine, with boric acid and sodium perborate; these compounds are part of the commercial presentation of a hair dye; the child suffered airway obstruction because of angioedema that required intubation, ventila tory support, steroids and antihistaminics; due to the airway involvement the patient presented acute pulmonary edema and subsequently pneumonia that required antibioticotherapy. Additionally, she had severe rhabdomyolysis that was treated with adequate fluid administration to avoid alterations in renal function. She remained at hospital for ten days and was discharged in good condition. We review the possible pathophysiologic mechanisms, the clinical manifestations and the treatment of paraphenylenediamine intoxication because this compound was the most important cause of the clinical manifestations of our patient