BMJ Case Reports 2010; doi:10.1136/bcr.09.2009.2277
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Severe type IV hypersensitivity to ‘black henna’ tattoo

  1. Sarah Frankton4
  1. 1Department of Acute Medicine, St Bartholomew's and The Royal London Hospitals, London, UK
  2. 2Department of Acute Medicine, The Royal London Hospital, London, UK
  3. 3Department of Clinical Pharmacology and General (Internal) Medicine, St Bartholomew's and The Royal London Hospitals, London, UK
  4. 4Departments of Acute Medicine, Endocrinology and Diabetes, The Royal London Hospital, London, UK
  1. Correspondence to Sarah Frankton, sarah.frankton{at}


A 16-year-old Bangladeshi girl presented with a 9-day history of an extensive pruritic, erythematous, papulovesicular skin eruption to both forearms. Appearance was 5 days following application of a home-made henna preparation. Examination revealed ulceration and scabbing along the whole henna pattern and early keloid formation. A diagnosis of type IV delayed hypersensitivity reaction superimposed by infection was initially made. As in this case, home-made henna preparations commonly combine commercial henna with black hair dye, paraphenylenediamine (PPD). PPD, widely known as ‘black henna’, darkens the pigment and precipitates the drying process. PPD is a potent contact allergen associated with a high incidence of hypersensitivity reactions. Despite treatment the patient was left with extensive keloid scarring in the pattern of the henna tattoo.


  • Competing interests None.

  • Patient consent Obtained.

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