Clinicopathological Analysis of Pigmented Contact Dermatitis Caused by Henna Dyeing

Jeon, Hyeon Woo; Lee, Jee Bum; Lee, Seung Chul; Won, Young Ho; Yun, Sook Jung

Abstract

BACKGROUND
Henna is a natural dye derived from the leaves of the tree Lawsonia inermis known for its very low allergic properties. Recently, however, cases of pigmented contact dermatitis after henna dyeing have been increasing.
OBJECTIVE
To analyze the clinical and histologic features of pigmented contact dermatitis caused by henna dyeing.
METHODS
We retrospectively reviewed the clinical and histopathologic features of patients diagnosed with pigmented contact dermatitis after henna dyeing from June 2014 to August 2017.
RESULTS
A total of 22 patients with a history of henna dyeing were included. All patients were female, and mean age was 58.9±8.2 years. They presented with rapidly spreading dark brownish patches located mostly adjacent to the hairline, such as at the forehead, temple, and lateral cheek. The mean duration between symptom onset and henna dyeing was 4.52 months (0~15). Standard patch test and as is test using henna showed no significant results. There were 18 patients with pruritus, which was only present at the early stage. Histopathologic examinations showed lichenoid inflammation with dermal melanin incontinence, vacuolar alteration, epidermal apoptotic cells, and perivascular inflammation.
CONCLUSION
These results suggest that pigmented contact dermatitis observed after henna dyeing was caused by the toxicity of henna itself, not by other additives. The active ingredient of henna is lawsone (2-hydroxy-1,4-naphthoquinone), which may have induced pigmented contact dermatitis by its own cellular toxicity. Dermatologists should consider henna dyeing as a potential cause of pigmentation of the face and neck.