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CASE REPORT
Year : 2019  |  Volume : 20  |  Issue : 4  |  Page : 338-340

Are henna tattoos harmless? Report of clinical cases


1 Pediatric Resident in Multicentric Program of Specialties of Tecnológico de Monterrey, Monterrey, Mexico
2 Pediatric Dermatologist in Zambrano-Hellion Hospital, Tecnológico de Monterrey, Monterrey, Mexico

Date of Web Publication30-Sep-2019

Correspondence Address:
Dr Monica Davalos-Tanaka
Cruz Verde 119 - 23, Col. Lomas Quebradas, Magdalena Contreras, C.P. 10000, Mexico City
Mexico
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_51_19

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  Abstract 


The black henna tattoo has been of use in Mexico for a long time. It has become popular in the last few years mostly in young children and adolescents. The traditional henna tattoo is obtained from the Lawsonia alba and inermis plant. However, para-phenylenediamine (PPDA) is added to this so it can last longer, look darker, and look like a permanent tattoo. This increases its allergic potential since it has no sanitary regulation of the concentration of PPDA that it is used. We present three cases of children with contact allergic dermatitis caused by black henna which resolved with low potency topical steroids. The objective of this is to educate contact health-care professionals to be aware of this adverse effect on black henna and also to educate patients and patients' families about the risk of applying it, since it can have severe allergic reactions.

Keywords: Black henna tattoo, contact allergic dermatitis, para-phenylenediamine


How to cite this article:
Davalos-Tanaka M, Fernández Galán BR, Gómez LI. Are henna tattoos harmless? Report of clinical cases. Indian J Paediatr Dermatol 2019;20:338-40

How to cite this URL:
Davalos-Tanaka M, Fernández Galán BR, Gómez LI. Are henna tattoos harmless? Report of clinical cases. Indian J Paediatr Dermatol [serial online] 2019 [cited 2019 Nov 13];20:338-40. Available from: http://www.ijpd.in/text.asp?2019/20/4/338/268398




  Introduction Top


The raw material of the traditional henna is obtained from the Lawsonia alba and inermis plants, which produces a green-colored powder that when combined with substances such as para-phenylenediamine (PPDA) it looks darker and makes it last longer; however, it increases its allergic potential.[1] The most common form of sensitization from the PPDA is contact dermatitis.[2] Black henna tattoos are very popular in our country, therefore, we consider this series of cases important.


  Case Reports Top


Case 1

A 4 year old male consults 1 week after having applied a henna tattoo in the right posterior arm. Presenting with pain, pruritus and swelling at the application site and with a dermatitis characterized by erythema, vesicles and scab formation demarcating the tattoo area. It was treated with topical betamethasone 0.1% for 7 days and with complete improvement in 2 weeks [Figure 1]a.
Figure 1: (a) Dermatosis present at 4 years of age, characterized by erythema, vesicles, and scab formation demarcating the tattoo area. (b) Dermatosis presented at 12 years of age, 24 h later with pruritus and erythema, vesicles, and scab

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He applied a new henna tattoo in the lateral region of the right arm at age 12 presenting just 24 h later with pruritus and same type of dermatitis as the previous occasion. He was treated with hydrocortisone 0.1% cream for 7 days with complete resolution [Figure 1]b.

Case 2

A 10 year old male consults after 1 month of application of black henna, presenting dermatitis over the contour of the application site characterized by erythema and papules with continuous pruritus despite the use of a combination cream with topical steroid and anti-inflammatory (betamethasone, clotrimazole and gentamicin) during 2 weeks without seeking medical advice. The treatment was changed to low-grade topical steroid and tacrolimus 0.1% with complete resolution within 4 weeks [Figure 2].
Figure 2: A 10-year-old male, dermatitis present over the contour of the tattoo with erythema and papules on the left side. On the right side, we see complete resolution after 4 weeks of topical steroids and tacrolimus

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Case 3

A 14 year old female consults after 3 weeks of having had applied a black henna tattoo presenting with vesicles and erythematous lesions over the contour of the tattoo. She was treated with topical betamethasone 1% cream with complete resolution within 3 weeks [Figure 3].
Figure 3: Dermatitis with vesicles and erythematous lesion in the contour of the tattoo

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  Procedure Top


Market stalls where temporary tattoos can be applied have become a common sight attracting the attention of children and teenagers, but they lack sanitary regulations and hence the increasing cases of allergic dermatitis within this population.[3]

There is no black henna ink from natural sources. This is a combination of natural henna and PPDA. The natural henna is obtained from the plant Lawsonia alba and inermis, and when applied to the skin, it interacts with keratin giving it a brown-red color. There are only a few cases of allergic reactions described from its use, but it is thought that it could be caused by the oils that it is mixed with rather than the henna itself, making it safe for use.

Black henna contains PPDA, added in order to speed up the coloring and drying process, darkening the color, enhancing the tattoo and prolonging its duration, and simulating a permanent tattoo. Its use has been approved by the European Union in a concentration <6% in dyes that have no direct contact with the skin;[4] however, in these market stalls where the preparations are homemade, we do not know the concentration they have and therefore the allergic potential they can have.

The sensitization to PPDA occurs when it is applied to the skin, and its manifestations appear 8–14 days later, but it can be as soon as 4–7 days. Around 80% of the patients have typical manifestations of contact allergic dermatitis such as erythema, edema, papules, vesicles, and sometimes bullae limited to the site of application of the tattoo, leaving the same pattern as the applied tattoo or sometimes there can be satellite lesions. It takes a few weeks for the dermatitis to resolve even though topic steroids are used. The postinflammatory hypopigmentation is very frequent, especially in children, lasting up to 6 months or even be permanent; however in teenagers and adults, hyperpigmentation is more frequent, and it can last up to 6 months. Hypertrophic and keloid scaring have been noted in some cases,[5] and there have been severe cases with facial angioedema, rhabdomyolysis, acute renal failure, and anemia.[6]

The diagnosis of allergic dermatitis is done with epicutaneous or patch tests showing sensitization to the evaluated substance through a Type IV cellular immunity reaction.

The treatment is with topical steroids of different strength depending on the site of the lesion, but intravenous or oral steroids can be used if there is a systemic reaction. The goal is to end the inflammatory process and to control the symptoms. Antihistamines and analgesics can be used as well for pruritus and burning sensation.


  Conclusion Top


In spite of the popularity of black henna tattoos and the thought that they are harmless, it is important to have in mind the adverse systemic reactions such as anaphylaxis and/or angioedema and also local reactions such as contact allergic dermatitis. It is important to let the general population know about these adverse effects and provide adequate information to prevent complications.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Turan H, Okur M, Kaya E, Gun E, Aliagaoglu C. Allergic contact dermatitis to para-phenylenediamine in a tattoo: A case report. Cutan Ocul Toxicol 2013;32:185-7.  Back to cited text no. 1
    
2.
Salvador JM, Martínez AE, Ferrer DS, Martínez AM, de la Cuadra Oyanguren J, Zaragoza Ninet V. Para-phenylenediamine allergic contact dermatitis due to henna tattoos in a child and adolescent population. An Pediatr (Barc) 2017;86:122-6.  Back to cited text no. 2
    
3.
Goldenberg A, Jacob SE. Paraphenylenediamine in black henna temporary tattoos: 12-year food and drug administration data on incidence, symptoms, and outcomes. J Am Acad Dermatol 2015;72:724-6.  Back to cited text no. 3
    
4.
Moya AS, Gatica M, Almagro DG, Larralde M. Allergic contact dermatitis for temporary “black henna” tattoos. Arch Argent Pediatr 2010;108:96-9.  Back to cited text no. 4
    
5.
de Groot AC. Side-effects of henna and semi-permanent “black henna” tattoos: A full review. Contact Dermatitis 2013;69:1-25.  Back to cited text no. 5
    
6.
Calogiuri G, Di Leo E, Butani L, Pizzimenti S, Incorvaia C, Macchia L, et al. Hypersensitivity reactions due to black henna tattoos and their components: Are the clinical pictures related to the immune pathomechanism? Clin Mol Allergy 2017;15:8.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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