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Public Health Advisory on Para-phenylenediamine (PPD)
(Additive in Black Henna Tattoos)
The Academy has written this notice to inform and warn the public that para-phenylenediamine (PPD), a common hair dye, is being added to henna to make black henna for use as temporary tattoos. The warning statement below recommends that this practice be stopped because there is the potential for long lasting allergy.
Warning Information
Henna tattoo artists are currently adding PPD to henna to make black henna. PPD has long been known to cause allergy and the concentrations used to make temporary black henna tattoos are significant.
Persons who become allergic to PPD may also demonstrate allergy to significant medically necessary medications (diabetic medications, hypertensive medications and anesthetics), in addition to hair dye and dyes used in clothing.
Health care providers should be aware of this adulteration of henna (which is brown) by PPD and warn patients and parents of the possibility of this long lasting allergy, which includes both anaphylactic and delayed types of allergy. Furthermore, PPD can have detrimental and permanent skin adverse effects (such as blisters, pigment changes and scarring).
Heath care providers should carefully evaluate patients in whom reactions have occurred and provide educational information, so that persons do not receive these black henna applications in the future.
Background
Paraphenylenediamene (PPD) is an oxidative chemical frequently used as a permanent hair coloring agent. Serious reactions to this chemical prompted a revision of the obsolete Food and Drugs Act of 1906 and development of the Food, Drug, and Cosmetic Act (c. 1938). The new act extended regulatory control of cosmetics for the first time and its first action was to remove Lash Lure™ (eyelash cosmetic with PPD) from the consumer market and the prohibition of PPD in cosmetics directly applied to the skin.
A recent increase in pediatric consumers using PPD-adulterated henna for temporary tattoos has likewise come with an increase in serious cutaneous inflammatory and scarring reactions. In addition to scarring, there is the potential for persons sensitized to PPD to have lifelong allergic intolerance of dyes in hair products, rubber chemicals, inks and textile dyes and to some medications to treat hypertension and diabetes (e.g. hydrochlorothiazide and sulfonylureas). To draw attention to the practice of PPD-henna tattooing, the journal Dermatitis, official journal of the American Contact Dermatitis Society (ACDS), named PPD as the “Allergen of the Year” in 2007. Despite this, the temporary tattooing practice continues to flourish, unregulated.
Health Canada, the federal department responsible for helping Canadians maintain their health, has alerted its citizens to avoid “black henna” temporary tattoo ink and paste containing PPD. Section 16 of their Food and Drugs Act prevents the sale of cosmetics that may harm the consumer, including “black henna” temporary tattoos containing PPD.
The Scientific Committee on Cosmetic Products and Non-Food Products (SCCPNFP) has assessed the use of PPD and similar chemicals as hair coloring agents, and made appropriate recommendations on the use concentrations, restrictions, and warnings for such application in the European Community Cosmetics Directive. This states that “When PPD and similar chemicals are used for skin staining (temporary tattoos), active sensitisation may occur within a few weeks, and the reactions can be very severe. Pigmentary variegation may persist for a prolonged period following such reactions. The sensitisation will be life long.” Notably “The SCCNFP is of the opinion that PPD and similar chemicals should not be used in skin stains (temporary tattoos).”
The American Academy of Dermatology, American Contact Dermatitis Society, and the Society for Pediatric Dermatology endorse the ban set forth by the Food and Drug Administration that paraphenylenediamine should not be applied to the skin and recommend that the practice of applying paraphenylenediamine-adulterated henna tattoos to the skin be stopped.Patient Information
Take two minutes to examine your skin now! Learn how to examine your skin so you can detect melanoma early. Note: Thanks to the Melanoma International Foundation for use of this video and Martin Weinstock, PhD, MD, creator of the video (with the American Cancer Society).
www.melanomainternational.org/minfo_examine.asp
Information on skin cancer prevention and treatment:
www.mdanderson.org/diseases/skincancer
Find out more about how to protect you and your family from the damaging rays of the sun while still enjoying your outdoor activities.
www.skincancer.org/prevention/index.php
Learn about the dangers of indoor tanning and why this is not a safe way to get a tan.
www.skincancer.org/artificial/index.php
Learn about Melanoma an increasingly common form of skin cancer that can affect people of all ages. With early detection the outlook for most patients with Melanoma is very good.
www.skincancer.org/melanoma/index.php
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