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This 9 year old boy had a henna tattoo of a Chinese dragon painted on his back while abroad on holiday. The tattoo colour faded over the subsequent week but the area became acutely erythematous, swollen, and blistered, and was painful and pruritic. Examination revealed an erythematous weepy dermatitis in the shape of a dragon on the boy’s back with surrounding eczematous changes. He had had a henna tattoo the previous year with no ill effects.
Traditional henna is a naturally occurring brown dye made from the leaves of the tree Lawsonia inermis. Henna is applied to the skin in a design and allowed to dry, and is later washed off. The longer the contact time with the skin the darker the resulting colour. Henna tattoos can be further darkened by the addition of an artificial dye, paraphenyldiamine (PPD), a major constituent fo permanent hair dye. This additive makes the tattoo quicker and easier to apply. Our patient was positive on patch testing to PPD and it was presumed that primary sensitisation occurred with his first uneventful henna tattoo the previous year. Re-exposure to PPD caused a type IV hypersensitivity (delayed) reaction resulting in the allergic contact dermatitis and secondary eczematous changes. Holiday henna tattoos are becoming increasingly fashionable, so parents shold be warned that the darker paints often contain PPD, a potent contact allergen.
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