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Endgames Case Review

Facial swelling and beard crusting

BMJ 2023; 381 doi: https://doi.org/10.1136/bmj-2022-072331 (Published 20 April 2023) Cite this as: BMJ 2023;381:e072331

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To dye or not to dye

Dear Editor
I read with interest this severe skin reaction to presumed black henna dye. As stated this is likely to be due to paraphenylenediamine (PPD) however without skin allergy patch testing which can confirm delayed type T-cell mediated hypersensitivity it is difficult to be sure. Paratoluenediamine (PTD) can be a solitary hair dye allergen in some cases hence patch testing is essential to determine which allergen needs to be avoided in the future. Sensitisation can occur with first exposure to temporary black henna tattoos often in childhood during a beach holiday abroad. We would recommend testing to various dye allergens to detect any cross reactions. Severe cases in the beard area can also lead to residual depigmentation of the skin.

Competing interests: No competing interests

20 April 2023
Mahbub M Chowdhury
Consultant Dermatologist and Cutaneous Allergy Lead
University Hospital of Wales, Cardiff
Department of Dermatology, University Hospital of Wales, Cardiff CF14 4XW
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