A blistering eruption after a holiday in India

The reaction usually occurs 24-48 hours after exposure to the allergen, and the intensity and duration of the inflammatory reaction depend on the patient's sensitivity to the allergen and the concentration absorbed. Because high concentrations are often used, black henna has also been reported...

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Bibliographic Details
Published in:BMJ 2011-12, Vol.343 (dec19 2), p.d7474-d7474
Main Authors: Worsnop, F S, Craythorne, E E, du Vivier, Anthony W P
Format: Article
Language:English
Subjects:
Adult
Allergens
Allergies
Anti-Allergic Agents - administration & dosage
Clobetasol - administration & dosage
Coloring Agents - adverse effects
Cosmetics - adverse effects
Dermatitis
Dermatitis, Allergic Contact - diagnosis
Dermatitis, Allergic Contact - drug therapy
Dermatitis, Allergic Contact - etiology
Dyes
Edema
Extremities - pathology
Female
Glucocorticoids - administration & dosage
Hair
Humans
India
Mometasone Furoate
Patch Tests
Patients
Phenylenediamines - adverse effects
Pregnadienediols - administration & dosage
Skin Diseases, Vesiculobullous - chemically induced
Skin Diseases, Vesiculobullous - diagnosis
Skin Diseases, Vesiculobullous - drug therapy
Tattoos
Travel
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Description
Summary:The reaction usually occurs 24-48 hours after exposure to the allergen, and the intensity and duration of the inflammatory reaction depend on the patient's sensitivity to the allergen and the concentration absorbed. Because high concentrations are often used, black henna has also been reported to provoke immediate antibody mediated type I hypersensitivity. 3 Vesiculous or vesiculobullous reactions are most common, and they typically present as a painful, erythematous, oedematous, blistering eruption. Anaphylaxis and angioneurotic oedema have also been reported after use of black henna. 4 5 Products containing paraphenylenediamine (PPD) and PPD related compounds Azo dyes Semi-permanent and temporary hair dye, ink, petrol, diesel fuel, and some food colourings Drugs Benzocaine, carbutamide, hydrochlorothiazide, 4-aminobenzoic acid (antituberculous drug), 4-aminosalicylic acid, sulfonamides Allergic contact dermatitis to PPD is an important problem, especially because-unlike most other common allergens-the incidence of reactions to PPD is rising. A recent six year retrospective study in a busy London dermatology department showed an upward linear trend of positive PPD patch test results in 6177 patients with suspected contact dermatitis. 6 The authors postulated that this rise was caused by the increased use of permanent oxidative hair dye. Because of this, in patients who have had a severe reaction, it should be applied at a concentration of 0.1%.
ISSN:0959-8138
1468-5833
1756-1833
DOI:10.1136/bmj.d7474