Hypersensitivity reactions due to black henna tattoos and their components: are the clinical pictures related to the immune pathomechanism?

Abstract

Hypersensitivity to para-phenylenediamine (PPD) and related compounds induced by temporary black henna tattoos has become a serious health problem worldwide. Different patterns of sensitization with various clinical aspects are described in literature due to PPD associated to henna tattoo and these manifestations are likely correlated with the immunological and dermatological pathomechanisms involved. Henna is the Persian name of the plant Lawsonia inermis, Fam. Lythraceae. It is a woody shrub that grow in regions of North Africa, South Asia, India and Sri Lanka. Nowadays it is rather frequent to see temporary “tattoos” performed with henna. To make tattoos darker and long-lasting PPD has been associated to henna in tattoo drawings mixtures, so obtaining “black henna”. In these years there has been a rise of contact sensitization to PPD and in medical literature an increased number of cases have been reported on temporary henna tattoo application. Here we review the various clinical patterns related to PPD and henna tattoo, to investigate the possible link between clinic-morphological pictures and the immunological response to PPD and henna. The literature underlines that different clinical manifestations are related to black henna containing PPD, and its derivative products may cause delayed-type as well as immediate-type reactions. Further studies are needed to investigate the relationship between clinical and morphological aspects of PPD contact dermatitis and the T cell subsets predominance.

A Case of Erythema Multiforme-Like Secondary to Black Henna Tatoo

“…1,2 Erythema multiforme-like secondary to black henna tatoos is rarely observed and the mechanism involved has not yet clarified but a mediated type III involving circulating immune complex and associated type IV hypersensitivity was suggested. [3][4][5][6] Sometimes lesions resolve with residual hypopigmentation. 2,6 Patch testing confirm the allergy.…”

“…Rising incidence of allergic contact dermatitis reactions to paraphenylendiamine (PPD) in black henna tattoos has been usually described. [1][2][3] Generalized erythema multiforme to PPD is rarely reported. 4,5 We present a case of a girl who developed a localized eczematous reaction to a henna tattoo on the dorsum of her hands followed by erythema multiforme-like lesions on her extremities…”

Contact Dermatitis Due To A Henna Tattoo: A Case Report

“…The PPD appears to be a haptene that interacts like a systemic drug, activating a hypersensitivity response. In patients sensitizedto CD4+ and CD8+ T cellclones specific for PPD, cytokines like IL-4, IL-5, IL-6, IL-8, IL-10 and IL-13 have been found in vitro [7].…”

“…The original henna ink isa dark green powder made from the leaves of the plant and commonly used for hair dyes and body tattoos [2]. When it comes in contact with the skin, the color tone turns orangebrown [3]. However the organic compound, p-phenylendiamine (PPD) which is a strong sensitizer,is frequently added to the henna pigment to make it darker [4].…”

Evaluation of in vitro testing strategies for hazard assessment of the skin sensitization potential of “real‐life” mixtures: The case of henna‐based hair‐colouring products containing p‐phenylenediamine

“…26,27 Nowadays, henna is extensively used worldwide, owing to the popularity of body art and hair dye products. 28 Despite this extensive use, ACD caused by pure henna is extremely rare, and the allergic skin reactions reported have been associated with adulteration of henna with PPD, 25,26,[29][30][31] highlighting the fact that these products deserve special attention from regulatory agencies.…”