Side‐effects of henna and semi‐permanent ‘black henna’ tattoos: a full review

SummaryHenna, the dried and powdered leaf of Lawsonia inermis, is widely used as a dye for the skin, hair, and nails, and as an expression of body art, especially in Islamic and Hindu cultures. As it stains the skin reddish‐brown, it is also called red henna. Black henna is the combination of red henna with p‐phenylenediamine (PPD), and is used for temporary ‘black henna tattoos’. This article provides a full review of the side‐effects of topical application of red and black henna, both cutaneous (allergic and non‐allergic) and systemic. Red henna appears to be generally safe, with rare instances of contact allergy and type I hypersensitivity reactions. In children with glucose‐6‐phosphate dehydrogenase deficiency, topical application of henna may cause life‐threatening haemolysis. Black henna tattoos will induce contact allergy to its ingredient PPD at an estimated frequency of 2.5%. Once sensitized, the patients may experience allergic contact dermatitis from the use of hair dyes containing PPD. There are often cross‐reactions to other hair dyes, dyes used in textiles, local anaesthetics, and rubber chemicals. The sensitization of children to PPD may have important consequences for health and later career prospects. Systemic toxicity of black henna has been reported in certain African countries.