Prolonged lichenoid reaction and cross‐sensitivity to para‐substituted amino‐compounds due to temporary henna tattoo

Abstract

An 8‐year‐old boy (case 1) was seen in September 2000 with pruritic papules on his left upper arm, 1 week after having received a so‐called henna painting in Egypt (Fig. 1a). An 18‐year‐old female student (case 2) was seen in August 2000 with pruritic papular skin eruptions on her lower back, 2 weeks after having obtained a so‐called temporary henna tattoo in Ibiza (Fig. 1d). In both patients, the skin lesions were localized to the paintings which had already faded, leaving a dragon‐shaped papular skin eruption and an infiltrated Chinese sign, respectively. 1a–e (a) Papular skin reaction following so called henna painting of a dragon (case 1); (b) Remaining hypopigmentation after 12 months (case 1); (c) Severe patch test reactions (72 h‐reading) to p‐phenylenediamine and IPPD (upper left), disperse orange 3 and disperse yellow 3 (upper right), tert. butylhydrochinone (lower left), p‐aminophenol, p‐toluylenediamine, disperse orange 3, p‐aminoazobenzol and 4,4′diaminodiphenyl methane (lower right) in case 1, an 8‐year‐old boy; (d) Chronic induration following so called henna painting of a chinese sign (case 2); (e) Histological specimen: lichenoid reaction (case 1) A histology obtained from the dragon‐shaped skin lesion showed irregular parakeratosis, plump acanthosis and spongiosis of the epidermis with exocytosis. The dermis showed monomorphous lichenoid lymphoid infiltrates, few histiocytes and eosinophils, partially erythrocyte extravasate and obliterated capillaries (Fig. 1e). In both patients patch test series (standard series*, textile dyes**, aromatic para‐substituted amino‐compounds***, cosmetics and skin care products****) were performed according to the German Contact Dermatitis Research Group. Additionally, procaine (pure), sulfamethoxazole (pure), saccharine (pure) and cyclamate (pure) were tested. In the 8‐year‐old patient, after 48 h and 72 h a +++‐reaction (i.e. erythema, infiltration and confluent vesicles according to the International Contact Dermatitis Research Group) occured to p‐phenylenediamine, p‐toluylenediamine, disperse orange 3, disperse yellow 3, p‐aminoazobenzol and p‐aminophenol; a ++‐reaction (i.e. erythema, infiltration, papules and vesicles) occured to IPPD, 4,4′diaminodiphenyl methane; and a +‐reaction (i.e. erythema, infiltration, papules) to tert. butyl hydroquinone (Fig. 1c). The 18‐year old patient exhibited a +++‐reaction to p‐phenylenediamine, p‐toluylenediamine, disperse orange 3 and p‐aminoazobenzol after 48 h and 72 h. Topical steroids were utilized for therapeutic intervention during the initial pruritic phase of skin lesions. In case 1, prednicarbat 0.25% cream was topically applied twice a day for 6 weeks. In patient 2, clobetasol‐17‐propionat 0.05% cream was used once a day for 2 weeks. When the discomfort ceased, this therapy was discontinued and a steroid‐free ointment (Unguentum leniens) was applied twice daily. In June 2001, in both patients, the skin lesions were invariably present. The infiltrate decreased on further follow‐up. At the 12‐months follow‐u...

A Case of Localized Hypertrichosis Due to Temporary Henna Tattoo

“…Bu komplikasyonlar çoğunlukla tip 4 aşırı duyarlılık reaksiyonuna bağlı olup alerjik kontakt dermatit, likenoid reaksiyonlar ve daha nadiren eritema multiforme şeklinde ortaya çıkar (1,3,9). Ürtiker ve anjiyoödem tip 1 aşırı duyarlılık reaksiyonu nedeniyle oluşur (1).…”

“…Doğal kınanın uygulandıktan sonra deriden emilmesi saatler sürer ve sonrasında kahverengi-turuncu bir renk oluşur (2,3). Bu nedenle kurumasını hızlandırarak uygulama süresini kısaltmak ve daha koyu bir renk oluşmasını sağlamak amacıyla doğal Hint kınasına başta para-fenilendiamin olmak üzere pek çok katkı maddesi eklenmektedir (1,2,4).…”

“…Bu nedenle kurumasını hızlandırarak uygulama süresini kısaltmak ve daha koyu bir renk oluşmasını sağlamak amacıyla doğal Hint kınasına başta para-fenilendiamin olmak üzere pek çok katkı maddesi eklenmektedir (1,2,4). Ancak bu katkı maddeleri dövme sonrası gelişen komplikasyonların riskini arttırmaktadır (1)(2)(3)(4). Lokalize veya jeneralize alerjik kontakt dermatit, hipertrofik skar, keloid, hiperpigmentasyon ve hipopigmentasyon en sık komplikasyonlardır (1,4).…”

Severe inflammatory and keloidal, allergic reaction due to para-phenylenediamine in temporary tattoos

“…[1,2] Henna can be used alone or in combination with other coloring agents, such as paraphenylenediamine (PPD), for speeding up dyeing, improving pattern definition, to darken its red color and to give the appearance of permanent tattoos. [1,3] Henna alone can be safe but due to additives such as para-phenylenediamine (PPD), p-toluenediamine and various essential oils, allergic contact reactions may occur. [4] A review about tattoo-associated dermatoses showed three categories of conditions: 1) allergic, lichenoid, granulomatous; 2) inoculation, infection and 3) coincidental lesions.…”

Skin allergy in children caused by consumer products

“…Whereas contact allergy to henna itself seems to be rare, additives are added to make the process faster and to obtain a darker pigment, particularly paraphenylenediamine, a strongly allergenic permanent hair dye, the concentration of which may be very high, even though the use of diaminobenzene derivatives is forbidden for dying skin [12]. The eczematous reactions may be long-lasting and present as erythema exsudativum multiforme-like or lichenoid reactions, or produce depigmentation [19,20] or hyperpigmentation, and even as hypertrophic scars [21]. Such allergies may have consequences for the future of these children as certain professions become risky, for instance hairdressing, and clothing dyed with azo or disperse dyes, which are cross-reacting chemicals, may become responsible for textile dermatitis.…”