Prospective study of ingestional hair dye poisoning in Northern India (Prohina)

Abstract

Hair dye (paraphenylene di-amine, PPD) poisoning has high morbidity and mortality and its incidence has increased dramatically in the past 4 years. A prospective study was planned to assess the clinical profile and outcome with different treatment approaches and mortality rate in patients with hair dye ingestion. The material comprised 1020 cases admitted in Medicine Department of MLB Medical College, Jhansi, U. P. from July 2004 to March 2009. Out of 1020 cases, 697 cases were of stone hair dye poisoning and 323 cases were of other branded hair dyes (powdered form containing less amount of paraphenylene diamine). Diagnosis was made solely on the basis of the history given by cases/attendant and symptoms of neck swelling, black colored urine and muscular pain. The cases were thoroughly studied for different complications (renal, hepatic and cardiac etc) and were treated accordingly. Out of 1020 cases studied, majority were females in the age group of 15 to 45 years (n=734) while the rest were males. A total of 161 (15.78%) cases expired during treatment. Neck swelling, respiratory distress and whole body muscular pain were most common symptoms at presentation, oliguria, chest pain, palpitation, presyncope/syncope, pain in abdomen, nausea with vomiting and dysphagia were other common symptoms. Paraphenylene diamine is highly toxic. Cases who consumed up to 10 gm of PPD usually survived if they are presented to hospital within 4 h of dye ingestion in whom proper management can be delivered in the form of i/v methyl prednisolone and other supportive care. Severe edema of face, neck and floor of mouth, renal failure and myocarditis were poor prognostic factors. Key words: Paraphenylene diamine, hair dye ingestion, rhabdomyolysis, myocarditis, angioneurotic edema, myoglobinuria, intravenous methyl prednisolone, hemoglobinurea.