Retrospective evaluation of childhood paraphenylenediamine intoxication due to black henna

Background and objectives: Paraphenylenediamine (PPD) is a toxic substance in henna. Oral intake of this substance causes severe systemic toxicity. To the best of our knowledge there are no studies in the literature conducted only on children exposed to henna intoxication.

Methods: Twenty-three patients aged between 1 and 17 who referred to Nyala-Sudan Turkey Training and Research Hospital between May 2015 and June 2018 were evaluated retrospectively in terms of demographic, clinic and laboratory characteristics.

Results: Four (17.39%) patients were male and 19 (82.61%) were female. Average age of patients was 10.95 ± 3.2. Most of the referrals to the hospital following PPD intoxication occurred in the first 16 hours. All of the patients between 10 and 17 had taken henna for suicidal purposes. All patients had vomiting and agitation. The most common symptoms apart from these were gastrointestinal symptoms, tachycardia, tachypnea and dyspnea. Twelve (52.17%) patients had elevated liver function tests and 3 (13.04%) had developed renal failure. None of the patients had neurological complications. Two (8.70%) patients developed a need for tracheostomy. Average hospitalization period of patients was 8.5 days. Two patients died. One was in 1-5 age group and died due to renal complications, while the other was in 6-10 age group and died due to hepatic failure.

Conclusion: PPD intoxication is a life-threatening situation even in low doses. For this reason, even asymptomatic cases should undergo physical examination and should be followed closely in terms of respiratory tract obstruction. Ensuring hydration and diuresis in the early period, steroid and adrenalin therapy for prophylaxis in terms of respiratory tract obstruction are important and tracheostomy should not be abstained in necessary cases. It should not be forgotten that symptomatic treatment for organ systems and dialysis will decrease mortality and morbidity.

Keywords: childhood; henna; intoxication; paraphenylenediamine.