Dr.Tasadoq Hussain Jaweed & Zaffar Ayub
Henna has been used to decorate women’s bodies during marriage ceremonies and other social celebrations since the Bronze Age. In the Indian subcontinent, henna is used for skin decoration and hair dying during social celebrations, and during marriage ceremonies people celebrate by adorning the bride, and the groom, with henna. Henna body art is made by applying henna paste to the skin. When henna paste is applied to the skin, the dye (lawsone) migrates from the paste to the outermost layer of the skin; a red-brown stain is attained if the paste is left on the skin for a longer time. In countries, where natural henna art is traditionally practiced, reports of allergic contact dermatitis to natural henna are very rare in the literature. It can therefore be assumed that natural henna is not a strong skin allergen.
However, most of our female population uses black henna as body art without knowing the latent threat to beauty associated with it. Black henna available in the form of tubes and cones mixed with PPD. para-Phenylenediamine (PPD) is an aromatic amine compound with chemical formula C6H8N2 was declared the Contact Allergen of the Year for 2006 by the American Contact Dermatitis Society (ACDS). It is a white to light purple powder that darkens on exposure to air because it oxidizes, turning first red, then brown then finally black. PPD gained infamy from being an ingredient, used either pure or as an “additive” to henna, to create or give henna a black tattoo-like appearance which otherwise gives an red-brown brown stain. Any product that calls itself black henna must contain this ingredient in addition to pure henna to achieve its color. Another reason for using PPD additives is to speed up the staining process. While traditional henna staining takes 2-12 hours, a pure black tattoo can be achieved within an hour or two with the addition of PPD, and there will be a longer lasting effect as well. In other words, there is no such plant that gives “black henna” and here we see scientific proof that it is the chemical called PPD that makes this phenomenon
PPD is a potent skin sensitizer and people applying it may develop dermatitis on their hands and occasional spreading to the arms and upper chest. Acute exposure to high levels of para-Phenylenediaminemay cause severe dermatitis, eye irritation and tearing, asthma, gastritis, renal failure, vertigo, tremors, convulsions, and coma in humans. Chronic dermal exposure Lethargy, anorexia, gastro-intestinal disturbances, liver and spleen enlargement, sub-acute atrophy of the liver, jaundice, chronic renal failure, progressive neurological symptoms and coma have all been attributed to chronic exposure to PPD. There is now an epidemic of sensitization (allergic reaction) to this chemical because of over-exposure. The allergic reactions can be severe and require hospitalization. Long term effects of exposure to this chemical include lupus, asthma, non-Hodgkins lymphoma, and there appear to also be links to breast, uterine and bladder cancer.
PPD has also been suspected of precipitating contact leukoderma and vitiligo in genetically predisposed individuals. In addition to local effects, there is the risk of systemic toxicity. Transcutaneous absorption of PPD is rapid and may lead to systemic effects including angioedema, gastro-intestinal disturbances, tremors, drowsiness, convulsions, dyspnoea, liver atrophy, acute renal failure, cardiac arrest and death.
“Poisoning by a mixture of henna dye and para-phenylenediamine dyes led to the hospitalization of 31 Sudanese children between 1984 and 1989. There was a characteristic clinical presentation. All children presented with an acute and severe angioneuroticoedema and 15 of the cases required emergency tracheostomy for respiratory obstruction. Acute renal failure occurred in five children who recovered after peritoneal dialysis. Mortality was high, all 13 deaths occurring within 24 hours of presentation. It is possible that similar cases may be occurring unrecognized where henna is traditionally used.
In acute severe cases of PPD dye dermatitis, wash the skin thoroughly with a mild soap or soap-less shampoo to remove the excess dye. Apply a 2% hydrogen peroxide solution or compresses of potassium permanganate in a 1:5000 dilution to completely oxidise the PPD. To soften the crust and tight feeling of the scalp, a wet dressing of cold olive oil and lime may be used. Further treatment with a topical application of an emulsion of water and water-miscible corticosteroid cream, or oral corticosteroids may be indicated. Management of PPD dermatitis on other parts of the body may be treated as for any acute dermatitis/eczema; this may include treatment with topical corticosteroids and emollients.
Sensitization by PPD has been considered by some countries to be so great a hazard that its use was banned in Germany in the early 1900’s. It was subsequently prohibited in France, and in 1964 in Sweden. In Jammu and Kashmir, a programme of public education and restriction of para-phenylenediamine is urgently required to stop this threat to beauty of female population.
—The authors can be reached at: [email protected]