Source: American Academy of Dermatology (AAD)

Released: Wed 30-Jul-2008, 13:05 ET  Printer-friendly Version

Consumer Alert: Black Henna Tattoos Can Cause Serious Skin Reactions

Newswise — Dermatologists are warning consumers that the harmless-looking, henna tattoos that are being sold everywhere from summer carnivals and open-air malls to cruise ships and vacation hot spots could contain a harmful chemical known as para-phenylenediamine, or PPD, used to create longer-lasting black henna tattoos. Notably, PPD has been associated with a rash of major skin problems.

At the American Academy of Dermatology’s Summer Academy Meeting 2008 in Chicago, dermatologist Sharon E. Jacob, MD, FAAD, assistant clinical professor of pediatrics and medicine (dermatology) at the University of California, San Diego, discussed the dangers of black henna tattoos and how dermatologists are treating an increasing number of patients, including very young children, with skin problems from allergic reactions to PPD.

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

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

“Perhaps the most alarming issue we are seeing with black henna tattoos is the increase in the number of children – even children as young as four – who are getting them and experiencing skin reactions,” said Dr. Jacob. “Kids make up a significant portion of the population that receives temporary tattoos, because parents mistakenly think they are safe since they are not permanent 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 of allergic contact dermatitis from black henna tattoos, with reactions ranging from mild eczema to blistering and even permanent scarring. The first sign of a reaction is typically redness and itching, followed by bumps, swelling and then blisters. Topical steroids can be used to stop the reaction, but Dr. Jacob explained that whether or not any scarring occurs depends on the depth and severity of the inflammation.

In addition, some people may become sensitized to PPD from just one exposure – meaning that the immune system becomes prepared to remember the chemical 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 an allergy can cause a cross reaction to other compounds, including certain medications. For example, use of some heart, hypertension and diabetes medications, and even some anesthetics used in topical hemorrhoid preparations or oral gels, can lead to allergic reactions in people previously sensitized to PPD.

“Each exposure to PPD re-challenges the immune system, so each time you get a black henna tattoo or use a hair dye that contains PPD, there is an increased risk of having a reaction,” said Dr. Jacob. “Many people are sensitized to PPD, but don’t have a reaction to it. However, each time you are exposed to black henna, you increase your risk of developing a lifelong allergy to it.”

Dr. Jacob advised if one does choose to obtain a henna tattoo, only do so if you can be certain that only vegetable henna is used, not PPD-adulterated
henna. “Unless the artist can tell you exactly what’s in the tattoo, don’t get one,” said Dr. Jacob.

The American Academy of Dermatology Association (AADA) endorses a ban on the practice of applying PPD-adulterated henna tattoos, and some state dermatology societies have started posted warnings on their Web sites about black henna tattoos.

For any skin reactions that develop from a temporary tattoo, Dr. Jacob recommended that people see their dermatologist for proper diagnosis and treatment. If a serious reaction occurs, such as severe blistering or swelling, she said seek immediate medical attention.

Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 15,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at
1-888-462-DERM (3376) or http://www.aad.org.