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Henna tattoos tied to bad allergic reactions: an ugly souvenir. (Clinical Rounds).

ST. JULIAN'S, MALTA -- Natural isn't always nice.

As temporary tattooing with henna gains popularity, doctors are seeing the fallout: contact dermatitis associated with these presumably "all-natural" decorations, Dr. Jana Kazandjieva said at an international symposium sponsored by the European Academy of Dermatology and Venereology

"This tattooing can cause serious reactions, especially when it is used on small children," said Dr. Kazandjieva of the Medical University of Sofia, Bulgaria.

Henna tattooing began hundreds of years ago in India and the Middle East as a form of personal decoration for celebrations. Mehndi, the traditional art of henna painting, uses dried henna leaves ground to a fine powder and mixed with water or oil to create a reddish-brown paste. The henna is applied to the skin and allowed to dry for about 30 minutes.

However, the henna tattoo that has become popular in tourist areas--both in the United States and abroad--is dark brown or black and can contain a bewildering variety of additives ranging from the simply not-too-nice to the downright dangerous, said Dr. Kazandjieva.

"Street artists in many countries use a variety of compounds to cause a darker pigment," she said. "These can include coffee, oil of eucalyptus, mustard, or dove, lemon juice, turpentine, tea, or even the fresh urine of camels or yaks." But the most dangerous component of black henna is p-phenylenediamine (PPD), which is present in some permanent hair dyes, as well as black rubber, printing inks, oils, greases, and gasoline. Short-term exposure to this potent chemical may cause eye irritation, asthma, gastritis, renal failure, vertigo, tremors, convulsions, and coma.

Black henna preparations with PPD are very sticky and don't wash off the skin. The long duration of skin contact and the high concentration of PPD (up to 16%) dramatically increase the risk of contact dermatitis, Reactions are typically type IV hypersensitivity presenting as pustular dermatitis, eczemarous and vesicular dermatitis, lichenoid reaction, or generalized dermatitis. Type I reactions sometimes occur as well.

Dr. Kazandjieva presented the case of a 19-year-old man who received a black henna tattoo on his arm. During the first week, he experienced mild pruritus over the design; 10 days after application, multiple small papules developed over the tattooed areas. Several days later, the design appeared eryrhematous and raised, while the unpainted surrounding area was unaffected.

These cases usually improve with topical class III or class IV steroids, but improvement can take several weeks, she said. Patients are often left with scarring, hypopigmentation, or hyperpigmentation along the design lines.

Henna (Lawsonia inermis) in its pure form has a very low allergic potential. In rare cases, however, the plant's active ingredient (lawsone) can cause life-threatening reactions, Dr. Kazandjieva said. Within a few hours of topical application to or ingestion by sensitive individuals, angiodema of the face, lips, pharynx, and larynx may occur, occasionally progressing to renal failure.

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Author:Sullivan, Michele G.
Publication:Family Practice News
Geographic Code:4EXBU
Date:May 15, 2003
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