Vesicular Erythema Multiforme‐like Reaction to Para‐Phenylenediamine in a Henna Tattoo

Abstract

Allergic contact dermatitis reaction to topical ''black henna'' tattoo is usually described secondary to the organic dye para-phenylenediamine, a derivative of analine. Allergic contact dermatitis reactions to paraphenylenediamine are well recognized and most commonly involve an eczematous reaction that may become generalized and an acute angioedema. Only four previous instances have been reported of an erythema multiforme-like reaction to para-phenylenediamine and its derivatives, including only one mild reaction to a tattoo. A vesicular erythema multiformelike reaction has not been reported. An erythema multiforme-like reaction to contact allergens is usually caused by potent allergens including plant quinolones in Compositae and sesquiterpene lactones in exotic woods, and it is also reported to topical drugs, epoxy resin, metals (particularly nickel), and various chemicals. A generalized vesicular erythema multiforme-like reaction is unusual, and rarely reported. We describe a 6-year-old boy who developed a localized, eczematous and severe generalized vesicular erythema multiforme-like contact allergy to para-phenylenediamine secondary to a henna tattoo. As henna tattoos are becoming increasingly popular, one should be aware of the possibility of such a reaction. This presentation also highlights the call to ban the use of para-phenylenediamine and its derivatives in dyes.

Fatal paraphenylenediamine poisoning due to black henna

“…The most common of such reactions are edema, erythema, erythema multiformelike skin lesions, bullous lesions, allergic contact dermatitis, eczema and permanent hypopigmentation. The reaction is generally limited to the area of application and can sometimes leave permanent scarring 8,9 . The skin of our patient was covered with erythemic plaques and was yellow-brown in color.…”

Erythema multiforme caused by tattoo: a further case

“…Previously, rare occurrences of EM-like reactions to PPD and its derivatives have been described [1][2][3].…”

“…Erythema multiforme (EM)-like reaction secondary to PPD henna tattoo contact is a well described but unusual manifestation, and only six previous cases are reported [1][2][3].…”

p-Phenylenediamine and Risk of Sensitization in Children

“…This is a sign of primary sensitization and elicitation has occurred by just one exposure to PPD [21,22,25,26,28,30,31]. More severe systemic reactions have also been observed [25,26,28], and rare symptoms such as generalized erythema multiforme in relation to a temporary henna tattoo have been reported [32,33]. It has even been described that temporary henna tattoos often get repainted at the end of the holidays to ensure the decorative henna's appearance for the longest time after returning home [26].…”