1997;18:2902. Lestringant GG, Bener A, Frossard PM. By comparing the available data, PPD seems to be a hapten with a peculiar aspect, because it may behave like a systemic drug to elicit a hypersensitivity response. suggested that patients sensitized to black henna tattoo should be divided into 2 groups according to their clinical course, that may be acute or subacute. Side-effects of henna and semi-permanent black henna tattoos: a full review. We present a case of this irreflected practice. 1979;5:8516. 2002;109:100311. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. As far as morphological clinical pictures are concerned, they appear to be more various and heterogeneous than time-pattern contact allergy manifestations (Table1). Moreover, Pichler et al. Henna is also used in traditional medicine to treat alopecia, burns, headaches, gastrointestinal symptoms,3 and as an antimycotic, tuburculostatic and as ultraviolet-A blocker.2, Henna has the advantage of easy, quick and painless application as well as being temporary. Contact Dermat.
Jasmin ZF, Darling JR, Handley JM. Learn more Pediat Dermatol. Mohamed M, Nixon R. Severe allergic contact dermatitis induced by paraphenylenediamine in paint-on temporary tattoos. We reviewed the available literature concerning the clinical presentations, the morphological pictures associated to allergy to black henna and the immunological mechanisms underlying the allergic reactions. Sosted H, Johanssen JD, Andersen KE, Menn T. Severe allergic hair dye reaction in 8 children. Some reactions may appear 45days later following the henna tattoo application [12], but sometimes cutaneous reactions may appear few hours following henna tattoo [13, 14]. In suggestive clinical pictures, like the urticarial-angioedema-like contact dermatitis, although the mechanisms appears as an IgE-mediated reaction, actually it is an early onset cell-mediated mechanism [26, 27]. Tosti A, Pazzaglia M, Corzza M, Virgili A. Allergic contact dermatitis caused by mehindi. Plants that are usually mentioned in this context are fig, celery, lime, lemon, parsley, carrot and dill belonging to the species Umbelliferae, Moraceae, Leguminosae, or Rutaceae.8 As some secret ingredients of henna may include one of these substances and as henna tattooing is usually done on skin exposed to the sun, it is possible that some cases of henna dermatitis are in fact cases of phytophotodermatitis. PMC legacy view The https:// ensures that you are connecting to the Lancet 1996;348:658. de Groot AC. Contact Dermat. Van den Keybus C, Morren MA, Goossens A. and the dyeing of hair; it is also used to relieve pain and pruritus and to treat infections. Positive patch test to PPD
a more serious contact allergy, as well as drug induced severe cutaneous eruptions are more frequently observed in slow acetylators [59]. 2006;28:438. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Many of the reported cases of henna tattooing dermatitis involve European tourists who visited the Middle-East or people with fair skin who had paint-on tattoos done by street or beach artists. Actually, henna has a Henna is a flowering plant that has been used since medieval times to stain skin, hair, and fingernails a light brown colour due to itsactive ingredient naphtha-quinone. The authors do not declare any conflict of interest for this work. It has a religious and social significance [3]. 2022 BioMed Central Ltd unless otherwise stated. Laeknabladid 2009;95:77173, Birnie AJ, Bath-Hextall FJ, Ravenscroft JC, et al. This is an open-access content distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 2004;42:122736. He did not have any chronic medical condition and no known allergies. 2001;56:248. 2010;110:73242.
will also be available for a limited time. Natural henna gives a brownish-orange pigment to the skin when applied (red henna), but the colour will darken to brown. Levy J, Sewell M, Goldstein N. short history of tattooing. The plant was used as a medicine for jaundice, leprosy, smallpox, Google Scholar. In 2002 Chung et al.
Al Suwaidi A, Ahmed H. Determination of paraphenylenediamine (PPD) in henna in the United Arab Emirates. This classification was based on the previous studies of Buckley on photographers [11]. Yokozeki H, Wu MH, Sumi K, Igawa Y, Miyazaki Y, Katayama I, et al. GC had the idea of the manuscript and was a major contributor in writing the manuscript. Traditionally, it is used by Muslims, Hindus and Jews as a decorative dye at weddings and other social events. It was left there for 6 hours in order to relieve the joint pain. Mohamed M, Nixon R. Severe allergic contact dermatitis induced by paraphenylenediamine in paint-on temporary tattoos. Hypersensitivity reactions due to black henna tattoos and their components: are the clinical pictures related to the immune pathomechanism?. Contact Dermat. Sharma VK, Mandal SK, Sethuraman G, Bakshi NA. J Dermatol Surg Oncol. It is traditionally used in Islamic and Hindu The use of henna tattooing has become popular beyond its traditional boundaries. Skin reaction on arm due to henna tattoo. J Ethnopharmacol. DeLeo VA. 2010;94:64564. The diagnosis of black henna tattoo reaction is usually made on the history and clinical appearance. Jenkinson C, Jenkins R, Aleksic M, Pirmoahamed M, Naisbit D, Park BK. 2010;7:168193. Correspondence to The incidence of positive patch testing could be high among the community, which warrants further studies to help in the management of allergic dermatitis. Although localised hypo-pigmentation is the most common consequence of the reaction, hyper-pigmentation was also described.2 The usual treatments for allergic contact dermatitis include application of topical corticosteroids and a short course of systemic antihistamines.1,2,4,5,7. The Bilcha KD et al. The erythema and blisters were raised about 2 mm high and were excoriated. Side-effects of henna and semi-permanent black henna tattoos: a full review. By continuing to use this website, you agree to our Terms of Use | Privacy Policy. Henna is made of the ground leaves of Lawsonia unermis or alba (family Lythraceae), mixed with water or oil. Walking difficulties due to an allergic reaction to a temporary tattoo. Pediatr Emerg Care. Calzavara-Pinton P, Capezzera R, Zane C, Brezzi A, Pasolini G, Ubiali A, et al. What is your diagnosis? Pediatr Dermatol.
Clin Exp Allergy. Lopez IE, Turrentine JE, Cruz PD. For medicinal purposes, it has been used as a bitter tea for stomach or intestinal problems, for fever and headache, as a paste to cure ringworm or nail fungus, to reduce chafing and prevent blisters and to soothe irritated, dry or chapped skin [3]. Natural substances such as lemon oil, vinegar, and eucalyptus oil are added to obtain different shades [5]. Choovichian V, Chatapat L, Piyaphanee W. A Bubble Turtle: bullous contact dermatitis after a black henna tattoo in a backpacker in Thailand. Copyright: 2018 El Amraoui M, et al. Hueber-Becker F, Nohyneck G, Meuling W, Beneech-Keffer F, Toutain H. Human systemic exposure to a 14-C-paraphenylenediamine containing oxidative hair dye and correlation with in vitro percutaneous absorption in human or pig skin. elaborated the pharmacological-immune interaction concept (p-i concept) as they found that some drugs like sulfamethoxazole and lidocaine can bind directly to the HLA peptide complex stimulating T lymphocytes through an HLA restricted processing and metabolism independent pathway [73]. In children with glucose-6-phosphate dehydrogenase deficiency, life threatening hemolysis has been reported.6 Certain additives to henna preparations may cause an allergic adverse skin reaction. infections and pruritus. Goldberg JB, Herman FF, Hirata I. Hence, people should be aware
Rosmaninho A, Machado S, Amorim I, Lobo I, Selores M. Henna tattoo and Sweet syndrome: a possible relation. Reports are also now appearing from tattoos applied in Europe and the USA. To make tattoos darker and long-lasting PPD has been associated to henna in tattoo drawings mixtures, so obtaining black henna.
Nacaroglu HT, Celegen M, Karkner CS, Gnay I, Diniz G, Can D. Eosinophilic cellulitis (Wells syndrome) caused by a temporary henna tattoo. The henna website publishes a warning about use of PPD black henna in various languages.23 It is also necessary to counsel holiday goers regarding use of henna in a foreign region to avoid a painful experience.24. Here we review the various clinical patterns related to PPD and henna tattoo, to investigate the possible link between clinic-morphological pictures and the immunological response to PPD and henna. The latter possibility is caused by a pre-existing sensitization to PPD, probably due to a hidden exposure to cross-reactive compounds belonging to the para-amino group substances [15]. 1999;41:401. J Eur Acad Dermatol Venereol. 2015;22:2878. The case presented is captured and documented in a digital image and it shares comparable characterisation of other reported cases in terms of dermatological manifestation, progression of PPD-positive reactivity and response to treatment. Severe allergic contact dermatitis to paraphenylenediamine in hair dye following sensitization to black henna tattoos. Am J Contact Dermat.
It is recommended that black henna should be avoided, especially in people who have had previous adverse reactions to henna, to certain medications or to hair dyes.
Bolhar ST, Mulder M, van Ginkel CJW. Hypersensitivity to para-phenylenediamine (PPD) and related compounds induced by temporary black henna tattoos has become a serious health problem worldwide. Before Henna has been used traditionally for medicinal purposes and as a cosmetic. Neri I, Giacomini F, Raone B, Patrizi A. Generalized erythema multiforme after localized allergic dermatitis from dark henna tattoo. Further studies are needed to investigate the relationship between clinical and morphological aspects of PPD contact dermatitis and the T cell subsets predominance. Intoxication with PPD has been reported to rarely result in systemic adverse effects includingacute renal failure, rhabdomyolysis and multiple organ failure.
White J, Basketter D, Pease C, Sanders D, McFadden J. Painless, highly decorative and, above all, temporary, the henna colour lasts for up to 3weeks, making it is the perfect way of creating a fashionable look while avoiding the consequences or risks connected to a permanent tattoo. Allergy. Hum Toxicol. Br J Dermatol 2009;160:946, Bjrnsson HM, Einarsdttir AE, Clausen MV. Le Coz CJ, Lefebvre C, Keller F, Grosshans E. Allergic contact dermatitis caused by skin painting (pseudotattooing) with black henna, a mixture of henna and p-phenylenediamine and its derivatives. A further investigation has recently shown that, once penetrated in human body, PPD oxidative products bind irreversibly to cysteine at 34 position on human serum albumin [63], so turning to a complete antigen, but it is unclear whether IgE are directed towards the chemical component only or towards the chemically modified albumin which has become immunogenic. Allergic contact dermatitis to temporary tattoo by p-paraphenylenediamine. 2006;17:535. Five days before the encounter, a henna tattoo was applied on his right arm during a visit to an amusement park. 2009;161:11305. IgE against ethylene oxide-altered human serum albumin in patients with anaphylactic reactions to dialysis. As far as allergic reactions are concerned [5, 6], the pure henna is a weak sensitizer and it is poorly responsible for allergic contact dermatitis [7,8,9], but when para-phenylenediamine (PPD), that is a strong sensitizing agent, is added the frequency of allergic reactions increases. Therefore, people who are allergic to these substances may adversely react to PPD.7, The clinical presentations of allergic reaction to henna include erythema, swelling, blisters, weepy dermatitis, eczematous dermatitis, erythema multiform, lichenoid dermatitis, pruritic dermatitis and papular dermatitis.
Schnuch A, Lessmann H, Frosch PJ, Uter W. Para-Phenylenediamine: the profile of an important allegens. His past medical history was clear. Allergy. They contain up to 16% (PPD) compared to the allowed limit of 3% in hair dyes [2], this high content saturates the acetylation pathway, the direct consequence of which is the increase in the amount of metabolites (PPD) in the skin and activation of dendritic cells and lymphocytes of sensitized individuals. Raupp P, Hassan JA, Varughese M, Kristiansson B. Henna causes life threatening haemolysis in glucose-6-phosphatase dehydrogenase deficiency.
dermatitis allergic acd causes treatment suwaidi ahmed henna reaction license cc al hand The area was exposed to sunlight. Contact Dermatitis 2006;54:21920. The acute measures would include treating the inflammation with a topical corticosteroid once or twice daily only for 12 weeks.16,17 The choice of corticosteroid potency depends on the site of the inflammation. It is not uncommon for a male member of this community to apply henna on their hair, scalp, mustache and beard to mask the gray hair associated with old age. Hence, intermittent exposure to low concentration of PPD may be equivalent to a higher concentration in a one-off exposure [65]. Sosted H, Johansen JD, Andersen KE, Menne T. Severe allergic hair dye reaction in 8 children. 1982;3:2178. Due to implications of PPD reaction on the immune system and possible renal complication, the patient was investigated for complete blood count, creatinine level, eGFR and electrolytes. and transmitted securely. The henna is left on the skin to dry for at least 2h and preferably up to 24h. The longer henna is put in contact with the skin, the darker the resulting colour will be [3]. It takes a few hours from the time that the henna is applied to the skin until the brownish-red colour is well established. Available at www.healthycanadians.gc.ca/consumer-consommation/products-produits/tattoos-tatouages-eng.php [Accessed 13 November 2013]. 2014;155(1):80103. Antigen-dependent and -independent IFN-gamma modulation by penicillins. Mavrolein G, Begishvili B, Frew AJ. cultures as a hair coloring and as a dye for decorating the nails or making temporary skin tattoos. we report a case of allergic contact dermatitis from pure henna that is also used for the relief of rheumatic pain. Enjoyed a stay in the other city of Marrakech to make two tattoos at the two front arms (a scorpion and a dragon) with black henna. 1987;7:3840. Temesvari E. Contact urticaria from paraphenylenediamine. Nowadays it is rather frequent to see temporary tattoos performed with henna. henna mixed with vinegar (S-K in Fig. The new PMC design is here! Neri I, Gaureschi E, Savoia F, Patrizi A. Childhood allergic contact dermatitis from henna tattoo.
Exceptionally, a Sweet syndrome [52], Wells syndrome [53, 54], prurigo nodularis [55] and connubial contact dermatitis [56, 57] have been also described. Lancet. The ever-increasing number of awareness cases (PPD) and the serious consequences for the quality of life of the patient justify the urgent need for public awareness and regulation of its use. Part of Clin Med Img Lib 4:088. doi.org/10.23937/2474-3682/1510088. The term tattoo derives from two Polynesians words, TA, which means to draw and TOO or TAU which means spirit. Allele unrestricted presentation of lidocaine by HLA DR molecules to alpha/beta+T cells clones. 2002;47:1734. Eustachio Nettis. Lubricant emollient is used once daily to maintain skin hydration and to treat itchness and irritation. 1984;11:125. American Academy of Allergy, Asthma and Immunology, American College of Allergy, Asthma and Immunology. The lesions were superinfected and the clinical examination for systemic involvement was without particularities (Figure 1). Article Their clinical history often includes a previous black henna tattoo, performed months or years ago, which behaves like a silent promoter of sensitization to PPD. Provided by the Springer Nature SharedIt content-sharing initiative.
there is a third group of patients, whose symptoms onset occurs few hours after a clear exposure to PPD. Clin Dermatol 2007;25:38387. Med Clin North Am. Black henna contact eczema is common and continues to increase. 1999;141:598600. The investigators confirmed that PPD was active in the LTT and that it stimulated CD4+, CD8+, and CD4/8 double-positive T-cell clones with a Th2 profile [63]. Such clinical expressions are based on a IgE-mediated reaction to vegetable components of henna, and particularly specific IgE towards a 25kDa henna protein have been detected by immunoblotting [19]. Hypersensitivity reactions due to black henna tattoos and their components: are the clinical pictures related to the immune pathomechanism? Open Access Publications from the University of California, Allergic contact dermatitis to pure henna, Utility of an anonymous online interactive forum for dermatology residency program directors and applicants, Educational attainment is inversely correlated with hidradenitis suppurativa severity, Post ambulatory swollen hands (POTASH) revisited: post ambulatory hand swelling in a half marathon participant, Innovation in dermatology: where are the dermatologists? HHS Vulnerability Disclosure, Help There is a growing community of East African people in these regions. a nonspecific irritant effect or may cause a chemical change in the henna such that it is more allergenic. Contact Dermat. Allergic contact dermatitis The use of henna dye is traditional in Islamic countries. Henna is used to celebrate various occasions such as weddings in Hindu and Middle Eastern cultures in India, Pakistan, Sudan, Libya and many other countries. Semin Cutan Med Surg 2009;28:7785. 8600 Rockville Pike
Google Scholar. J Deuscht Dermatol Gesel.
Br J Med.
Shavit I, Hoffmann Y, Shachor-Meyouhas Y, Knaani-Levinz H. Delayed hypersensitivity reaction from black henna tattoo manifesting as severe facial swelling. A retrospective review of the Pitchbook Database, Milia en plaque manifesting as a post-herpetic isotopic response. Interventions to reduce Staphylococcus aureus in the management of atopic eczema. Our goal is to raise awareness, through this clinical case, the health authorities at first and the general public in a second time. As a result of this migration and settlement, healthcare policy and practice that are prevalent among this community should be addressed.3 Caroll J et al., in their work with a Somali community, asserts that healthcare providers must be able to understand specific cultural health beliefs to tailor health prevention efforts to targeted group.4 The use of black henna (PPD) among East African community members is increasingly seen in general practice. 2013;69:125. Australas J Dermatol. In a case of henna tattooing dermatitis, reaction to henna additives should always be considered. 2000;42:356. PubMed suggested that detoxification enzymatic pathway defects are involved in toxic epidermal necrolysis and other severe cutaneous pathogenesis, allowing reactive metabolites accumulation for drugs as sulfonamides and anticonvulsant [59]. Wolkenstein et al. Nowadays, and with the trend of tattoos, it is mixed with various chemicals to obtain a fast, durable and darker coloration, including para-phenyldiamine (PPD), a frequent source of local toxicity, including contact eczema and sensitization, and sometimes systemic. Such a study would provide baseline data that could be used to determine the prevalence of allergic dermatitis due to PPD use among the community. Article Allergy.
The patient had uneventfully used black henna for a celebratory occasion 3 months prior to this incident and this may have primed the body for the subsequent allergic reaction that resulted in severe acute allergic dermatitis and skin blistering. We recommend avoiding exposure to temporary paint-on black henna tattoos, because of the high risk of sensitisation. 2), probably due to delayed hypersensitivity, and a stronger reaction to natural Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Calogiuri G, Foti C, Bonamonte D, Nettis E, Muratore L, Angelini G. Allergic reactions to henna-based temporary tattoos and their components. Papular reaction Int Immunol. Springer Nature. Every care is taken to reproduce articles accurately, but the publisher accepts no responsibility for errors, omissions or inaccuracies contained therein or for the consequences of any action taken by any person as a result of anything contained in this publication. The diagnosis of contact dermatitis to black henna mixed with para-phenyldiamine (PPD) was discussed and withheld. Kazandjieva J, Grozdev I, Tsankov N. Temporary henna tattoos. 2015;32:1912.
Coulter EV, Jenkinson C, FarrellJ Lavergne SN, Pease C, White A, et al. The active ingredient is lawsone, a naphthoquinone. The role of the GP is important in acute management with the use of high-potency corticosteroid and long-term counseling and education of patients regarding the type of henna to avoid.22 One way to educate is through brochures and booklets in a language easy to understand explaining the possible impact of black henna on a person.
Identification and quantification of para-phenylenediamine in a temporary black henna tattoo. Goldberg et al. Measurement of CD4 and CD8 T-lymphocyte cytokine secretion and gene expression changes in para- phenylenediamine allergic patients and tolerant individuals. Reactions were read at 48 and 72 hours. The contact allergic reaction usually appears in the pattern of the tattoo 714 days after first exposure. The active ingredient of henna is lawsone (2-hydroxy-1, 4-naphthoquinone). J Immunol. Often kerosene or petrol is also added to improve the uptake of the colour. A detailed history and thorough physical examination will point to the culprit being black henna and hair dye use. Lythraceae. A woman who collapsed after painting her soles. EDL was the co-contributor in writing the manuscript. CAS
Black henna tattoo reactions Cutaneous B-cell pseudolymphoma due to paraphenylenediamine. 2000;41:16871. Fukunaga T, Kawagoe R, Hozumi H, Kanzaki T. Contact anaphylaxis due to paraphenylenediamine. Arch Dermatol. and skin complaints [4]. In this article, Cutan Ocul Toxicol. Actually, no specific IgE to PPD or any related oxidative product have been identified in vitro, but it has been demonstrated that a radio-labelled PPD containing oxidative hair dye applied to human volunteers for 30min is eliminated predominantly (8090%) by renal excretion, being accumulated in urine [68]. Application of henna to the skin in order to achieve temporary tattooing is common practice in the Middle East and India. 2005;54:21920. Calogiuri, G., Di Leo, E., Butani, L. et al. Another kind of hypersensitivity reactions to PPD is represented by a severe facial angioedema, appearing few hours after a dark hair painting in patients who have previously performed a black henna tattoo [25,26,27]. Pharm Intern. Allergy and skin infection after use of temporary henna tattoo-case report. If you have any concerns with your skin or its treatment, see a dermatologist for advice. Abdullah K, McDavidson N. A woman who collapsed after painting her soles. Cutaneous reactions to henna and associated additives. series including p-phenylenediamine (PPD), natural henna diluted with sterile saline solution in 1 percent concentration, 2014;25:912.
The patient was patch tested with the European Standard
2010;130:16174. BL revised the manuscript. PPD can induce different types of hypersensitivity reactions, which may be framed from different points of view, according to the time-pattern onset or according to their morphological aspects. E-mail: Received 2005 Mar 1; Revised 2005 May 26; Accepted 2006 Feb 21.
A week later, the young person consulted for erythemato-squamous lesions, very itchy at tattoo sites.
The results were all reported as normal. In fact, an increased number of cases have been reported through temporary henna tattoo application. The Hebrews follow Torah exhortations (you wont make any incision on your body, Deuteronomy, 14 but also Leviticus, 19:28) while for the Maoris the tattoo drawings on the face indicate the social class and status, the profession, the clan and the ability in a battle [1]. Consent was not required as the patient cannot be identified, The author has stated that there are none, National Library of Medicine Int J Environ Res Public Health. Henna is the Persian name of the plant Lawsonia inermis, Fam. All authors were actively involved in the development of this work the authors do not declare any conflict of interest for this work. Temporary henna tattoo reactions in children. Keloid scarring has been reported. On physical examination, the area of the tattoo was red and swollen. Miulli Hospital, Acquaviva delle Fonti, Bari, Italy, Department of Pediatrics, University of California Davis School of Medicine, Sacramento, USA, Allergy Outpatients Clinic, ASL-TO3, Ospedale Civile E. Google Scholar. Results of IVDK. Dermatology Made Easybook. Am J Forensic Med Pathol. 1992;12:36.
As a cosmetic, henna has been used as a hair thickener, as a nail colorant and conditioner and as a decorative stain for the body. D Jenkins, Elizabeth T Chow (2015) Allergic contact dermatitis to para-phenylenediamine. By using this website, you agree to our Ann Allergy Asthma Immunol 2006; 97:S1. 2009;9:30510. 2011;27:7456. Pediatr Dermatol. Some in vitro studies have confirmed that such immunological model is working not only for drugs, but even for some contact allergen like PPD [74]. Finally, we suggest that future patch testing could be carried out among East African community members. Polat M, Dikilita M, Ozta P, Alli N. Allergic contact dermatitis to pure henna. On physical examination, there was erythema and blistering of about 3-cm length following the intricate details and patterns of henna drawings on the forearms and hands. cultures as a hair coloring and as a dye for decorating the nails or making temporary skin tattoos. 2010;32:7004. This was reported also in mice, because PPD-HSA causes a transient activation of CD8+cytotoxic cells only [63]. A diagnosis of allergic contact dermatitis to henna was made and the patient was advised to apply betamethasone dipropionate The compound PPD in hair dye is implicated as the main culprit for allergic dermatitis. Henna is one of these plants and is used especially for mycotic Patient Educ Couns 2007;66:33745. 2006;152:2423. Contact Dermat. had previously demonstrated that the allergenic component of PPD accumulates in the skin. one week after the application of henna mixed with vinegar. official website and that any information you provide is encrypted statement and Hair dye reaction. Available at: www.hennapage.com. Black henna temporary tattoo. Immunopharmacol Immunotoxicol. to pure henna is extremely rare [1, 2]. Cambridge: Polity Press; 2000. However, further studies are needed to investigate the relationship between clinical and morphological aspects of PPD contact dermatitis and the T-cell subsets predominance. Kluger N, Debu A, Girard C, Bessis D, Guillot B. Psoriasis in a tattoo. A young teenager of 16 years, without notable pathological antecedents including not known allergic to natural henna.