It happens every summer. As soon as school lets out and families go on vacation, a handful of news reports go viral about a vacationer getting a “black henna” tattoo and ending up in the hospital. Too often, they are children. Severe reactions to “black henna” can result in painful, weeping blisters, permanent scarring, and a multitude of other symptoms. In some cases, a reaction may be life-threatening.
This image was from a viral news report in 2017.
Without proper public awareness, and without an effort on the part of the local law enforcement to stop the use of “black henna” in tourist destinations, these occurrences continue. “Black henna” is not henna. Too often, the news stories conflate the two, leaving readers to believe that henna is the culprit. While black henna mixtures may sometimes include some true henna, the active ingredient is a high concentration of para-phenylenediamine, or PPD. This highly sensitizing compound is used at a lower concentration in commercial hair dyes, where it is legal. In the United States, hair dyes can contain up to 6% PPD. However, any use of PPD directly on the skin is illegal. Chances of sensitization and reaction increase with the concentration of the product, as well as frequency of exposure. Because “black henna” involves the application of 25% PPD or higher directly onto the skin, there is a very high likelihood of becoming sensitized, even after a single application.
For every story that hits the news, there are likely dozens that go unmentioned. And for every person who experiences a severe reaction to “black henna,” there are even more who become sensitized without any initial reaction. About 50% of people who get a “black henna” tattoo become sensitized to PPD. Of those people about 40% of them will have a future reaction severe enough to need hospital care [1,2]. Too often, a person seeking medical care for a reaction to hair dye is found to have had a “black henna” tattoo in the past [3]. To learn more about PPD, read the article, What You Need to Know about Para-Phenylenediamine (PPD) and visit The Henna Page.
Photographs of black henna injuries on children from Florida Department of Health. Photo source: Florida Department of Heath, Bureau of Environmental Health, Division of Disease Control and Health Protection. “Black Henna.” Florida Department of Heath. http://www.myfloridaeh.com/community/Black_Henna/index.htm
This article will explore the difficulties in detecting and stopping “black henna” use, and explain what steps a person can take if they believe someone is using “black henna.” If you have recently had a “black henna” tattoo applied and are experiencing a reaction, please seek immediate medical care, and also schedule an appointment with an allergist. It will be important to determine whether your PPD sensitization has led to cross-sensitization to other substances, in order to avoid future reactions.
The Spread of “Black Henna”
While traditional henna has been used to decorate the skin for 6,000 years, “black henna” is relatively new. In the 1970s, people in East African countries began adding concentrated hair dye to their henna, or using it to replace henna altogether. Whereas a traditional henna requires keeping the paste on the skin for several hours, and results in a deep red to coffee brown stain, PPD stains the skin jet black within an hour. The result looks very similar to a real tattoo, and the dark stain was more visible on darker skin tones.
The practice first spread within regions where henna has been traditionally used, and then moved out to the western tourist markets. Concentrated PPD is cheap and easy to obtain, in the forms of powdered black hair dyes and “henna stone.” Often advertised as a natural product harvested from the banks of the Nile river, “henna stone” is neither henna, nor natural. It is a chunk of industrial-grade, PPD at an extremely high concentration.
Peacock brand, often referred to as “piku,” is commonly used to create “black henna” paste. It has about 50% PPD. Because the product comes in a powder form, concentration can be higher depending on how little liquid is used to dilute.
Often referred to as “henna stone” this is a chunk of industrial grade PPD, at up to 90% concentration.
“Black henna” was offered in tourist areas in Northern Africa, South Asia, and the Middle East, before it jumped to Europe and North America with the help of pop culture and music. In 1998, “black henna” gained a boost in popularity when Madonna appeared in a music video wearing it on her hands. Now, it is widely available around beaches, resorts, amusement parks, malls, and festivals. It is especially popular with children and young adults because it mimics the looks of a “real” tattoo. About 25% of UK school-aged children report having gotten a “black henna” tattoo while on holiday [4].
This map shows the areas where “black henna” is offered to tourists, and the home countries of tourists who travel to those locations for vacation.
Catching “Black Henna” Artists
If using PPD on the skin is illegal, why is it still happening? Concentrated forms of PPD hair dye are cheap and easy to obtain. There have been cases of vendors selling “black henna” kits to people looking to make extra money in tourist areas. Applying “black henna” takes very little skill, especially when stencils can be used, and can be quite lucrative. Some artists may not know that their materials are harmful.
Those who offer “black henna” to vacationers often move around, setting up a stall in one location, then packing up and moving elsewhere. An artist can easily operate with just a small kit, a stool, and a sign. PPD exposure often results in a delayed hypersensitivity reaction, which does not occur for 3-30 days after application. By this time, the customer may be home from their vacation, and the “black henna” artist is nowhere to be found.
A “black henna” artist applying a design on a beach. Photo source: Amber Yarbrough. My Life as an Expat. Tuesday, August 28, 2012 http://amberslifeinjakarta.blogspot.com/2012/08/bali-part-one-1.html
Additionally, it is difficult to prove that an artist is using PPD. Many artists use packages without ingredients labels, storing their dye powder in small bags or bottles. They may claim that they are simply using black paint, the ink from black magic markers, or some other lie. Authorities need to be able to test a sample of the substance to determine whether or not it contains PPD. Finally, local authorities simply do not allot enough time and resources to catching people who offer “black henna.”
Taking Action
PPD sensitization is a serious problem. If you suspect that a body artist is using “black henna,” please take the following steps. Doing so will help stop the spread of PPD sensitization by making it harder for “black henna” artists to go unchecked. If an illegal vendor knows that people are spotting and reporting “black henna” users, they will be more hesitant to set up shop.
A “black henna” booth.
Photo source: cyncymc, comment “Have a Henna Tattoo” posted to Tattoo in Borocay Island, Philippines March 8, 2010 http://www.virtualtourist.com/travel/Asia/Philippines/Province_of_Aklan/Boracay_Island-1407255/Things_To_Do-Boracay_Island-Tattoos-BR-1.html
Recognizing “Black Henna”
True henna is a paste, often applied with a cone or a needle-tip bottle, and sometimes a brush or stick. It is a dark green or brown color, and often smells of plant matter and essential oils. It smells “good.” Its initial stain is a deep orange color, which darkens over 24-48 hours. You may see orange to coffee-brown stains on the artist’s hands. If the artist makes their own paste and cones, the cones will usually be made of a plain or patterned cellophane wrap, like those in craft stores.
“Black henna” is a dark gray or jet-black liquid, applied with a needle-tip bottle, or a brush. Look for bottles of grayish powder. There may also be bottles of peroxide for mixing. This liquid has very little scent. The stain is immediately black. You may see black stains on the artist’s hands. “Black henna” must be mixed fresh and used within about an hour, so you may see bowls or containers for mixing, or you may actually see an artist stir together a gray powder with water or peroxide.
Mixing “black henna.” The small, brown bottles are consistent with those in powdered hair dyes. Photo source: Peta Rasdien, “Bali black henna health alert” The West Australian. September 4, 2013.
Some pre-made henna cones contain PPD. Even if they don’t, they likely contain a cocktail of ingredients that are not safe for the skin. These cones have printed labels with brand names and images. They do not always include a list of ingredients.
These manufactured “henna” cones are easily available through the internet, despite laws preventing their sale.
To learn more about the differences between true henna, pre-made henna cones, and “black henna,” read this article.
Reporting “Black Henna”
If you believe that someone is using “black henna,” gather as much information as you can. It is not recommended to confront the person. Take photos of the stand, materials, and the artist. If possible, get a photo of the artist’s face, while they are in the act of applying “black henna” to a client. Ask if they have a business card. Take note of the exact location where you found them. If at all possible, obtain a sample of their materials. Contact the local health department and provide them with all of the information you have gathered. It is likely that the artist is operating without a license, so even if the authorities do not manage to prove the existence of PPD in their materials, they can prevent the artist from continuing.
If you are at a festival, contact the organizers of the event, as well. If it is at a hotel, amusement park, or other business, contact the owners. Businesses and events can be hit with fines, penalties, or even legal action if they are caught offering “black henna,” and they are aware of this. Most businesses will take reports of “black henna” use seriously.
Spreading Awareness
“Black henna” artists will continue as long as there are customers. Too many people are unaware of the dangers of PPD. They do not understand that while true henna is safe, “black henna” is not. While many have heard about injuries from “black henna” through the news reports, some still believe that the likelihood of suffering a reaction is low. This “it won’t happen to me” attitude is exactly what perpetuates the demand for “black henna” in tourist spaces.
It is important that local communities spread awareness about the truth. Some communities will put up signs, or hand out pamphlets. Here is an informational pamphlet that you are free to use. Print it out to take to festivals, or local areas where you suspect “black henna” may be used.
Click Here to Download the Printable “Black Henna” Pamphlet
“Black Henna” Use in Traditional Henna Cultures
This article has mainly focused on the use of “black henna” on western tourists. It is important to acknowledge that it also widely used in cultures where natural henna was traditionally used. Too often, people are ordering materials online or going to their local shops for pre-made henna cones and black hair dye, rather than mixing their own natural henna paste.
Because henna is used for holidays, celebrations, and weddings, as well as an everyday cosmetic, the people of those cultures have a higher chance of repeated exposure to “black henna.” In fact, the rates of PPD sensitization in African, Middle Eastern, and South Asian countries are often higher than those of North America and Europe. It may be more difficult to stop because the use is often within homes, among family and friends, rather than as a business. A deep sense of culture and tradition may make people more defensive of their use of “black henna.” But remember: “black henna” is only a few decades old, and true henna is an option that has existed long before PPD entered the market.
This map shows where henna was traditionally used. Many of these areas now use “black henna” as well.
If you feel that members of your community are using “black henna,” decide whether you feel comfortable approaching them about it. Try to suggest natural henna instead. Common responses may be that traditional henna is too time-consuming, too expensive, or not dark enough. Many people will claim that they have used “black henna” for years, and have never had a problem. If possible, try to convey the facts about the likelihood of sensitization, and the severity of potential reactions. Feel free to refer them to this blog, and to the resources here.
Final Notes
The consequences of “black henna” stay with people for life. Once sensitized, a person will experience a reaction each time they come in contact with PPD. Often, these reactions worsen with each exposure. PPD is commonly found in hair dyes. It is also used in fur and fabric dyeing, rubber manufacturing, and in printing. PPD sensitization can lead to cross-reactions with numerous related compounds, such as PABA, found in sunscreens. Others include those found in synthetic fragrances, anesthetics, and even food dyes. This means that one “black henna” tattoo can lead to a lifetime of continual allergy problems.
Currently, the rate of PPD sensitization is growing, with an estimated 16% of western adults expected to have a PPD allergy by 2030. Putting an end to the illegal use of PPD on skin will prevent tens of thousands of future injuries by preventing initial sensitization. If you see “black henna” being used, please do not hesitate to act.
References
[1] Kligman, Albert M. "The identification of contact allergens by human assay: III. The maximization test: A procedure for screening and rating contact sensitizers." Journal of Investigative Dermatology 47, no. 5 (1966): 393-409.
[2] Smith, Vanessa M., Sheila M. Clark, and Mark Wilkinson. "Allergic contact dermatitis in children: trends in allergens, 10 years on. A retrospective study of 500 children tested between 2005 and 2014 in one UK centre." Contact dermatitis 74, no. 1 (2016): 37-43.
[3] Søsted, H., T. Agner, Klaus Ejner Andersen, and T. Menné. "55 cases of allergic reactions to hair dye: a descriptive, consumer complaint‐based study." Contact Dermatitis 47, no. 5 (2002): 299-303.
[4] Cartwright-Jones, Catherine. “‘BLACK HENNA’ AND THE EPIDEMIC OF PARA-PHENYLENEDIAMINE SENSITIZATION: Demographics of Extreme Allergic Reactions to Oxidative Hair Dye.” Lecture. The Society of Cosmetic Chemists’ 70th Annual Scientific Meeting
New York, New York, December 10, 2015. See http://www.hennapage.com/henna/ccj/SCCPPD12_7-15.pdf