Prevalence of Contact Allergy to p-Phenylenediamine in the European General Population

Abstract

Population-based studies on contact allergy to p-phenylenediamine (PPD) are scarce. A cross-sectional study was performed to assess the prevalence of contact allergy to PPD and its risk factors in the general population of 5 European countries. A total of 10,425 subjects were interviewed, and a random sample (n = 2,739) was patch tested to PPD. Overall, 5,286 individuals (50.9%) reported having used hair colorants at least once in their lifetime (78% female, 20% male), and 35% had used hair colorants during the last 12 months. Hair colorant avoidance because of any skin problem during the lifetime was reported by 6%. Black henna tattoos had been used by 5.5% during their lifetime. The prevalence of PPD contact allergy was 0.8% (95% confidence interval 0.6-1.0%), with no statistically significant association with gender or hair dye use. The prevalence of PPD in black henna tattoo users was 3.2% versus 0.6% in nonusers (P < 0.001). A clinically relevant positive patch test reaction to PPD related to hair coloring products was found in 0.1% (95% confidence interval 0.0-0.2%). A significant association with PPD contact allergy was observed for subjects who had black henna tattoos in their lifetime, with an age- and gender-adjusted odds ratio of 9.33 (95% confidence interval 3.45-25.26, P < 0.001). Black henna tattoos are an important risk factor for PPD contact allergy.

Contact sensitization to hair colours in acquired dermal macular hyperpigmentation: results from a patch and photo‐patch test study of 108 patients

“…27,28 Though we identified PPD and hair colours as the predominant contact sensitizers amongst our patient population having dermal hyperpigmentation, the type of antigens can vary depending upon the skin phototype, geographical localization and cultural practices of the studied population. 37 This especially holds true in Indian population where the application of henna tattoos is a common cultural practice. Moreover, even if subtle eczema does develop, it is difficult to discern the pinkness of skin in darker phototypes III-VI.…”

Two decades of p‐phenylenediamine and toluene‐2,5‐diamine patch testing – focus on co‐sensitizations in the European baseline series and cross‐reactions with chemically related substances

“…The prevalences of contact allergy in both the general and the patch tested population remain high, at 1.3% and 3.3%, respectively, in the population of The Netherlands . Diepgen et al reported a similar prevalence, namely 0.8%, in the general population of Europe .…”

Monitoring of Lawsone, p‐phenylenediamine and heavy metals in commercial temporary black henna tattoos sold in Turkey

“…In the past 10 years, natural henna has been mixed with additives such as p ‐phenylenediamine (PPD), coffee or black tea, lemon juice, eucalyptus and clove or mustard oil to obtain a darker colour in the applications, and the new mode of this application, called ‘temporary black henna tattoo’, has become very popular in holiday resort areas. Although pure henna is relatively safe, with only a few reports of allergic reactions, black henna tattoos have been increasingly reported as a cause of allergic skin reactions , because PPD is known as a potent contact allergen . Although PPD is limited in hair dye to 2% calculated as free base , it is still being found in unregulated temporary black henna products at alarming levels ranging up to 64%.…”