Dermatitis associated with henna tattoo

Abstract

A 32-year-old woman presented with a 5-day history of a severely pruritic, erythematous reaction in the distribution of a temporary black henna tattoo that had been applied 2 weeks earlier while she was vacationing on theboardwalk in New Jersey. She was not a cosmetologist and had no history of previous exposure to henna in hair dyes. In fact, the patient had no history of ever coloring her hair. She denied having a history of allergic contact dermatitis, atopy, and asthma. Physical examination revealed a geometric, erythematous, edematous, crusted lesion in the sun-shaped pattern of the patient's henna tattoo on the medial aspect of her right ankle (figure 1). A diagnosis of allergic contact dermatitis was made. She was treated with 60 mg of oral prednisone taken daily and tapered over 2 weeks. Topical triamcinolone acetonide cream was applied to the area twice daily and as needed for pruritus, and she was cautioned to avoid any exposure to henna in temporary tattoos and hair-dye products. Patch testing revealed a 2+ reaction to p-phenylenediamine (PPD). The remainder of the patch test was negative. The patient was then advised to avoid all permanent hair-dye products. She returned for follow-up about 1 month later. At that time, the dermatitis had resolved, leaving a faint hyperpigmented area in the design of the henna tattoo.