Severe allergic contact dermatitis induced by paraphenylenediamine in paint-on temporary 'tattoos'

Paraphenylenediamine (PPD) is a black dye with well known sensitizing properties. Its increasing use as a skin paint to produce temporary 'tattoos' has led to recent reports of allergic contact dermatitis. Hitherto, such cases of allergic contact dermatitis due to PPD have been localized to the original site of application of the skin paint. We report two cases of severe allergic reactions to paint-on 'tattoos'. Both of these patients had no prior history of sensitivity to PPD, although case 2 had previously used permanent hair dyes. In both cases, the primary eruption at the 'tattoo' site was followed within days by a generalized eruption which ultimately required treatment with oral corticosteroids, because the initially prescribed topical corticosteroids proved ineffective.     

Textile dye allergic contact dermatitis prevalence

This article summarizes textile dye prevalence studies and makes recommendations for advancing knowledge about textile-dye sensitization. Prevalence data is provided by study and by dye. Dermatology teams are encouraged to conduct textile-dye prevalence studies in countries other than Italy, include dyes for which the least prevalence data has been collected, to standardize method of application and reading, and to verify purity and identity of dyes used for patch testing. Testing with pure dyes and other chemicals in dye formulations should provide insights in choosing dye systems that will decrease sensitization.     

Hand dermatitis as an unsuspected presentation of textile dye contact sensitivity

The aim of this study was to evaluate disperse dye sensitization in patients with hand dermatitis. From January 1996 to December 2000, we identified 130 patients with hand dermatitis reacting to one of the 7 dyes included in our standard series. In 82 subjects the dermatitis was localized to the hands alone, whereas 48 patients had lesions both on the hands and on other skin sites. Disperse Blue dyes, and Disperse Orange 3 were the most common sensitizers. Among the 13 subjects allergic to disperse dyes alone, we found 3 cases of occupational allergic contact dermatitis, 1 child with atopic dermatitis worsening after the use of synthetic fibre garments, 4 subjects affected by clothing dermatitis, and 5 individuals occupationally exposed to irritants with a dermatitis involving the hands alone. In the latter, the hands may represent a 'locus minoris resistentiae', and both induction and elicitation of contact sensitization could be caused by impaired barrier function at a skin site repeatedly exposed to sensitizing garments.     

55 cases of allergic reactions to hair dye: a descriptive,consumer complaint-based study

Severe facial and scalp dermatitis following the use of permanent hair dyes has been reported in several cases. Para-phenylenediamine (PPD) is known as a potent contact allergen, and PPD is allowed in hair dye at a concentration of 6%. Hair dye reactions are usually diagnosed by the patients themselves, and adverse reactions to hair dye may not necessarily be recorded by the health care system, unless the reactions are especially severe. Based on this assumption, we suspected that hair dye dermatitis was occurring more frequently than reported in the literature. Consumer complaint-based data were obtained by advertising for persons with adverse reactions to hair dye. Among those responding to the advertisement, 55 cases of severe, acute allergic contact dermatitis were identified. The main symptoms were severe oedema of the face, scalp and ears, and clinically this was often mistaken for angio-oedema. The 55 cases comprised a total of 75 visits to the health service and 5 admissions to hospital. 18 persons had sick leave, which supports the impression of very severe dermatitis reactions. 60% were treated with antihistamine, while 52% were treated with corticosteroids. 29% of the cases were patch tested and all were found positive to PPD. Our data presented here clearly show that PPD and its derivatives in hair dye at the present concentrations presents a significant health risk for the population. Furthermore, the severe acute allergic skin reactions are often misdiagnosed in the health care system. The frequency of allergic contact dermatitis resulting from hair dye is likely to be underestimated. New methods to survey the frequency of adverse reactions should be considered.     

Hypertrophic allergic contact dermatitis from hair dye

We report a case of hypertrophic allergic contact dermatitis probably due to p-phenylenediamine (PPDA) in a 26-year-old female, which developed at the sites of application of a black hair dye to the skin. Histological examination revealed an eczematous process. The lesions subsided completely except for leukoderma that remained on the leg. Patch tests showed positive reactions to PPDA, p-aminophenol and Disperse Orange 3. PPDA, which was one of the components of the dye, was considered to be the primary sensitizer because it was the only substance able to reproduce at the patch test site both the hypertrophic pattern and the permanent leukoderma found in the patient's lesions. To explain the difference in reaction between PPDA and the other 2 para-group substances, we speculate that they are due to different quantities of reactive intermediates, oxidation products and free radicals, produced by these substances.     

Allergic contact dermatitis from temporary henna tattoo

Temporary henna tattooing has been very popular during recent years. Henna ( Lawsonia inermis ) is a plant from the Lythraceae family. For henna tattooing, henna dye is used. It is a dark green powder, made from the leaves of the plant, used for hair dyeing and body tattooing. Very often, para-phenylenediamine (PPD) is added to henna dye to make color blacker and to speed up dyeing. PPD may be a very potent contact sensitizer. We report a 9-year-old boy with allergic contact dermatitis due to temporary henna tattooing. Patch testing showed a positive reaction to PPD. After the treatment with topical corticosteroid and oral antihistamines, the lesion cleared with discrete residual hypopigmentation.     

The purpuric patch test in patients with allergic contact dermatitis from azo dyes

The histopathological features of the purpuric patch test have been described in individual cases only. We report a series of patients with allergic contact dermatitis, who developed purpuric patch tests at the sites of allergens from the azo dye group. 105 patients were clinically evaluated and tested with the TRUE Test and the textile color & finish series (Chemotechnique Diagnostics) because of suspected clothing dermatitis. Positive results to the latter were found in 31 patients (29.5%). In 9 of these, purpuric patch tests were observed at the sites of the allergens Disperse Blue 124, 106 and 85. 10 biopsies were performed and studied. The histopathological changes of the purpuric patch test included: spongiosis (in 90% of cases), exocytosis (70%), and dilated blood vessels (100%) without signs of vasculitis, surrounded by an inflammatory infiltrate composed mainly of T lymphocytes. Extravasated erythrocytes were seen perivascularly, but also in the interstitium, surrounding the acrosyringium, at the dermoepidermal junction, and in the epidermis. Increased number of mast cells were found in 22.2% of cases. Disperse Blue 124, 106, and 85 are potent allergens that can elicit purpuric patch test reactions. The purpuric patch test in our cases was a manifestation of an allergic reaction, based not only on histopathological changes, but also on evolution and relevance of the patch tests.     

Multiple azo disperse dye sensitization mainly due to group sensitizations to azo dyes

A female patient, with a previous episode of contact dermatitis caused by a blue dress developed similar dermatitis due to a navy -blue dress. Patch tests revealed multiple allergic positive reactions to paraphenylenediamine (PPD). The navy-blue dress, its extracts, 6 azo disperse dyes in a textile series, as well as 3 dye components, including Disperse (DP) Red 153, which were present in the dress: these were composed of 9 azo disperse dyes, all dyes being of a different chemical structure. On the basis of chemical similarities between these 16 azo dyes including PPD, these are classified into the following 4 groups: thiazol-azoyl-PPD group (including DP Blue 106. DP Blue 12-1 and 5 used dyes), aminoazobenzene group (DP Red 1. DP Red 17. DP Brown 1 and 2 used dyes). PPD group (PPD and DP Orange 3) and benzothiazol-azoyl-PPD group (2 dyes in DP Red 153). With few exceptions, cross-sensitizations between dyes in the same group have been reported by other authors, or are suggested by us, in the former 3 groups. Multiple azo disperse dye sensitization is therefore considered lo be attributable mainly to group sensitizations to azo dyes.)