Doctors Say Think Before Getting Ink

Studies show that black henna - a popular alternative to real tattoos - contains a dye that carries a serious health risk.

When members of the Yashar family decided to get black henna tattoos while vacationing on the beach in Crete four weeks ago, they could not have imagined they would end up in the hospital.

Seven-year-old Rotem asked for a tattoo of a dragon on his back and under his neck. "A week later," his mother, Nicole Yashar, said, "he developed a terrible allergy. Big sores appeared along the lines of the dragon and his skin turned white."

Rotem was treated at the dermatology department of the Beilinson Hospital in Petah Tikva but he still has not yet completely recovered.

"The doctors said he must not have tattoos like that in the future and he can never dye his hair because he has developed an allergy to one of the components of the black henna which is also found in hair dye," his mother said.

Henna decorations on the skin, which look like tattoos, are very popular with pre-adolescents and teens alike, as well as with their parents who are happy that the tattoos are not permanent. The decoration usually fades in a week or two.

The substance that gives the henna its black color is called paraphenylenediamine (PPD) and is what causes the allergy. Allergic reactions to substances that are found in dyes in industrial products are well documented in medical literature. Researchers in Denmark who studied 4,000 subjects found that 75 percent of the women and 18 percent of the men dyed their hair.

Some 5 percent reported that they had had allergic reactions to the hair dyes and 15 percent of them (equivalent to 1 percent of the population) developed severe allergic reactions and required medical attention.

Some doctors believe the allergic reaction to dyes is the result of a genetic tendency.

In most cases, the allergy to PPD caused by hair dye does not develop on the scalp but rather on the face. It takes the form of swelling and edema around the eyes or on the forehead as well as in the nape of the neck.

"The recommendation today is not to do temporary black henna tattoos because of the high risk," says Dr. Akiva Trattner, head of ambulatory dermatological services at Beilinson. However he says that there is no reason not to have tattoos from natural red or brown henna which do not contain the allergen.

Other studies indicate the growing incidence of allergy to PPD in hair dye, in recent years, apparently as a result of the increased use of commercial dyes in various parts of the world. However, a study carried out at the L'Oreal cosmetic laboratories in Paris and published in the journal Dermatitis shows that in North America there has actually been a decrease in reports of PPD allergies since 1970.

There are also cases of allergy to dyes in fabrics. A study carried out at the Meir Hospital in Kfar Sava revealed that near-black navy blue is the color that causes most allergies, followed - at a long distance - by red, orange and black.

"A black henna tattoo is supposed to last for a few days on the skin and to disappear when washed, but the PPD allergen is very strong and can cause a serious reaction," Trattner said. "The allergy appears in the form of redness and itchy blisters and in some cases can move to another area of the body. The higher the concentration of the allergen, the greater the tendency to develop an allergy."

The medical literature speaks of a number of cases of death following exposure to allergens in hair dye when used in high doses. This year a woman in Maryland died under such circumstances. In September 1997, there was a case in Chicago where a 68-year-old woman had an allergic reaction to hair dye and when she used the same dye two years later, developed shortness of breath, collapsed and died.

In Sudan there have also been reports of such cases. Trattner says this is because "certain women there tend to dye their hair with a deep black hue that contains a high proportion of PPD."

He added, "An allergic reaction accompanies a person for life. A 10-year-old boy who has developed a sensitivity or an allergic reaction to a small back henna tattoo cannot use most of the hair dyes that are usually found on the market for the rest of his life."

Another danger is that the allergy to the dye will become an allergy to other substances "like medications that contain substances with a similar chemical composition such as medicines used for diabetes and antibiotics," he said.