Black Sudani henna can trigger severe allergic reactions

As good as it looks, "Black Sudani Henna" can cause serious life-threatening reactions due to certain chemicals found in hair dye that are usually mixed with natural henna to produce the Sudani henna's distinctive black colour.

Many Sudanese brides have collapsed and died on their wedding days after using this blackened henna because henna artists use a highly poisonous crushed-rock powder that they mix with natural henna to produce a deep black colour. In other cases, the use of Para-Phenylene Diamine (PPD), an active ingredient in many black hair dyes, is responsible for the severe allergic reactions.

Many Sudanese and Asian henna artists in the UAE often refuse to divulge the chemical composition of their products, keeping it as a trade secret instead. Thus, it would be impossible for a customer to know if a henna preparation would cause an allergic reaction or not before hand.

A study published in the Lancet medical journal in 1996, conducted by Abdulla K. A. and Davidson N. M., titled "A Woman who Collapsed after Painting Her Soles" said that PPD is a potent skin sensitiser and can cause angioneurotic edema, collapse, and renal failure in severe cases.

A study conducted by the Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, reported that commercial hair dye products are known to cause hypersensitivity in certain individuals and several mutagenic PPDs found in hair products have been reported to be carcinogenic in animals.

The study found that 10 samples of commercial hair dye, that had been tested using gas chromatography and mass spectrometry, had an average PPD level of 7.7 per cent with individual samples ranging in PPD content form 0.04 per cent to 66.5 per cent.

Hiam Kamal, a housewife, said that applying henna is part of the traditions of many nations, used by women for beautification and cosmetic purposes in many countries.

"In the past, women used to apply natural Henna which is taken from trees directly and mixed up with natural products such as lemon and sugar if they wanted a reddish colour, others mix a natural liquid called Mahlabiya with henna to produce the distinctive black colour. Women also used to repeat the Henna application several times to get the black colour, but now they use chemical products to produce a black colour in a short time" Hiam said.

Talking about her personal experience with henna, Hiam said it was a terrible experience: " I had a hard time when I used the chemical henna, it caused skin irritation and I had trouble breathing and I developed swelling on my legs, feet, arms and the palm of my hand which took more than two months to be treated. I still scarring on my skin that will stay for the life."

Rihab Khalafallah, narrated her cousin's story who died of chemical henna poisoning when the henna was absorbed by her skin and led to renal failure and trouble breathing. She said her cousin applied henna on her wedding day in different parts of her body. She said that her cousin was complaining of itching, irritation, but the salon lady told her that this was a normal feeling experienced by all women who apply henna.

"Suddenly the bride was hardly breathing and she finally fainted and died on the spot" Rihab said. The medical report revealed that the victim had a severe allergic reaction which caused an asthmatic attack and death followed. "Preparations for the wedding turned to preparations for a funeral and happiness turned to sadness and mourning." Manal Abdul Hameed said that she too was a victim of the chemically improved henna, she experienced symptoms of eye redness and swelling on her skin. She was admitted to hospital for urgent treatment. The doctor advised her to avoid applying henna during pregnancy and breast feeding because it also affects the fetus and baby. From that date she applied only the natural henna to avoid any health risks.

A study by Ashraf W., Dawling S., and Farrow L. J., titled "Systemic PPD Poisoning: a Case Report and Review", said that deliberate or accidental ingestion of PPD itself is associated with muscle damage leading to death in humans. Children who receive PPD black henna body art are also apt to accidentally ingest the chemical.

Dr Amira Jailani, a physician at Ras Al Khaimah Hospital, said that the dye which is used in Sudani Henna, can cause skin allergy, itching and permanent scaring and unsightly marks on the skin. She said some people manifest severe reactions others show mild reactions, adding that severe reactions are caused by absorption of dye in large quantities which can cause acute renal failure, in fact a person can die on the spot.

She said in those who are allergic to the chemical, reactions can range from severe hypotension and may lead to asphyxiation, it can lead to generalised oedema all over the body and affect the upper respiratory system and lead to sudden death. For asthmatic patients, it can also cause severe asthmatic attack and lead to death without medical intervention.

Dr Jailani said even if a patient does not suffer acute reaction from first use, through repetitive use it can cause chronic renal failure and redness in the eyes for those who use dyes that contain Oxygen or Baijen, two other ingredients found in hair dye.

Dr Shubhaida Mandar Bichu, dermatologist at Qasimi Hospital, said that she sees between five and eight cases of severe skin reaction to cosmetics and black Sudani Henna each month, on an average two cases each week.