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.

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

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.

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.

Screening for PPD using HPLC- dad in fatal cases with hair dye in upper Egypt

Para-phenylenediamine [PPD] is used alone or in combination with Henna as hair dye or skin decoration. The present study was conducted on 84 fatal cases[27 males and 57 females] who used hair dye using biological samples [urine and blood] referred to Assiut Forensic Chemistry Laboratory of Medico-legal Department, Assiut, from January 2007 to December 2012 to confirm PPD intoxication and to understand the magnitude and pattern of accidental suicidal and homicidal poisoning by PPD among males and females in Upper Egypt. During this period, the cases were reported. The suicidal homicidal and accidental cases were 77[91.7%], 6[7.1%] and I [1.2%], respectively. The suicidal poisoning of females was higher 55 cases [71.4%] than of males 22 [28.6%]. Most of the PPD deaths were between the third and fourth decades of life. PPD was detected by High Performance Liquid Chromatography - Photo Diode Array detector Agilent technologies 1200 Series [USA] [HPLC-DAD] in blood and urine samples. The present study concluded an the advice of "public education and strict control over the sale and distribution of PPD should be done to reduce poisoning by this agent

Determination of 2, 4-toluenediamine in urine by gas chromatography / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To establish a method for determining the content of 2,4-toluenediamine, a urinary metabolite of toluene diisocyanate, by gas chromatography.</p><p><b>METHODS</b>Urine samples were collected, and acidification, extraction, derivatization, separation with a capillary column, and detection with an electron capture detector were performed. The target compound was qualified by retention time and quantified by peak area.</p><p><b>RESULTS</b>The concentration of 2, 4-toluenediamine showed a linear relationship with peak area within 0.0∼40 ng/ml, with a correlation coefficient 0.9995; the limit of detection was 0.44 ng/ml, the lower limit of quantification was 1.47 ng/ml, the relative standard deviation was 1.85%∼4.05%; the recovery rate was 97.98%∼99.28%.</p><p><b>CONCLUSION</b>The method has the advantages of high sensitivity and high accuracy and can be used for determination of 2, 4-toluenediamine in urine.</p>

Patch Test (T.R.U.E. Test) Results in Patients with Allergic Contact Dermatitis: 2007~2011, Chungcheongnamdo / 대한피부과학회지

BACKGROUND: A number of skin manifestations in patients with allergic contact dermatitis result from sensitization with specific allergens, and patch testing is used as a diagnostic means of identifying theses allergens. In Korea, the commercial patch test panel, the TRUE-test, has been available since 2005. However, there have been few reports regarding the results of the TRUE-test. OBJECTIVE: The purpose of this study was to analyze the type, frequency, and changes in common contact allergens in Korea using the TRUE test. METHODS: A total of 311 patients with allergic contact dermatitis were evaluated by the TRUE test between January 2007 and December 2011 at Soonchunhyang hospital. Patch test reading was performed on day 2 and day 4. RESULTS: A total of 311 cases of TRUE test records (male 79, female 232) were compiled and analyzed. The highest age distribution was the 4th decade in females. The face, with exception of the lips, was the most frequently affected site (40.2%). Overall, 58.8% of patients had at least on positive reaction, and the most common allergens were nickel sulfate (31.8%), p-phenylenediamine (13.5%), cobalt chloride (10.0%), thiomersal (7.4%), and carba mix (5.5%). Nickel allergen displayed higher positive rates than the rates in other countries. CONCLUSION: There was no significant difference in the overall positive rate of patch test results compared with recent studies. However, we confirmed that metal-related allergens remain the most common, and that the results provide the basis for the use of the TRUE test in patients with contact dermatitis in Korea.

Praziquantel Treatment in Trematode and Cestode Infections: An Update

Status and emerging issues in the use of praziquantel for treatment of human trematode and cestode infections are briefly reviewed. Since praziquantel was first introduced as a broadspectrum anthelmintic in 1975, innumerable articles describing its successful use in the treatment of the majority of human-infecting trematodes and cestodes have been published. The target trematode and cestode diseases include schistosomiasis, clonorchiasis and opisthorchiasis, paragonimiasis, heterophyidiasis, echinostomiasis, fasciolopsiasis, neodiplostomiasis, gymnophalloidiasis, taeniases, diphyllobothriasis, hymenolepiasis, and cysticercosis. However, Fasciola hepatica and Fasciola gigantica infections are refractory to praziquantel, for which triclabendazole, an alternative drug, is necessary. In addition, larval cestode infections, particularly hydatid disease and sparganosis, are not successfully treated by praziquantel. The precise mechanism of action of praziquantel is still poorly understood. There are also emerging problems with praziquantel treatment, which include the appearance of drug resistance in the treatment of Schistosoma mansoni and possibly Schistosoma japonicum, along with allergic or hypersensitivity reactions against praziquantel treatment. To cope with and overcome these problems, combined use of drugs, i.e., praziquantel and other newly introduced compounds such as triclabendazole, artemisinins, and tribendimidine, is being tried.

Tatuajes de henna negra: revisión de la literatura a partir de un caso clínico / Black henna tattoos: case report and review of the literature

En la actualidad los tatuajes de henna negra se utilizan en forma muy frecuente, por lo que el número de reportes sobre reacciones adversas asociadas a su uso se ha incrementado. La Parafenilendiamina o PPD es el químico que más se adiciona a la henna para intensificar y prolongar la duración del color del tatuaje. Posee un gran poder sensibilizante y se le atribuyen la mayoría de las reacciones, desde dermatitis leve hasta reacciones generalizadas tipo eritema multiforme-like. Se presenta el caso de un paciente de 7 años con lesiones cutáneas frente a segunda exposición a tatuaje de henna. Con diagnóstico de dermatitis de contacto se maneja con corticoidestópicos con excelente respuesta clínica. Como prevención primaria planteamos la necesidad de programas que permitan educar a la comunidad en relación a los riesgos asociados a la exposición a PPD, recomendando el NO uso de tatuajes de henna negra.

Today, black henna tattoos are very commonly used, so the number of reports on adverse reactions associated with its use has increased. The paraphenylenediamine or PPD is the chemical that is most commonly added to henna to intensify and prolong the duration of the color tattoo. PPD act as sensitizer of most of the reactions, from mild dermatitis to generalized reactions erythema multiforme-like. We show a case of a 7 year old patient with skin lesions that appears during the second exposure to henna tattoos. We made the diagnosis of a contact dermatitis and we manage it with topical corticosteroids with excellent clinical response. As primary prevention we suggest the need of educational programs for the community regarding the risks associated with the exposure of PPD, and avoiding the use of black henna tattoos.

Modified methylene blue method for measurement of hydrogen sulfide level in plasma / 生理学报

In past decade, hydrogen sulfide (H₂S) as a novel gasotransmitter, covered many fields in biological and medical research. However, there is no effective, convenient and high-throughput method for determination of circulatory H₂S until now. Here, we aim to develop an easy method for measurement of circulatory H₂S by modified methylene blue method. In the present study, we added Zn²⁺ to plasma sample to deposit H₂S, HS⁻ and S²⁻, as well as plasma protein, then used NaOH to re-dissolve plasma protein. ZnS deposition was re-dissolved by the addition of N, N-dimethyl-p-phenylenediamine, and the remnant protein was deposited by trichloroacetic acid. After centrifugation, ferriammonium sulfate was added to the supernatant fluid to generate methylene blue, which was analyzed by spectrophotometer at 665 nm. Using the present method, we found that most ions including sulfate and thiosulfate did not affect detection of H₂S concentration, but albumin (physiological concentration) reduced the detection value, which suggested the binding of serum albumin and a certain amount of H₂S. The relative recovery ratio of present method is 81.9%, which implies that the method is relative accurate for the determination of H₂S concentration in plasma or serum. H₂S levels of frozen plasma samples from 65 healthy volunteers detected by the present method were (13.93 ± 4.98) µmol/L. There was no obvious difference between the detection values of fresh and frozen samples from the same SD rats. These results suggest the modified methylene blue assay is stable, sensitive, convenient and high-throughput. The method can be used to analyze the circulatory H₂S in clinical and basic research.

Patch Test in Children: Common Allergens and Comparison with Adult Group / 대한피부과학회지

BACKGROUND: Allergic contact dermatitis (ACD) was once regarded as a disorder of the adult population, while ACD in children was considered rare. However, ACD in children may be more common than previously realized and more recently, it has been estimated that more than 20% of the pediatric population is affected by ACD. However, in Korea results of patch testing in the pediatric population has not yet been reported. OBJECTIVE: The purpose of this study was to analyze allergens responsible for ACD in Korean children and investigate the influence of sex, involved site, and atopic dermatitis on contact allergen sensitization. We also wanted to compare the results between the pediatric and the adult group. METHODS: A retrospective analysis of all patch test results from our data base between 2009 and 2011 was performed. A total of 234 patients were patch tested. The pediatric population was defined as patients 18 years and younger, and total 30 pediatric patients were included. RESULTS: A total of 30 patch tested cases (male 12, female 18) were analyzed. Overall, 66.7% of pediatric patients had at least one positive reaction and common allergens were nickel sulfate (33.3%), thimerosal (13.0%), and black rubber mix (10.0%) in order of frequency. There were no significant differences between contact allergen sensitivity and sex or involved sites. However, in the atopic group, the positive reactions to wool alcohols were significantly higher than in the non-atopic group (p=0.0076). In adults, common allergens were nickel sulfate (34.8%), p-tert butylphenol formaldehyde resin (11.8%), cobalt chloride (11.3%) and thimerosal (11.3%) in order of frequency. This was not significantly different to the pediatric group. CONCLUSION: ACD in children is not uncommon and patch testing in suspected children revealed 66.7% of positive reaction.

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.

TRUE Test in Patients with Contact Dermatitis: A Multicenter Study / 대한피부과학회지

BACKGROUND: The TRUE test is a commercially available ready-to-apply patch test widely used in many countries, but no large-scale study is available on the TRUE test in Korea. OBJECTIVE: The purpose of this study was to analyze the type, frequency, and changes in the common contact allergens in Korea using the TRUE test. METHODS: From January 2009 to March 2010, TRUE tests were performed on patients with contact dermatitis at the Departments of Dermatology of 15 hospitals. The epidemiological findings of patients, and the results of the patch tests were analyzed. RESULTS: In total, 795 patch tested cases (246 males, 549 females) were compiled and analyzed. The oldest age distribution was the third decade in both males and females, and housewives and office-workers were the most common jobs, comprising 29.7% and 19.8% of the occupations, respectively. Overall, 65.1% of patients had at least one positive reaction, and the most common allergens were nickel sulfate (34.1%), thimerosal (12.6%), cobalt chloride (11.1%), and p-phenylenediamine (8.4%), in order of frequency. A univariate analysis of multiple variables including age, gender, occupation, and affected sites was conducted and a comparison with a previous multicenter study was also analyzed. CONCLUSION: These results provide the basis for use of the TRUE test in patients with contact dermatitis in Korea.

Knowledge and practices of, and attitudes towards, the use of hair dyes among females visiting a teaching hospital in Riyadh, Saudi Arabia

Use of hair dye is extremely common worldwide. However, our literature search failed to find studies concerning the knowledge and attitudes of the public with regard to hair dyes. We sought to explore the knowledge and practices of, and attitudes towards, the use of hair dye among females. A cross-sectional survey conducted on females who attended various outpatient clinics at King Khalid University Hospital in Riyadh, Saudi Arabia, a tertiary referral hospital open to the general public. A self-administered questionnaire about the use of hair dyes was distributed randomly among females attending the outpatient clinics at a university hospital in 2008. The response rate was 87.2%, with completion of 567 of the 650 distributed questionnaires. The mean [SD] age of respondents was 32.0 [10.2] years. Among respondents, 82.6% [464/562] had at some point dyed their hair. Furthermore, 69.3% [334/482] had dyed their hair in the past 12 months. The mean [SD] age of the participants when they first dyed their hair was 22.2 [7.1] years [range, 7-50]. Of the participants, 76.8% [354/461] used permanent dyes, and about the same percentage of participants believed such dyes were the safest hair dye type. However, 52.4% [278/531] of the participants believed that hair dyes are harmful, and 36% [191/531] believed that hair dyes could cause cancer. Younger females tend to dye their hair less frequently [P<001l], whereas those with less education tend to dye their hair more frequently [P=.013]. Use of hair dye is very common among females. Because the practice starts at a very young age, we conclude that hair dyes are overused and misused. The public should be informed about the risks associated with excessive hair dye use

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.

Detection of sterigmatocystin based on the novel aflatoxin-oxidase/chitosan-single-walled carbon nanotubes/poly-o-phenylenediamine modified electrode / 生物工程学报

A sensitive electrochemical biosensor based on Aflatoxin-Oxidase (AFO) was developed for detection of sterigmatocystin (ST). The enzyme was immobilized on chitosan-single-walled carbon nanotubes (CS-SWCNTs) hybrid film, which attached to the poly-o-phenylenediamine (POPD)-modified Au electrode. The fabricated procedures of the biosensor were characterized with atomic force microscopy (AFM), fourier transform-infrared spectroscopy (FT-IR), and electrochemical impedance spectroscopy (EIS). The cyclic voltammetric results of the biosensor indicated that AFO exhibited a surface-controlled and quasi-reversible electrochemical redox behavior with a formal potential of -0.436 V (vs. Ag/AgCl) in 0.1 mol/L PBS (pH 7.0), which resulted from the direct electron transfer between entrapped AFO and the underlying electrode. The enzymatic electrode exhibited an excellent electrocatalytic response to ST. The linear range of ST determination was from 10 ng/mL to 310 ng/mL with correlation coefficient of 0.997, the detection limit was 3 ng/mL (S/N=3), and the response time was less than 10 seconds. The apparent Michaelis-Menten constant (K(M)app) was estimated to be 7.13 micromol/L. The biosensor had the advantages of good repeatability and stability, remaining 85.6% of its original current value after storage at 4 degrees C for a month, and the RSD for 11 replicate determination of 20 ng/mL ST was 3.9%. This AFO/CS-SWCNTs/POPD/Au modified electrode showed high selectivity and sensitivity in real sample analysis, giving values of recovery in the range of 87.6%-105.5%. The proposed method can be applied to the determination of ST in real samples with satisfactory results.

Myocardial damage in hair dye poisoning--an uncommon presentation.

A 22-year-old female presented to us after consuming hair dye with features of angio-neurotic edema, asphyxia and irregular pulse. Serial ECGs revealed presence of ST segment elevation and T wave inversion in anterior chest leads. Strongly positive c-troponin-T test further confirmed the myocardial damage. This is a rare manifestation of para-phenylene diamine poisoning mentioned in literature. Patient also had elevated liver enzymes and oliguria.