title: Severe allergic reactions to para-phenylenediamine in children and adolescents: should the patch test concentration of PPD be changed?
abstract: BACKGROUND
  Semipermanent henna tattoos containing para-phenylenediamine (PPD) are a well-known cause of severe contact dermatitis, mainly in children. Another relevant exposure source to PPD are hair dyes, which are increasingly used by children and have also been reported to cause intense facial and scalp dermatitis. German patch test guidelines for children recommend that PPD should only be tested in patients who have had a henna tattoo, and then at a reduced concentration of PPD 0.5 % for 24 hours.
  
  
  METHODS
  We report on patch test results in four patients, three children and one adolescent, with a history of contact dermatitis to henna tattoos or hair dye. We used the recommended or even lower patch test concentrations of PPD with 24-hours exposure in all patients.
  
  
  CONCLUSIONS
  All patients showed very strong patch test reactions to PPD and cross-reactions to related compounds even after dilution of PPD to as low as 0.05 %. Therefore, we suggest that in children with a history of allergic reactions to this compound, a titration test should be performed beginning at a concentration of maximal 0.05 %. This procedure has also been proposed previously based on a larger cases series in adults.
authors.affiliation: Clinic and Polyclinic for Dermatology, Carl Gustav Carus University Hospital, Technical University Dresden, Fetscherstrasse 74, Dresden, Germany. petra.spornraft-ragaller@uniklinikum-dresden.de
authors.forename: Petra
authors.initials: P
authors.lastname: Spornraft-Ragaller
authors.forename: Eva
authors.initials: E
authors.lastname: Kämmerer
authors.forename: Claus
authors.initials: C
authors.lastname: Gillitzer
authors.forename: Jochen
authors.initials: J
authors.lastname: Schmitt
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004396:Coloring Agents / Q000009:adverse effects; D003877:Dermatitis, Contact / Q000175:diagnosis* / Q000209:etiology*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D010328:Patch Tests / Q000379:methods*; D010655:Phenylenediamines / Q000008:administration & dosage / Q000009:adverse effects*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013653:Tattooing / Q000009:adverse effects*
chemical_list: D004396:Coloring Agents; D010655:Phenylenediamines; C029728:4-phenylenediamine