The patient had a history of atopia. Treatment with topic clobetasol 0.05% in a daily

application was performed for 1 week and intensified by occlusive technique every day for 10 days and to alternate days for 2 more weeks. Cutaneous tests were not realized. The evolution went to the total resolution 5 weeks from the beginning of the symptoms. Which is the reason of the above-mentioned reaction? SOLUTION: Contact dermatitis caused by a temporary tattoo with black henna. The temporary tattoos with henna (powder of greenish color, obtained from Lawsonia inermis’s leaves) are traditionally used as adornment in certain cultures (Muslim and Hindu principally) or ceremonies (weddings, Lumacaftor datasheet pregnancy). The obtained dye can be of different colors: brown, red, purple, black. Its use is habitual in Africa, Asia, and the Middle East and it has spread to Occident at the same time as other procedures like definitive tattoos or piercings. These tattoos are well accepted

by occidental travelers in view of its non-permanent character (2–3 wk of duration) and they INK 128 concentration are normally made by “ambulant artists” or in establishments with low sanitary guarantees, since already it had been detected in the destination visited by our patient.1 To improve the quality of the tattoo (color, dried, duration) the henna can be mixed with certain additives, one of them is ρ-phenylenediamine (PPD), a coloring authorized in low concentrations (up to 6%) for cosmetic products like dyes for hair, products that our patient had never used before. PPD is a well-known contact allergen2 being used to obtain the black henna, occasionally in concentrations of up to 15%.

Its use explains the high incidence of contact dermatitis in this type of tattoos.3,4 PPD can cause immediate or late reaction and other problems such as crossed reactivity Phosphoprotein phosphatase to dyes used habitually in hairdresser’s shop, clothes, or footwear, even with certain medicaments such as sulfonamides or sulfonylureas. The injuries of our patient suggest a contact dermatitis caused by a delayed-type allergy IV that appeared after a wide lag time of 10 days typical of a first exhibition to the allergen, similar to the two cases described by Laüchl and colleagues.3 Although we believe that PPD is the most probable reason of the reaction we cannot confirm with absolute safety that it should be the responsible allergen given the absence of cutaneous specific tests. The reaction evolved to the complete resolution but permanent injuries have been described as hypo- or hyperpigmentation and cicatrizial queloids.5 In addition, the previous contact with black henna/PPD can cause the permanent sensibilization to commented dyes,6 with the limitation that it can suppose for the affected persons.