Prakash C. Vaghela, Naresh B. Gohel
Kalarav Children hospital, Kushal Neonatal Nursery, Bhavnagar, Gujarat, India

Correspondence to: Dr Prakash C Vaghela, Kalarav children hospital, Kushal neonatal nursery, Akar complex, Opp. Sir T Hospital, Bhavnagar 364001, Gujarat, India Email: prakash_vghl@yahoo.co.in

Hair dye is composed of paraphenylenediamine. Para-phenylenediamine (PPD) is mixed with henna, which is traditionally applied to color the palms, soles and hair. Toxicity of PPD consists of local skin irritation, contact dermatitis, chemosis, and blindness. Systemic side effects are angioneurotic edema, in later phase rhabdomyolysis, acute renal failure, and convulsions. We report a case of accidental ingestion of PPD who presented with angioneurotic edema requiring tracheostomy. Eighteen months old male child presented with accidental ingestion of hair dye followed by swelling of face, neck, tongue and difficulty in breathing within six hours. On examination, the child was irritable, had pulse of 190/min, respiration was laboured and there was cyanosis. There was edema of face, neck, pharynx and tongue. Investigations showed hemoglobin of 9.8gm%, white cell count of 14,500/cumm (86% polymorphs, 10% lymphocytes), SGPT of 324 IU/L and normal renal function tests, electrolytes, CPK, LDH and urine analysis.

The lethal dose of PPD is 7-10gm. Treatment is mainly supportive. No specific antidote is available. For upper airway obstruction, emergency tracheostomy may be needed. Maintenance of hydration, oxygenation, and adequate urine out put are essential. Intravenous corticosteroids and antihistamines have been tried.

Key words: Hair dye, Paraphenylenediamine, Angioneurotic edema

1. Nott HW. Systemic Poisoning by hair dye. Br Med J. 1924;1:421-2
2. EI Ansay EH, Ahmed MEK, Clague HW. Systemic Toxicity of PPD. Lancet 1983;1:1341
3. Sood AK, Yadav SP, Sood S et al. Hair dye Poisoning. JAPI. 1996; 44: 69.
4. Kallel H, Chelly H, Dammak H, Bahloul M, Kisibi H, Hamida CB et al. Clinical manifestation of systemic paraphenylene-diamine intoxication. J Nephrol. 2005;18:308-11
5. Motaouakkil S, Chaari B, Hachimia, Ezzouine H, Guedari H, Nejmi H at al. Rhabdomyolysis and Paraphenylene-diamine poisoning. Ann Fr Anesth Reanim. 2006;25: 708-13.
6. Ashra FW, Dawling S, Farrow LJ. Systemic Paraphenylene-diamine poisoning; A case report and review. Hum Exp Toxicol. 1994;13:167-170
7. Anuradha S, Arora S, Mehrotra S et al. Acute renal failure following PPD poisoning; A case report and review. Ren fail. 2004;26:329-32.

Last updated: 1st July 2007. Vol 4 Issue 7, Art # 28

Vagela PC, Gohel NB. Hair dye (paraphenylenediamine) poisoning. Pediatric Oncall [serial online] 2007 [cited 2007 July 1];4. Art # 28. Available from: