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Schwere allergische Kontaktdermatitis durch temporäre Henna-Tätowierungen
Abstract
Background
Contact allergy can be a cause of severe disease. The consequences of contact allergic reactions are often underestimated.
Case reports
We report on a 10-year-old girl, a 10-year-old boy and a 40-year-old man, who received temporary paint-on “tattoos” (temptoos) with black henna paint in Italy, Turkey or India, respectively. Both the girl and the man had a refreshment of their temptoos within two weeks after the first painting. The patients developed within 10 to 31 days after the first application of the dye an acute local contact dermatitis. The male patients also developed severe, long standing generalized vesicular and crusted eruptions, the boy had constitutional symptoms in addition. The children received systemic steroids because of their significant symptoms, and their skin lesions resolved within several weeks. The man was treated with topical corticosteroids, his dermatitis resolved also slowly within several weeks after recurrent generalized eczematous eruptions. Besides, he developed textile dermatitis when wearing black clothes. In all three patients marked post-inflammatory hypo- or hyperpigmentations were seen at the sites of the temptoos after resolution of the contact dermatitis. All three individuals had no indications of prior contact sensitization.
Patch testing with the standard series yielded a 3+ reaction to p-phenylendiamine (PPD; 1%) in the 10-year-old girl. The boy and the man were patch tested with 0,1% PPD, they developed also 3+ reactions. Furthermore, the girl showed patch test reactions to structurally related compounds.
Conclusion
We want to draw attention to the serious hazards of these temptoos. They contain PPD in such a high concentration that they can cause sensitization and manifestation of allergic contact dermatitis even after a single application. Temptoo contact dermatitis often leaves cosmetically disturbing hypo- or hyperpigmentation, sometimes even scars. Contact allergy to PPD and structurally related compounds persists for a long time, even lifelong, thus causing significant restrictions of private life and occupational possibilities.
... Depending on the quantity of PPD contained in the temporary tattoo, contact dermatitis may occur even with firsttime use. There have been numerous reports of severe contact dermatitis following exposure to PPD [49]. ...
Knowledge about the linear patterns of the skin is a key competence of dermatologists. Four major groups of linear patterns can be distinguished: Langer lines, dermatomes, Blaschko lines and exogenous patterns. Langer lines run in the direction of the underlying collagen fibers (least skin tension) and play an important diagnostic role for some exanthematous skin diseases. In the thoracodorsal region, the distribution of the Langer lines gives rise to what is referred to as a ’Christmas tree pattern’. A dermatome is an area of skin that is supplied by a single spinal nerve. Disorders with a neuronal origin follow this pattern of distribution. The lines of Blaschko delineate the lines of migration of epidermal cells during embryogenesis. Exogenous linear patterns are caused by external factors.
The present CME article will highlight important skin disorders that primarily present in the form of one of the aforementioned patterns. In addition, we will also address skin conditions that may secondarily follow with these patterns (or distinctly not do so) as the result of various mechanisms such as the Koebner phenomenon, reverse Koebner phenomenon, and Wolf’s isotopic response.
... Ist die verwendete PPD-Dosis hoch, können die Kontaktekzeme bereits bei Erstapplikation auftreten. Zahlreiche schwere Kontaktekzeme auf PPD sind beschrieben [49]. ...
Zusammenfassung
Die Kenntnis der Linienmuster der Haut stellt eine Schlüsselkompetenz für jeden Dermatologen dar. Vier Hauptgruppen von Linienmustern sind relevant: Langer‐Linien, Dermatome, Blaschko‐Linien und exogene Muster. Die Langer‐Linien markieren die Richtung der geringsten Spannung der Haut und sind diagnostisch wichtig für einige exanthematische Hauterkrankungen. Die thorakodorsale Manifestation der Langer‐Linien wurde als christmas tree pattern herausgestellt. Dermatome sind Hautfelder, die von den sensiblen Spinalnerven innerviert werden. Hauterkrankungen mit neuronaler Pathogenese folgen diesem Muster. Blaschko‐Linien sind kutane Manifestationen genetischer Mosaike, die während der Embryogenese entstehen. Exogene lineare Muster werden durch äußere Faktoren verursacht.
Im Folgenden werden einerseits primär in diesen Mustern auftretende Dermatosen besprochen und andererseits Hauterkrankungen aufgezeigt, die sekundär durch Mechanismen der Anbindung (wie Köbner‐Phänomen, Renbök‐Phänomen oder isotope Reaktion) diesen Mustern folgen oder diese aussparen.
All the chapters under the part "Dia-Klinik" of the eBook "Fortschritte der praktischen Dermatologie und Venerologie 2004" by Gerd Plewig, Peter Kaudewitz and Christian A. Sander eISBN: 978-3-540-28691-2 was retracted as we do not have rights to publish these chapters due to legal restrictions.
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 angioneurotic oedema 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. Hypotensive shock gave a poor prognosis. It is possible that similar cases may be occurring unrecognized where henna is traditionally used. A programme of public education and restriction of para-phenylenediamine is urgently required in The Sudan and other affected nations. Ingestion was accidental in 12 children, deliberate in 10 and homicidal in three cases. Cutaneous absorption was likely in the remaining six.
We have described 100 subjects sensitized to textile dyes. Of these, 16 had clinically been suspected of having a textile dermatitis from among 1145 patients referred for patch testing. 41 patients were identified from among 861 consecutive subjects tested with the GIRDCA (Italian Research Group on Contact and Environmental Dermatitis) standard series supplemented with 4 disperse dyes (Disperse Blue 124, Disperse Red 1, Disperse Yellow 3, Disperse Orange 3). The remaining 43 patients were identified from among 746 subjects tested with the GIRDCA standard series, supplemented with the 4 disperse dyes mentioned above and a further series of 12 other textile dyes. The clinical picture was extremely variable: most patients had a typical eczematous dermatitis, but we also observed persistent erythematous-wheal-type reactions, a transient urticarial dermatitis and an erythema-multiforme-like eruption. Among these textile dyes, Disperse Blue 124 caused most reactions. With the addition of the 4 disperse dyes to the GIRDCA standard series, we identified 4.8% sensitized to textile dyes, a much higher figure than the 1.4% observed among patients being patch tested on the basis of their history and the clinical findings; the addition of a further 12 textile dyes to the series further increased the detection rate to 5.8%. We stress the importance of routinely patch testing with textile dyes, which can help to elucidate the cause of certain kinds of atypical dermatitis.
An anaphylactic reaction to a hair dye is reported. Skin testing with the dye and its individual components demonstrated a wheal and flare response to an oxidation product of p-phenylenediamine. This product is N'N'-bis-(4-aminophenyl)-2,5-diamino-1,4-quinonediimine. Passive transfer of this sensitivity by the patient's serum to a normal control implicated an IgE-mediated reaction.
A case of a hairdresser who developed an immediate-type hypersensitivity with urticaria, rhinitis, and bronchial asthma on exposure to henna is reported. Prick tests with henna 1% in aqua and in ethanol showed positive reactions. Both patch tests and prick tests performed with the dye in henna, lawsone, or 2-hydroxy-1, 4-naphtoquinone, which is supposed to be an allergen, had negative results. These results suggest that not only 2-hydroxy-1,4-naphtoquinone but also other still undetermined ingredients of the henna powder should be considered as possible allergen(s).
Vegetable dyes can be recommended to patients sensitized to oxidative dyes due to their low allergenic power. The most important of these is henna which is used as a reddishbrown hair dye in some parts of the world. Different pathologies have been described caused by henna but the incidence of contact dermatitis appears to be extremely rare. In the present paper, we describe the case of a 30-year-old woman who developed allergic contact dermatitis following application of henna, but who did not work with the dye professionally.
Paraphenylenediamine (PPD) is a black dye with well known sensitizing properties. Its increasing use as a skin paint to produce temporary 'tattoos' has led to recent reports of allergic contact dermatitis. Hitherto, such cases of allergic contact dermatitis due to PPD have been localized to the original site of application of the skin paint. We report two cases of severe allergic reactions to paint-on 'tattoos'. Both of these patients had no prior history of sensitivity to PPD, although case 2 had previously used permanent hair dyes. In both cases, the primary eruption at the 'tattoo' site was followed within days by a generalized eruption which ultimately required treatment with oral corticosteroids, because the initially prescribed topical corticosteroids proved ineffective.
Contact dermatitis to henna are rarely reported. Most of the time, they are related to additives, especially scented oils or paraphenylene diamine. This latter substance is added to shorten the time of application and to enhance the darkness of the color. We report one case of an allergic contact dermatitis to henna skin tattoo, probably related to a paraphenylene diamine derivative.
A 25-year-old woman developed an allergic contact dermatitis at the site of application of two henna skin tattoos on her right arm. She never dyed her hair and wore dark clothing without problems. Epicutaneous tests were positive for henna paste, paraphenylene diamine, N-isopropyl-N'phenylparaphenylene diamine and five chemical dyes, probably related to cross- reactions between paraphenylene diamine and these dyes. Epicutaneous test with henna powder was negative, confirming the absence of allergy to henna. Fluorescence analysis detected the presence of a primary amine in henna paste but high performance liquid chromatography analysis did not reveal the presence of paraphenylene diamine or any suspect dye. An another allergen, related compound of paraphenylene diamine, was probably present but we failed to identify it with precision.
Labile henna skin tattoos are in fashion at the moment in western European countries. They can be a secrete source of paraphenylene diamine, or one of its related compounds, sensitization.
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