P-Phenylenediamine Hair Dye Allergy and Its Clinical Characteristics

BACKGROUND: P-phenylenediamine (PPD) has been identified as the most frequent contact sensitizer of hair dye and the clinical characteristics of hair dye contact allergy (HDCA) are diverse. OBJECTIVE: The purpose of this study was to identify the clinical characteristics of HDCA and to assess the relationships between HDCA, exposure time to PPD and PPD positivity. METHODS: We analyzed 105 patients with patch test-confirmed hair dye allergy who presented between July 2009 and March 2015. Clinical symptoms, signs, associated skin diseases, involved ACD area, and patterns of hair dye use were obtained by reviewing medical records and by interview. RESULTS: HDCA was more common in women and in individuals aged more than 50 years. Pruritus was the most common symptom; erythematous macules and patches were the most frequently observed clinical signs. The most common site of HDCA was the face and non-specific eczema and urticaria were frequently observed with HDCA. Exposure time to hair dye, represented as frequency and duration, showed a positive correlation with the area affected by hair dye allergy (p < 0.001). Hair dye allergy was identified in most patients (80%) before diagnosis by patch test. However, only 28.6% of all patients stopped using hair dye, even after the diagnosis was confirmed. CONCLUSION: The extent of hair dye allergy involvement was related to exposure time to hair dye. For effective treatment of HDCA, it is important to properly educate patients with HDCA about the clinical manifestations of HDCA and to keep away from allergens.

Tatuagens: de temporárias a permanentes / Tattoos: from temporary to permanent

A realização de tatuagens temporárias é frequente, sendo percebida como inofensiva. A tinta usada deriva da henna, pigmento castanho-avermelhado obtido de uma planta. No entanto, para obter "henna negra" e facilitar a realização da tatuagem, são adicionados outros compostos, mais frequentemente a parafenilenodiamina. Esta está associada a reações alérgicas, por vezes graves e com sequelas. Os autores apresentam um caso de uma criança de 10 anos com uma reação alérgica exuberante com provável sobreinfecção bacteriana em local de tatuagem temporária. Havia história de sensibilização prévia, pelo que a reação foi precoce e mais agressiva. Os sinais inflamatórios francos motivaram o internamento sob corticoterapia sistêmica e antibioticoterapia endovenosa. Apesar da boa evolução clínica, permaneceu uma lesão hipopigmentada sequelar. Pretende-se alertar para os perigos desta realidade e também para a falta de legislação existente.

Temporary tattoos are quite popular, and they are perceived as harmless. The ink used in temporary tattoos is made from henna, a reddish-brown coloring pigment obtained from a shrub. However, in order to obtain "black henna" and facilitate the tattooing process, other compounds are added to the mixture, especially p-phenylenediamine. This compound is associated with allergic reactions that are sometimes severe and may leave sequelae. The authors describe a case of a 10-year old child presenting with allergic reaction and probable bacterial superinfection in a temporary tattoo area. The patient had a history of prior skin sensitization, and therefore the reaction was early and more aggressive. The severity of the inflammatory signs motivated hospital admission for systemic corticosteroid therapy and intravenous antibiotic therapy. Despite the good clinical evolution, a hypopigmented lesion persisted. Our goal is to raise awareness on the dangers of this practice and to highlight the lack of legislation in the area.