Review: Paraphenylene Diamine (Hair Dye) Poisoning in Children

Abstract

Introduction: Paraphenylene Diamine (PPD) is an aromatic amine not found in nature. It is used in a variety of industrial products and in different hair dye formulations. It is well known that PPD is an allergen that may cause contact dermatitis, erythematous urticarial papules and eczema in susceptible individuals. However, the major systemic problem occurs when it is ingested accidentally, for purposes of suicidal intent or during attempted murder. Information on the systemic effects and outcome of hair dye poisoning in children is limited. In this article we review the literature for PPD intoxication in children.
Review: PPD intoxication is a major health problem in eastern Africa, particularly Sudan, and in Morocco. It is also common in the Indian subcontinent. In two large series from Morocco and Sudan, Children constituted 11.5% and 18% of affected individuals respectively. Acute poisoning by PPD causes characteristic severe angio-edema of the upper airway, often requiring tracheostomy, accompanied by a swollen, dry, hard and protruding tongue. PPD intoxication results in multisystem involvement and can cause rhabdomyolysis and acute kidney injury (AKI), flaccid paralysis, severe gastro-intestinal manifestations, cardiotoxicity and arrhythmias. This form of severe intoxication is fatal if not treated aggressively. There is no specific antidote and treatment is mainly supportive with renal replacement therapy commonly used in cases with AKI. Reported mortality rates range between 12-42%.
Conclusion: PPD intoxication is a life threatening condition. Clinical outcomes rely on early recognition, prompt referral, and aggressive supportive treatment in collaboration with different specialties.

Keywords: Children; Hair Dye; Paraphenylene Diamine; Poisoning