PPD Hair Dye Poisoning Overview

Paraphenylene Diamine (PPD) Hair Dye Poisoning

• PPD is a key ingredient in various hair dyes, producing different shades based on concentration.
• In Sudan, PPD is used to color hair and, mixed with henna, to color skin.
• PPD toxicity results from skin absorption.
• PPD is an allergen.
• Systemic issues arise from accidental or intentional ingestion.
• Toxic dose: 3-5 mg.
• Symptoms of acute poisoning include severe facial and neck edema, requiring tracheostomy in some cases, a swollen tongue, and dark brown urine.
• PPD intoxication can cause multisystem involvement leading to rhabdomyolysis and acute renal failure.
• Other reported symptoms include flaccid paralysis, severe gastrointestinal issues, cardiotoxicity, and arrhythmias.
• This form of intoxication is often fatal if not treated aggressively.
• There is currently no specific antidote.

Clinical Presentation

• Key clinical symptoms include oedema (94%), acute respiratory insufficiency (56%), tracheal intubation (72%), tracheostomy (21%), signs of rhabdomyolysis (88%), gastrointestinal symptoms (53%), and oliguric acute renal failure (32%).

Epidemiology

• PPD intoxication is a significant health concern in Sudan, Morocco, and India.
• Acute PPD poisoning is a common cause of suicide attempts needing hospitalization in Morocco.
• In adult cases, 70-90% of PPD poisonings are due to suicide attempts.
• Mortality rate ranges from 10.6% to 38.7%.
• Statistics from a Khartoum ENT hospital (1995-2005) show 3159 cases with an average of 287.1 per year.
• The affected age group is mainly 15-24 years old, accounting for 52% of cases.
• 80.7% of cases are females, with 87% linked to suicidal attempts.

Management

• ABC (Airway, Breathing, Circulation) is crucial.
• Angioneurotic edema may require tracheostomy.
• Respiratory failure needs mechanical ventilation.
• Fluids are essential.
• Gastric lavage will be performed.
• Renal dialysis may be required.

Investigation

• Blood tests for PPD levels.
• Urine tests for PPD.
• Renal function tests (RFT).
• Liver function tests (LFT).
• Electrocardiogram (ECG).

Prevention and Treatment

• Early recognition, prompt referral, and aggressive supportive treatment can lower mortality.