Contact Dermatitis From a Temporary Tattoo in a Boy With Contact Allergy to P-Tert Butyl Phenol Formaldehyde Resin

Abstract

PRECÍSPPDA is the usual allergen in temporary tattoo reactions. We report a case not due to PPDA and probably related to PTBFR. DISCUSSIONAn 8-year-old boy developed an acute dermatitis on his upper right arm, involving the area covered by a black temporary tattoo that was performed less than 24 hours before the first symptoms appeared. Intense pruritus and erythema evolved in a few hours to frank eczema with vesicles and marked infiltration. The dermatitis resolved after about 2 weeks, leaving a striking residual hypopigmentation reproducing the original design of the tattoo (Fig. 1).The tattoo was applied by a transient artist in the seafront of Valencia, Spain, using a noncommercialized ''black henna'' preparation. The artist transferred the design with some kind of a carbonless copy paper put in direct contact to the skin of the patient. The paper was removed leaving the outline of the design visible on the skin. Finally, the black henna mixture was spread over the outline using a thin brush and left to dry.Our suspected diagnosis was, logically, a temporary tattoo reaction caused, as usual, by p-phenylenediamine (PPDA) allergy. We proceeded to patch testing, initially with the Spanish baseline series. Readings at day 2 (D2) and day 4 (D4) were performed, and the only positivity was p-tert butyl phenol formaldehyde resin (PTBFR), with erythema, frank infiltration, and vesicles. The examination result was negative to PPDA. We retested the patient with India ink and pure henna powder, and the results were also negative. Unfortunately, we have not been able to obtain samples of the materials used in the tattoo.Allergic contact dermatitis after black temporary tattoo application due to PPDA sensitization has been widely reported. These skin paints may contain chemical coloring agents, diaminotoluenes, and diaminobenzenes such as PPDA.

Contact Allergy in Children

“…Extensive reviews on temporary henna tattoos have been published [114] and often affected children and adolescents [115]. More recently, also resorcinol, albeit an exceptional allergen, [116] and p-tert-butylphenol-formaldehyde resin [117] were reported in this regard.…”

Tattoo Hypersensitivity Reactions: Inky Business

“…Other aromatic amines including aminophenols have been identified in black henna tattoo ink, and these chemicals also may contribute to ACD. 3 Less common sources of contact allergy from temporary black henna tattoos include resorcinol, 4 para-tertiary butylphenol formaldehyde resin, 5 and fragrance. 6 Clinically, ACD to PPD in temporary tattoos presents 1 to 3 days after application if the patient is already sensitized or 4 to 14 days if the patient is sensitized by the tattoo ink.…”