A Child with Allergic Contact Dermatitis Due to Para-Phenylenediamine

Abstract

An 8-year-old male patient presented to our clinic with a pruritic, burning, and erythematous lesion on the left forearm 7 days after having a temporary henna tattoo done. Past medical history revealed inhaled allergen sensitivity and bronchial asthma. On physical examination, the patient had papular, erythematous, and excoriated lesions, in the shape of the initials of his and his girlfriend's name along with a heart and arrow, on the left forearm (Figure 1). A few isolated satellite papular and erythematous lesions were also noticed at the different sites of the body (Figure 2). The patient was discharged on topical methyl-prednisolone and systemic antihistamine therapy. The follow-up visit 3 weeks after the initial presentation showed resolution of the papular, erythematous, and excoriated lesions with a residual hypopigmented lesion left behind (Figure 3). The standard patch test (TRUE Test; SmartPractice Denmark ApS, Hillerød, Denmark) was performed for the differential diagnosis after 6 weeks. Patch testing of the skin showed a double-positive result (erythema, infiltration, and vesiculation) for para-phenylenediamine (PPD), which clarified the final diagnosis as allergic contact dermatitis due to PPD (Figure 4).Figure 2A few papular and erythematous lesions of both hands.View Large Image Figure ViewerDownload (PPT)Figure 3The residual hypopigmented lesion is shown at the forearm on follow-up after 3 weeks.View Large Image Figure ViewerDownload (PPT)Figure 4The erythema, infiltration, and vesiculation due to para-phenylenediamine during the patch test.View Large Image Figure ViewerDownload (PPT) The temporary tattoos with henna are traditionally used as adornment in certain cultures, especially of Muslim and Hindu origin. Henna is obtained from the leaves of the tree Lawsonia unermis. Temporary tattoos are frequently mixed with PPD to hasten drying and to darken the color. PPD is also used in some commercial hair dyes and is a common cause of allergic reactions. Allergic reactions due to PPD in the pediatric population are on the rise in recent years and occasionally can cause severe allergic reactions; thus, the test should be performed with a 100-fold diluted standard PPD solution. Patients who have contact allergic reactions should be cautious, because hair dyes, dyes used in textile industry, and some industrial products contain PPD and may cause cross reactions.1Eager R.P. Atopy to henna tattoos in children.Eur J Emerg Med. 2005; 12: 189-190Crossref PubMed Scopus (14) Google Scholar, 2Schnuch A. Lessmann H. Frosch P.J. Uter W. para-Phenylenediamine: the profile of an important allergen. Results of the IVDK.Br J Dermatol. 2008; 159: 379-386Crossref PubMed Scopus (91) Google Scholar, 3Sidwell R.U. Francis N.D. Basarab T. Morar N. Vesicular erythema multiforme-like reaction to para-phenylenediamine in a henna tattoo.Pediatr Dermatol. 2008; 25: 201-204Crossref PubMed Scopus (40) Google Scholar Because henna tattoos are a common practice in our country, we would like to share our recent experience of an allergic contact dermatitis due to a PPD with our colleagues through this case report.