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Consumer Alert: Black Henna Tattoos Can Cause Serious Skin Reactions

Thursday, July 31, 2008 General News J E 4
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CHICAGO, July 30 Dermatologists are warning consumers thatthe harmless-looking, henna tattoos that are being sold everywhere from summercarnivals and open-air malls to cruise ships and vacation hot spots couldcontain a harmful chemical known as para-phenylenediamine, or PPD, used tocreate longer-lasting black henna tattoos. Notably, PPD has been associatedwith a rash of major skin problems.

At the American Academy of Dermatology's Summer Academy Meeting 2008 inChicago, dermatologist Sharon E. Jacob, MD, FAAD, assistant clinical professorof pediatrics and medicine (dermatology) at the University of California, SanDiego, discussed the dangers of black henna tattoos and how dermatologists aretreating an increasing number of patients, including very young children, withskin problems from allergic reactions to PPD.

Natural henna used for temporary tattoos is made from leaves of thelawsonia inermis plant, which provides a vegetable coloring that comes inshades of brown, green or red. Temporary coloring (dyeing) of the skin withnatural henna is considered harmless and only lasts for a few days. Toincrease the intensity of the tattoo beyond which can be attained with naturalhenna color and to prolong the longevity of the temporary tattoo from days toweeks, some henna tattoo artists are adding PPD (commonly also used for blackhair dye) into the henna mix. This turns the tattoo black.

The U.S. Food and Drug Administration (FDA) prohibits the directapplication of PPD to the skin because of its known health risks. However,since the tattoo industry is not regulated, people are still getting blackhenna tattoos and exposing themselves to serious medical problems.

"Perhaps the most alarming issue we are seeing with black henna tattoos isthe increase in the number of children -- even children as young as four --who are getting them and experiencing skin reactions," said Dr. Jacob. "Kidsmake up a significant portion of the population that receives temporarytattoos, because parents mistakenly think they are safe since they are notpermanent and are available at so many popular venues catering to families.In fact, nothing could be further from the truth."

Dr. Jacob noted that to date, there have been hundreds of case reports ofallergic contact dermatitis from black henna tattoos, with reactions rangingfrom mild eczema to blistering and even permanent scarring. The first sign ofa reaction is typically redness and itching, followed by bumps, swelling andthen blisters. Topical steroids can be used to stop the reaction, but Dr.Jacob explained that whether or not any scarring occurs depends on the depthand severity of the inflammation.

In addition, some people may become sensitized to PPD from just oneexposure -- meaning that the immune system becomes prepared to remember thechemical to which it has been exposed or a chemical with a similar structure.When this happens, a person can develop a lifelong sensitivity to PPD and anallergy can cause a cross reaction to other compounds, including certainmedications. For example, use of some heart, hypertension and diabetesmedications, and even some anesthetics used in topical hemorrhoid preparationsor oral gels, can lead to allergic reactions in people previously sensitizedto PPD.

"Each exposure to PPD re-challenges the immune system, so each time youget a black henna tattoo or use a hair dye that contains PPD, there is anincreased risk of having a reaction," said Dr. Jacob. "Many people aresensitized to PPD, but don't have a reaction to it. However, each time youare exposed to black henna, you increase your risk of developing a lifelongallergy to it."

Dr. Jacob advised if one does choose to obtain a henna tattoo, only do soif you can be certain that only vegetable henna is used, not PPD-adulteratedhenna. "Unless the artist can tell you exactly what's in the tattoo, don't
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