Effect of Henna
2
Indian Journal of Pharmacology 2002; 34: 436-437 CORRESPONDENCE ADVERSE REACTIONS TO HENNA The henna plant Lawsonia inermis Linn is a fragrant shrub native to Asia and northern Africa. The spe- cies is sometimes referred to as L. alba or L. rubra and is cultivated in India, the Middle East, Egypt and tropical America. Mehendi or henna dye is prepared by grinding the fresh leaves of this plant or by pow- dering the dried leaves and then mixing into a grayish- green paste with water. The resulting brown dye is extensively used as decorative skin paint, for nail coloring and as hair dye and conditioner. The dye stays for a few weeks and then fades. The use of this natu- ral cosmetic is a much-loved tradition in India dating back to antiquity. For instance, wedding ceremonies in many parts of the country would be incomplete without the ritual of creating intricate designs on the hands and feet of the bride with henna. Orthodox jews and muslims who shun synthetic colors use only henna as a natural paint and hair dye. The custom of using henna for paint-on tattooing is spreading, even in western countries. A casual enquiry from a dermatologist colleague prompted a literature search for potential toxic effects of henna. What emerged is worth sharing. Most numerous are reports of allergic contact der- matitis. These can occur in any user and manifest as eczematous, lichenoid or more severe reactions 1 . The dermatitis results from a contact hypersensitivity re- action and mostly remains restricted to the actual area of contact. There may be residual depigmentation for weeks or even scarification. Interestingly, pure natural henna per se rarely, if at all, causes contact hypersensitivity. In most cases, the reaction appears to be provoked by the addition of synthetic dyes like para-phenylenediamine (PPD), para-toluylenediamine, or related chemicals 2 . These are added to natural henna to darken the coloration and shorten applica- tion times. The resulting product is called black henna. Patch testing with PPD is often strongly positive in subjects showing allergic reaction to black henna tat- tooing. Similar sensitization is probably also respon- sible for chronic asthmatic reactions to henna follow- ing occupational exposure, such as in hairdressers. Immediate-type hypersensitivity reactions, possibly IgE mediated, manifesting as urticaria, rhinitis, and acute bronchospasm, have also been reported in hair- dressers. Severe and fatal angioneurotic edema oc- Figure 1. 2-Hydroxy-1,4-naphthoquinone (lawsone), the entity responsible for hemolysis caused by henna in G6PD deficiency. The structure is closely related to 2-me- thyl-1,4-naphthoquinone (menadione), the water solu- ble parent vitamin K compound that can also cause hemolysis. However, menadione does not share the nephrotoxic activity of lawsone. curred in a series of deliberate and accidental poisonings in children exposed to henna-PPD mix- tures in Khartoum, Sudan 3 . Also serious are reports of life-threatening hemolytic crisis on topical exposure to henna in individuals de- ficient in glucose-6-phosphate dehydrogenase (G6PD). A recent case series reported 4 instances of such a reaction in G6PD-deficient children - a neonate, an infant and two pre-school children 4 . The hemolytic crisis was manifest within 24 - 72 hr of the henna application. The male infant could not be saved despite exchange transfusion. The culprit in this case appears to be the oxidizing agent 2-hydroxy-1,4- naphthoquinone or lawsone ( Figure 1) which occurs naturally in henna and has been documented to cause dose-dependent hemolytic anemia and nephrotoxic- ity in laboratory rats 5 . Lawsone is the actual dye in henna. In addition to its extensive use as natural cosmetic, henna has some potential medical uses too. Henna extracts have shown fungistatic, bacteriostatic and anti-inflammatory activity. Lawsone may exert anti- sickling effects in sickle cell anemia. Allyl derivatives of lawsone, but not the parent compound, have shown activity against Trypanosma cruzi in vitro 6 . An inter- esting application of henna is as a durable skin-mark- ing agent in patients undergoing external radiotherapy, especially during conformal techniques 7 . Accuracy is increased and bathing is permitted in this situation improving patient comfort. In view of the existing and potential uses of henna, practitioners should remain alert to adverse reactions. The use of black henna, in particular, needs to be
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Transcript of Effect of Henna
Indian Journal of Pharmacology 2002; 34: 436-437 CORRESPONDENCE
ADVERSE REACTIONS TO HENNA
The henna plant Lawsonia inermis Linn is a fragrantshrub native to Asia and northern Africa. The spe-cies is sometimes referred to as L. alba or L. rubraand is cultivated in India, the Middle East, Egypt andtropical America. Mehendi or henna dye is preparedby grinding the fresh leaves of this plant or by pow-dering the dried leaves and then mixing into a grayish-green paste with water. The resulting brown dye isextensively used as decorative skin paint, for nailcoloring and as hair dye and conditioner. The dye staysfor a few weeks and then fades. The use of this natu-ral cosmetic is a much-loved tradition in India datingback to antiquity. For instance, wedding ceremoniesin many parts of the country would be incompletewithout the ritual of creating intricate designs on thehands and feet of the bride with henna. Orthodox jewsand muslims who shun synthetic colors use onlyhenna as a natural paint and hair dye. The custom ofusing henna for paint-on tattooing is spreading, evenin western countries.
A casual enquiry from a dermatologist colleagueprompted a literature search for potential toxic effectsof henna. What emerged is worth sharing.
Most numerous are reports of allergic contact der-matitis. These can occur in any user and manifest aseczematous, lichenoid or more severe reactions1. Thedermatitis results from a contact hypersensitivity re-action and mostly remains restricted to the actualarea of contact. There may be residual depigmentationfor weeks or even scarification. Interestingly, purenatural henna per se rarely, if at all, causes contacthypersensitivity. In most cases, the reaction appearsto be provoked by the addition of synthetic dyes likepara-phenylenediamine (PPD), para-toluylenediamine,or related chemicals2. These are added to naturalhenna to darken the coloration and shorten applica-tion times. The resulting product is called black henna.Patch testing with PPD is often strongly positive insubjects showing allergic reaction to black henna tat-tooing. Similar sensitization is probably also respon-sible for chronic asthmatic reactions to henna follow-ing occupational exposure, such as in hairdressers.Immediate-type hypersensitivity reactions, possiblyIgE mediated, manifesting as urticaria, rhinitis, andacute bronchospasm, have also been reported in hair-dressers. Severe and fatal angioneurotic edema oc-
Figure 1. 2-Hydroxy-1,4-naphthoquinone (lawsone), the entityresponsible for hemolysis caused by henna in G6PDdeficiency. The structure is closely related to 2-me-thyl-1,4-naphthoquinone (menadione), the water solu-ble parent vitamin K compound that can also causehemolysis. However, menadione does not share thenephrotoxic activity of lawsone.
curred in a series of deliberate and accidentalpoisonings in children exposed to henna-PPD mix-tures in Khartoum, Sudan3.
Also serious are reports of life-threatening hemolyticcrisis on topical exposure to henna in individuals de-ficient in glucose-6-phosphate dehydrogenase(G6PD). A recent case series reported 4 instancesof such a reaction in G6PD-deficient children - aneonate, an infant and two pre-school children4. Thehemolytic crisis was manifest within 24 - 72 hr of thehenna application. The male infant could not be saveddespite exchange transfusion. The culprit in this caseappears to be the oxidizing agent 2-hydroxy-1,4-naphthoquinone or lawsone ( Figure 1) which occursnaturally in henna and has been documented to causedose-dependent hemolytic anemia and nephrotoxic-ity in laboratory rats5. Lawsone is the actual dye inhenna.
In addition to its extensive use as natural cosmetic,henna has some potential medical uses too. Hennaextracts have shown fungistatic, bacteriostatic andanti-inflammatory activity. Lawsone may exert anti-sickling effects in sickle cell anemia. Allyl derivativesof lawsone, but not the parent compound, have shownactivity against Trypanosma cruzi in vitro6. An inter-esting application of henna is as a durable skin-mark-ing agent in patients undergoing external radiotherapy,especially during conformal techniques7. Accuracy isincreased and bathing is permitted in this situationimproving patient comfort.
In view of the existing and potential uses of henna,practitioners should remain alert to adverse reactions.The use of black henna, in particular, needs to be
informed and possibly restricted. Manufacturersshould voluntarily declare whether or not their hennaproducts are additive free. Adulteration must be pros-ecuted. Henna can be avoided in neonates and youngchildren and in individuals known to be G6PD defi-cient. Potential mishaps may thus be curtailed.
REFERENCES
1. Chung WH, Chang YC, Yang LJ, Hung SI, Wong WR, LinJY, et al. Clinicopathologic features of skin reactions totemporary tattoos and analysis of possible causes. ArchDermatol 2002;138:88-92.
2. Le Coz CJ, Lefebvre C, Keller F, Grosshans E. Allergiccontact dermatitis caused by skin painting(pseudotattooing) with black henna, a mixture of hennaand p-phenylenediamine and its derivatives. ArchDermatol 2000;136:1515-7.
3. Sir Hashim M, Hamza YO, Yahia B, Khogali FM, SuliemanGI. Poisoning from henna dye and para-phenylenediaminemixtures in children in Khartoum. Ann Trop Paediatr1992;12:3-6.
4. Raupp P, Hassan JA, Varughese M, Kristiansson B. Hennacauses life threatening haemolysis in glucose-6-phosphatedehydrogenase deficiency. Arch Dis Child 2001;85:411-2.
5. Munday R, Smith BL, Fowke EA. Haemolytic activity andnephrotoxicity of 2-hydroxy-1,4-naphthoquinone in rats.J Appl Toxicol 1991;11:85-90.
6. Pinto AV, Pinto CN, Pinto Mdo C, Rita RS, Pezzella CA, deCastro SL. Trypanocidal activity of synthetic heterocyclicderivatives of active quinones from Tabebuia sp. Arznei-mittelforschung 1997;47:74-9.
7. Wurstbauer K, Sedlmayer F, Kogelnik HD. Skin markingsin external radiotherapy by temporary tattooing with henna:Improvement of accuracy and increased patient comfort.Int J Radiat Oncol Biol Phys 2001;50:179-81.
AVIJIT HAZRA
Department of Pharmacology,University College of Medicine,
Calcutta Univesity, 244B Acharya J.C. Bose Road,Calcutta - 700 020.
e-mail: [email protected]
CORRESPONDENCE 437
INDIAN JOURNAL OF PHARMACOLOGY
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