Black henna tattoos can cause a bad reaction. (Photo: Stocksy)
Doctors are suggesting that everyone consider avoiding black henna tattoos, especially while traveling, after a 10-year-old boy from the United Kingdom had a painful allergic reaction. According to a new paper in BMJ Case Reports, he had just been on a trip to Spain with his family.
The boy visited his doctor’s office after experiencing an inflammatory outbreak of raised red spots along the outline of the tattoo. The rash began four days after the black henna was applied; the skin lesions were crusted, hot, and painful to the touch. Doctors treated him with antibiotics, along with a topical corticosteroid, a local anesthetic, and moisturizers. After 48 hours, the lesions did improve, although after 10 days there was still hyperpigmentation where the tattoo had been.
The reaction was likely caused by textile dye paraphenylenediamine (PPD), according to the study’s lead author, Jaya Sujatha Gopal-Kothandapani, PhD, a researcher in pediatric endocrinology in the Department of Oncology & Metabolism at the University of Sheffield.
“This dye is a known contact allergen and can cause significant side effects like redness, blistering, itching, and discoloration of the skin,” Gopal-Kothandapani told Yahoo Beauty. “It can cause a permanent damage to the skin or lead to a life-threatening allergic reaction in some individuals. Exposure to this dye can also increase the risk of developing rapid and severe allergic reaction to hair dye in the future and vice versa.”
And it’s not just hair dye either, says Gopal-Kothandapani. The PPD dye can sensitize individuals to chemicals in black clothing dye, black rubber, PABA sunscreen, and hair dye, causing a cross-reaction when exposed to these agents in the future.
A 10-year-old boy’s serious allergic reaction to a black henna tattoo. (Photo courtesy of the University of Sheffield)
Skin reactions from black henna tattoos are all too common, says Gopal-Kothandapani, and the severity of the reaction is generally based on the concentration of and the length of exposure to the PPD dye. Black henna tattoos often have concentrations of PPD as high as 30 percent, which clocks in way above the regulated levels for the dye in most countries. As a comparison, companies can use only up to 6 percent PPD in hair dye and none in skin products in the United States and Europe.
The FDA has administered warnings in the past about black henna reactions. Many cases of inflammation, like what happened to the 10-year-old boy visiting Spain, arise from application in European countries, but travelers should exercise caution in other locations too. “Tourists visiting countries like Indonesia, Morocco, Turkey, Egypt, and [nations in] the Middle East most commonly report reactions to black henna tattoos applied by temporary tattoo artists at holiday resorts and street carnivals,” says Gopal-Kothandapani.
Not all henna is bad, though. If you want to get one of those intricate tattoos, Gopal-Kothandapani says it’s important to distinguish between “natural henna” and “black henna” — because only natural henna is safe. “Natural henna paste is greenish, smells natural, takes six or eight hours to stain, will never burn the skin, and leaves a deep maroon color that can last for up to three weeks,” she says. “Black henna is dangerous. The paste is jet-black, smells like a chemical, takes less than an hour or two to stain skin, may burn, and will leave a black color for more than three days.”
If you’re in any way unsure whether the henna is black or natural, skip it. Also of note to parents: The severity of an allergic reaction from the PPD in black henna is usually much higher in children than adults, says Gopal-Kothandapani.