Severe type IV hypersensitivity to ‘black henna’ tattoo
- 1Department of Acute Medicine, St Bartholomew's and The Royal London Hospitals, London, UK
- 2Department of Acute Medicine, The Royal London Hospital, London, UK
- 3Department of Clinical Pharmacology and General (Internal) Medicine, St Bartholomew's and The Royal London Hospitals, London, UK
- 4Departments of Acute Medicine, Endocrinology and Diabetes, The Royal London Hospital, London, UK
- Correspondence to Sarah Frankton,
A 16-year-old Bangladeshi girl presented with a 9-day history of an extensive pruritic, erythematous, papulovesicular skin eruption to both forearms. Appearance was 5 days following application of a home-made henna preparation. Examination revealed ulceration and scabbing along the whole henna pattern and early keloid formation. A diagnosis of type IV delayed hypersensitivity reaction superimposed by infection was initially made. As in this case, home-made henna preparations commonly combine commercial henna with black hair dye, paraphenylenediamine (PPD). PPD, widely known as ‘black henna’, darkens the pigment and precipitates the drying process. PPD is a potent contact allergen associated with a high incidence of hypersensitivity reactions. Despite treatment the patient was left with extensive keloid scarring in the pattern of the henna tattoo.
Competing interests None.
Patient consent Obtained.