Raised itchy blister appeared on 5-year-olds hand a week after getting a Henna Tattoo

Henna paste ingredient can make unwanted marks

Minneapolis Star Tribune - Sheree Peterson and a party of female relatives were delighted with the swirly, black designs a henna artist had piped onto their hands and forearms at a mall in Minneapolis, Minn.

Peterson, of Minnetonka, Minn., her 5-year-old daughter Sophia and four others had piled into one car and set off to get temporary henna tattoos from the artist, who had been recommended by a store clerk. The group was directed to a booth filled with colorful scarves and other merchandise. A woman at the back of the booth charged $5 per tattoo. That was in late December.

A week and a half later, as Sophia's tattoo began to fade, a raised, itchy blister took its place. Peterson discovered that an ingredient found in some henna pastes is a strong allergen that's illegal to apply to skin but goes largely unregulated.

"I was just thinking, oh, this is henna, which I had known to come from a plant. I didn't think twice about a potential reaction," Peterson said.

The culprit in Sophia's case is a chemical called paraphenylenediamine (PPD), a pediatrician told Peterson.

It also may have been the culprit at an eighth-grade graduation party in 2011. About a week after an artist used a dark-colored paste to draw henna tattoos on 35 students, about half of them developed blisters and weeping lesions. According to a news release by the Minnesota Department of Health, the children were treated with steroid cream and three were given oral antibiotics. The department urged customers to check for PPD in henna pastes before getting a tattoo.

Many henna artists mix their own henna paste solutions and some add PPD to darken the staining and lengthen the tattoo's life. PPD may be present in pre-mixed henna sold by retailers and may not be properly labeled.

There's a cultural reason behind henna tinting, said Dr. Sanober Amin, a resident in the University of Minnesota's dermatology department. "A darker henna outcome is associated with better luck, especially when it's applied on the hands of a bride," Amin said, referring to the practices of many Southeast Asian and African cultures.

"On the wedding day, everybody will come and look at the color intensity ... the henna on your hands, and bless you with good luck or not," said Amin, who got the henna tattoos herself when she was wed in Pakistan.

"We see a lot of patients with allergies to PPD. It's a very common contact allergy," said Dr. Bethany Cook, a colleague of Amin. Most patients are treated for a reaction to the PPD legally found in about two-thirds of hair dyes, but since the 1990s dermatologists have been seeing more and more cases attributed to henna tattoos, Amin said.

When PPD is laced into henna pastes, it's usually at a much higher concentration than that found in hair dye, Cook said.

Skin exposure to PPD-laced henna can have long-term consequences. A common complication is a lifelong sensitivity to hair dye containing PPD, Amin said. Some patients develop scars and skin discoloration that turn what was supposed to be a temporary tattoo into a permanent one.

Though the FDA has not approved henna in its pure form for skin application, the plant appears to be safe and is widely available on the Internet. "So far, we have not seen an allergy to henna itself," Amin said.

Henna artists have banded together to promote the safe use of henna. Amy Leinen started a "temporary body art" business called Mehndi Moments a few years ago.

"I'm networked with a whole bunch of other henna artists who are only using natural henna," Leinen said. "We educate about the dangers of PPD and we're networked throughout the world."

Leinen applies "henna crowns" containing "healing symbols" on the heads of cancer patients, symbolic imagery on pregnant women's bellies and provides tattoos at birthday parties and festivals. She gets her raw henna from a reliable source, she said, and mixes it with lemon juice and essential oils.

PPD-free henna is usually brownish when mixed and bright orange when the paste is removed from the skin, darkening gradually before it fades, Leinen said. Black paste indicates the presence of PPD.

The U.S. Food and Drug Administration regulates most color additives, including PPD.

The Peterson family filed a complaint with the FDA about the incident. Peterson is crossing her fingers that her daughter will emerge without scarring or a permanent ghost design. "Her doctor told us that most likely by the time summer hits, she'll have some traces of it and it's really important to use sunscreen so that there isn't any discoloration of the skin," Peterson said.

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