p-Phenylenediamine and Risk of Sensitization in Children

Abstract

Opinion statementContact allergy to p-phenylenediamine (PPD) in children has been described over almost 2 decades, indicating a major problem. PPD can be found in permanent hair dyes and temporary henna tattoos. Children often get sensitized to PPD at a relatively young age when getting a temporary henna tattoo while away on holiday in exotic surroundings. This results in a localized acute allergic reaction at the site of the tattoo within 1-2 weeks after the tattoo has been drawn. The symptoms will clear over weeks on treatment with topical corticosteroids. However, sensitization to PPD will be life-long and may later result in very severe allergic reactions if re-exposure to PPD happens, e.g., by hair dyeing. Populationbased studies indicate that even young children may get their hair dyed and that many teenage girls dye their hair regularly. Exposure to permanent hair dyes with PPD and related substances may in itself lead to PPD sensitization and severe allergic reactions. The allergic reaction will typically develop within hours after dyeing the hair, with clinical presented symptoms such as facial edema and facial dermatitis, which also may generalize. This may lead to hospital admission and treatment with systemic corticosteroids. It is important to note that this is a delayed-type hypersensitivity reaction and should be treated as such. Antihistamines have no effect in this situation. PPD sensitization may have long-term carrier consequences, as, for example, PPD contact allergy in a teenage girl may hinder her entering the hairdressing trade. Patch testing is used to make the diagnosis of PPD sensitization. In children with severe clinical reactions to temporary henna tattoos and/or permanent hair dyes, it is advisable to start the patch testing with PPD in a low concentration, e.g., 0.01 % PPD in petrolatum. It is not recommended to get temporary henna tattoos under any circumstances and children under the age of 16 years should not use permanent hair dyes in order to avoid severe allergic reactions and life-long sensitization to PPD.

Contact allergy in Danish children: Current trends

“…Cases of connubial dermatitis caused by PPD have even been reported . As sensitization to PPD may cause severe allergic reactions, dermatologists and researchers have warned against the use of black henna tattoos and hair dye in children . Hopefully, our finding reflects such preventive measures, in which case we expect the prevalence of PPD allergy in children to decrease even further in the future.…”

Results of the patch tests with European baseline series in children: Five years of experience from a single center in Turkey and a review of the literature

“…Many patients allergic to PPD can be reactive to semi‐permanent dyes of darkly‐colored synthetic clothes 19 . There are case reports in the literature illustrating children who had a history of localized reaction to black henna tattoos developing severe generalized reactions when they encountered hair dyes 20 . Another point to take into consideration is that cross‐reaction between PPD and drugs such as benzocaine, diuretics (hydrochlorothiazide), and sulfonamides might trigger lifelong sensitization resulting in generalized contact dermatitis upon drug intake 21 .…”

“…19 There are case reports in the literature illustrating children who had a history of localized reaction to black henna tattoos developing severe generalized reactions when they encountered hair dyes. 20 Another point to take into consideration is that cross-reaction between PPD and drugs such as benzocaine, diuretics (hydrochlorothiazide), and sulfonamides might trigger lifelong sensitization resulting in generalized contact dermatitis upon drug intake. 21 The limitation of our study was that due to the retrospective structure of the study design, we could not determine the clinical relevance of patients showing allergen sensitization.…”

Rhus semialata M. extract ameliorate para-phenylenediamine-induced toxicity in keratinocytes

“…Temporary exposure to PPD could cause symptoms of allergic reaction including eye irritation, itching, swelling, blistering, and renal failure within a few hours, or reaction may often be delayed by a few weeks after application [ 31 ]. Even if someone does not have a reaction to PPD initially, regular repeated exposure to PPD or other para-substituted substances, will make them sensitized to PPD [ 32 , 33 ]. The hair coloring and tattooing industries are continuously promoting individual expression, as well as a more youthful appearance with use of such products.…”