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      Paraphenylenediamine: Blackening more than just hair

      case-report

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          Abstract

          Paraphenylenediamine is an important constituent of hair dye toxicity of which one could herald fatal complications such as rhabdomyolysis, renal failure, angioneurotic edema, and respiratory failure. We present a case of hair dye poisoning that presented with respiratory distress due to laryngeal edema and later developed trismus, subclinical tetany, apnea, and conduction abnormality on electrocardiogram. This case report highlights the need for a thorough toxicological review of the components of any ingested substance.

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          Hair dye poisoning--an emerging problem in the tropics: an experience from a tertiary care hospital in South India.

          I Ramya, Anugrah Chrispal, Anand Zachariah … (2010)
          Super-Vasmol, a cheap, freely-available hair dye is emerging as a major cause of suicidal poisoning in India. It contains potential toxins including paraphenylene diamine, resorcinol, sodium ethylenediaminetetraacetic acid and propylene glycol which can result in multiorgan dysfunction. A retrospective study was conducted over 3.5 years (January 2006-July 2009) of 13 consecutive patients with Super-Vasmol poisoning admitted to a tertiary care, referral hospital in South India. A chart review including records of clinical presentations, laboratory findings and treatment details was carried out. Eleven of the patients were women and the mean age was 27.2 years. The predominant clinical features were cervico-facial oedema and pain, cola-coloured urine and oliguria. Laboratory investigations revealed elevated hepatic transaminases (100%), leucocytosis (92.3%), elevated creatinine phosphokinase (92.3%), metabolic acidosis (84.6%), hypocalcaemia (61.5%), hyperphosphataemia (46.2%) and renal failure (38.5%). Eight of the patients were discharged with complete recovery. Trends towards a poor outcome were evident among the following patients: late presentation at our centre; when no gastric lavage was done at the primary-care centre; those requiring tracheostomy/intubation at the primary centre; presentation with a low Glasgow Coma Score or seizures; established renal failure; and those who subsequently require dialysis, mechanical ventilation or intensive care. Hair dye poisoning classically presents with cervico-facial oedema, severe rhabdomyolysis and renal failure. Early therapy with tracheostomy and aggressive forced diuresis are essential in order to prevent the high mortality associated with this toxin. It is imperative to raise public awareness of the potential toxicity of the dye as well as to educate physicians about the need for aggressive and early treatment.
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            Hair dye poisoning in Bundelkhand region (prospective analysis of hair dye poisoning cases presented in Department of Medicine, MLB Medical College, Jhansi).

            N. A. P. Kiran Kumar, P. Jain, Nutan Agarwal … (2011)
            Hair dye (Paraphenylene di-amine, PPD) poisoning has high morbidity and mortality and its incidence has increased dramatically in the past 4 years. A prospective study was planned to assess the clinical profile and outcome with different treatment approaches. The material comprised of 1020 cases admitted in Medicine Department of MLB Medical College, Jhansi, U.P. from July 2004 to March 2009. Out of 1020 cases 697 cases were of stone hair dye poisoning and 323 cases were of other branded hair dyes (powdered form containing less amount of Paraphenylene diamine). Diagnosis was made solely on the basis of the history given by cases/attendant and symptoms of neck swelling, black coloured urine and muscular pain. The cases were thoroughly studied for different complications (renal, hepatic and cardiac etc) and were treated accordingly. Out of 1020 cases studied, majority were females in the age group of 15-45 yrs (n=734) while the rest were males. A total of 244 (23.92%) cases expired during treatment. Neck swelling, respiratory distress and whole body muscular pain were most common symptoms at presentation, oliguria, chest pain, palpitation, presyncope/syncope, pain in abdomen, nausea with vomiting and dysphagia were other common symptoms. Paraphenylene diamine is highly toxic. Cases who consumed up to 10 gm of PPD usually survived if they presented to hospital within 4 hour of dye ingestion. Severe edema of face, neck and floor of mouth, renal failure and myocarditis were poor prognostic factors. No deaths occurred in cases of Branded Hair dye ingestion.
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              Super vasomol hair dye poisoning

              Praveen Kumar, Keerthi Talari, T. K. Dutta (2012)
              Hair dye poisoning is not rare but is an emerging poisoning in India. The main component of hair dye causing toxicity is paraphenylenediamine (PPD). Acute poisoning by PPD causes characteristic severe angioedema of the upper airway accompanied by a swollen, dry, hard, and protruding tongue. Systemic intoxication results in multisystem involvement and can cause rhabdomyolysis, acute renal failure (ARF). PPD consumption is an uncommon cause of ARF. There is no specific antidote for PPD and treatment is mainly supportive. We report a case of suicidal ingestion of hair dye that presented with cervicofascial edema and later developed rhabdomyolysis and ARF. Our patient improved with dialysis and symptomatic management.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Res Med Sci
                Journal ID (iso-abbrev): J Res Med Sci
                Journal ID (publisher-id): JRMS
                Title: Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 1735-1995
                ISSN (Electronic): 1735-7136
                Publication date (Print): June 2012
                Volume: 17
                Issue: 6
                Pages: 584-586
                Affiliations
                [1]Internal Medicine/Critical care, Princess Durru-Shehvar Children's and General Hospital, Purani Haveli, India
                [1 ]Pulmonology and Critical care, Medwin Hospital, Nampally, Hyderabad, Andhra Pradesh, India
                Author notes
                Address for correspondence: Dr. Dilip Gude, Intensivist & Research Coordinator Department of Internal Medicine/Critical care, Princess Durru-Shehvar Children's and General Hospital, Purani Haveli, Hyderabad, Andhra Pradesh, India. E-mail: letsgo.dilip@ 123456gmail.com
                Article
                Publisher ID: JRMS-17-584
                PMC ID: 3634302
                PubMed ID: 23626641
                SO-VID: 6c3bf575-8e4f-41ad-bdf4-a8d1b9d8ec0b
                Copyright © Copyright: © Journal of Research in Medical Sciences
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 02 November 2011
                Date revision received : 27 November 2011
                Date accepted : 03 May 2012
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Medicine
                Keywords: renal failure,paraphenylenediamine,hair dye poisoning
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: renal failure, paraphenylenediamine, hair dye poisoning

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