If you or your kids get a henna tattoo while on vacation, be sure the artist is using only natural henna, not additives.

CONSUMER ALERT: Serious reactions to black henna tattoos

A souvenir from a summer vacation or the result of a girl's trip to the mall, harmless-looking henna tattoos may have a dark side. In order to create longer-lasting, black tattoos, a harmful chemical known as para-phenylenediamine, or PPD, may be added into henna mix. PPD has been associated with many allergic reactions and skin problems.

Natural henna used for temporary tattoos is made from leaves of the lawsonia inermis plant, which provides a vegetable coloring that comes in shades of brown, green or red. Temporary coloring (dyeing) of the skin with natural henna is considered harmless and only lasts for a few days. However, to increase the intensity of the tattoo beyond which can be attained with natural henna color and to prolong the longevity of the temporary tattoo from days to weeks, some henna tattoo artists are adding PPD (also commonly used for black hair dye) into the henna mix. This turns the tattoo black.

Problems with PPD:

Dermatologist Sharon E. Jacob, MD, FAAD, assistant clinical professor of pediatrics and medicine at the University of California, San Diego noted that to date, there have been hundreds of case reports of allergic contact dermatitis from black henna tattoos, with reactions ranging from mild eczema to blistering and even permanent scarring. The first sign of a reaction is typically redness and itching, followed by bumps, swelling and then blisters. Topical steroids can be used to stop the reaction, but Dr. Jacob explained that whether or not any scarring occurs depends on the depth and severity of the inflammation. She also recommended that people see their dermatologist for proper diagnosis and treatment, and seek immediate medical attention for any serious reactions. Some people may become sensitized to PPD from just one exposure meaning that the immune system becomes prepared to remember the chemical to which it has been exposed or a chemical with a similar structure. When this happens, a person can develop a lifelong sensitivity to PPD and an allergy can cause a cross reaction to other compounds, including certain medications. For example, use of some heart, hypertension and diabetes medications, and even some anesthetics used in topical hemorrhoid preparations or oral gels, can lead to allergic reactions in people previously sensitized to PPD. "Each exposure to PPD re-challenges the immune system, so each time you get a black henna tattoo or use a hair dye that contains PPD, there is an increased risk of having a reaction," said Dr. Jacob. "Many people are sensitized to PPD, but don't have a reaction to it. However, each time you are exposed to black henna, you increase your risk of developing a lifelong allergy to it." The U.S. Food and Drug Administration (FDA) prohibits the direct application of this chemical to the skin because of its known health risks. However, since the tattoo industry is not regulated, people are still getting black henna tattoos and exposing themselves to serious medical problems.
Targeted to children?

"Perhaps the most alarming issue we are seeing with black henna tattoos is the increase in the number of children even children as young as four who are getting them and experiencing skin reactions," said Dr. Jacob. "Kids make up a significant portion of the population that receives temporary tattoos, because parents mistakenly think they are safe since they are not permanent and are available at so many popular venues catering to families. In fact, nothing could be further from the truth."
Dr. Jacob advised that if one does choose to obtain a henna tattoo, only do so if you can be certain that only vegetable henna is used, not PPD-adulterated henna. "Unless the artist can tell you exactly what's in the tattoo, don't get one."

Information provided by the American Academy of Dermatology.