Paraphenylene diamine hair dye poisoning in an adolescent

Abstract

A 14-year-old female was referred to the pediatric nephrology unit with a short history of progressive angio-oedema of the face requiring tracheostomy. She ingested an unusual substance which caused swollen tongue, cervical oedema and dark coloured brown urine. These clinical features with the laboratory tests confirmed the diagnosis of paraphenylene diamine (PPD) poisoning. Psychological assessment confirmed that the child had severe depression. The suicide attempt was just immediately after failure in the final qualifying examination to secondary school. She did not have any family support but she used to be punished in different ways. In Sudan PPD in its pure form is available in the local market and until recently there was no restrictions for its use or trade. Adolescents are well aware of its toxic effects and it is commonly used to attempt suicide. Legislation and laws should prevent its use in different hair dye formulations and look for another substitute. Clinical management is hampered by the lack of a rapid diagnostic test; no other treatment other than supportive measures can be offered.

Clinical Profile and Outcomes of Hair Dye Poisoning in a Teaching Hospital in Nellore

“…Accidental or intentional poisoning results in systemic toxicity [11] in a dose-dependent manner [12]. In our study, we observed the classical features of poisoning within four to six hours of ingestion.…”

“…During the hospital stay, 24 (48%) required ventilatory support for airway compromise; among them, two (4%) patients died due to respiratory failure during hospital stay. The mean ICU stay was 6.35 ± 4.19 days (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). The duration of ventilator support was 6.19 ± 4.19 days (1-13).…”

Paraphenylene diamine poisoning

“…Apart from intentional or accidental excessive exposure to PPD which results in above manifestations, the routine use of this compound on the regular basis for a long time can also lead to toxic effects. [10] Membranous nephropathy has also been reported when toxicity occurs in smaller doses. It occurs due to formation of immune complexes.…”

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

“…p-Phenylenediamine * (78) m-Aminophenol (76) Toluene-2,5-diamine (sulfate) (80) m-Aminophenol * (75) p-Phenylenediamine (50) m-Aminophenol (68) p-Aminophenol * (60) Toluene-2,5-diamine (sulfate) (49) 2-Methylresorcinol (39) N,N-Bis(2-hydroxyethyl)-pphenylenediamine * (41) 4-Amino-2-hydroxytoluene (35) 4-Amino-2-hydroxytoluene (35) 2,4-Diaminophenoxyethanol * (36) 2-Methylresorcinol (33) p-Aminophenol (25) 4-Amino-2-hydroxytoluene * (36) p-Aminophenol (32) 2,4-Diaminophenoxyethanol-HCl (25) 2-Methylresorcinol (32) 2,4-Diaminophenoxyethanol-HCl (30) 4-Amino-m-cresol (18) Toluene-2,5-diamine *(21) N,N-Bis(2-hydroxyethyl)-p-phenylenediamine sulfate Designates allergens that were reported as either a free base, sulfate, or HCL.…”