PPD Sensitization in Men: Unique Risks and Gendered Behavior


Para-phenyelenediamine (PPD) is one of the most common allergens in cosmetics. While genetics can increase chances of allergy, anyone can develop a PPD allergy. High concentrations and repeated exposure increase the likelihood of becoming sensitized. Basic information about PPD is covered in an earlier article, What You Need to Know About Para-Phenylenediamine.

 Occupations that involve repeated exposure to PPD, such as hair stylists, and fur and textile workers, show higher rates of employees with PPD sensitization [13]. Outside of occupation-related sensitization, the average person is sensitized to PPD through a black henna tattoo, or through the use of hair dye. Prevalence rates of PPD sensitization are about 6.2% in North America, 4% in Europe, and 4.3% in Asia [1]. Overall, sensitization rates appear to be increasing over time [2]. Rates are higher in populations with darker hair, as dark hair dyes contain higher PPD concentrations.  Rates of sensitization are also higher in countries where “black henna” is commonly used in place of traditional henna.

PPD sensitization rates also vary between genders. Both body art and the use of hair dye are gendered behaviors; more women participate than men. This leads some to presume that PPD sensitization is more of a concern for women. While it is true that, overall, a higher percentage of women have PPD sensitization than men, it is important to discuss issues specific to men’s self-grooming and help-seeking behaviors that put the male population at unique risks. Certain populations of men experience higher rates of facial dermatitis due to frequent beard dyeing. Men who work in industries involving frequent contact with products that contain PPD or cross-reacting allergens may be forced out of their jobs to avoid continual allergic reaction. Men show reluctance to seek medical attention; this puts them at risk for future complications which could be avoided. Understanding gendered behavior may lead to better education, prevention, and treatment of PPD sensitization in men.

This man will have permanent scarring from his “black henna” body art, and is now sensitized to PPD.
Source: https://shewhoseeks.blogspot.ca/2012_02_01_archive.html

Avenues of PPD Sensitization

Traditionally, self-grooming and concerns for beauty have been characterized as feminine behaviors. Men spend less time and money in the use and consumption of beauty products and services.  Gender-specific grooming practices will be explored further in the next section. About 30-40% of women and up to 10% of men in North America are regular hair dye users [2],[3]. Another study estimated that 70% of women and 20% of men have used hair dye at least once in their lifetime [4].

On the other hand, getting a “black henna” tattoo is much less gendered in western cultures, leading to a fairly even split in the numbers of males and females getting a temporary “black henna” tattoo. Traditional henna body art is highly gendered; it is used for decorating and beautifying women, especially for celebrations and social events. In contrast, “black henna,” when it is used in spaces of tourism, is used to mimic the look of true tattoos. It is not limited to a specific custom or style. “black henna” is readily available on boardwalks and beaches, and in shopping malls, resorts, amusement parks, festivals, and fairs. Those who get “black henna” body art are usually children or young adults. [5], [6]. Children are attracted to body art that mimics tattoos because they like to imitate adult behavior. Parents who believe that “black henna” is harmless allow their children to have body art done, unaware of the risk of sensitization. Thus, both young boys and girls get “black henna” body art.

A young boy is scarred and sensitized by a “black henna” tattoo.
Source: Daily Mail

Of those who get a “black henna” tattoo, an estimated 50% will become sensitized [6], [7]. Some will experience a delayed contact dermatitis reaction following; some will not. A person can develop a sensitization even if they did not react to their first exposure. It is rare for consumers of “black henna” to understand the connection between the product used to create “black henna” body art, and hair dye. Children become sensitized to PPD through “black henna,” then later on may choose to dye their hair. The chances of a person previously sensitized by black henna having a severe (+++) reaction to PPD hair dye is about 40% [8]. A study found that 16% of adolescents in Manchester, England had a PPD allergy. Most of this was likely caused by the “black henna” they had gotten on holiday [8]. We will see a wave of hair dye reaction cases around 2030, when this population begins showing gray hair.

Source: Presentation to USFDA June 30, 2016: ‘‘Black Henna’ and the Epidemic of para-Phenylenediamine Sensitization: Awareness, Education and Policy, Catherine Cartwright-Jones PhD

While girls and women favor delicate designs, boys and men are more likely to choose tribal-style patterns that cover large areas of the skin with a solid application of “black henna.” This larger surface area increases the amount of PPD to which the person is exposed, thus increasing the risk of sensitization. If the client experiences a delayed hypersensitivity reaction to the body art, a larger area of their body is subject to dermatitis symptoms such as blistering, permanent scarring, and hypopigmentation. This is only just one way gendered behavior creates unique variables in PPD sensitization.

If a parent sees that their child is suffering from a reaction to their “black henna” tattoo, they will probably take the child to a medical professional. Adults, especially men, may be less likely to seek medical attention for their own allergic reaction, especially if it is not severe. Neglecting to seek medical attention causes a person to remain uneducated about the nature of their allergy, putting them at risk for repeated exposures and reactions. Men’s help-seeking behaviors will be discussed later in this article.

Grooming Practices as Gendered Behavior

Conventional ideals for appearance differ greatly between those for men and those for women. Entire books are dedicated to the sociology behind gendered beauty norms; therefore, it is impossible to cover this subject in its entirety within this article. One salient feature is that feminine and masculine norms are often presented as binary, and in opposition with one another [9]. If one behavior is used in traditionally feminine self-grooming, it is avoided in traditionally masculine self-grooming [9], [10], [11]. This is particularly evident in the way we treat hair.  In western societies, most men keep their hair short, while most women have longer hair. Of course, there are many exceptions, and there are people and groups who intentionally choose to defy norms through their appearance. As societal constructs of masculine and feminine ideals shift, so do people’s choices in personal style. However, there is still an overall trend in gendered grooming behaviors. Cosmetics companies actively seek to maintain these norms in the sorts of images they use in marketing their products.

Use self-grooming products while still being manly… Because sports…Or something. Source: Media in Canada

Overall, women dye their hair more than men. Women’s fashion trends change more rapidly than men’s, and women change their personal style more frequently than men do [10], [11]. They do so by altering the length, color, and texture of their hair. Cutting, dyeing, curling, straightening, braiding, and using tools, products, and accessories all help in keeping a style “fresh” or “up-to-date.” Conventional feminine beauty values youth, and fears the appearance of age [9]. Women are much more likely to dye their hair to mask grays, while gray hair is less of a concern for most men. These behaviors play into the higher rate of PPD sensitization in women.

Men’s styles focus on conformity, consistency, and professionalism. Men do not change their hair as frequently.  Feminine beauty is associated with youth; gray hair is undesirable.  On the other hand, men are less concerned with going gray. Gray hair may even increase a man’s attractiveness. It is “distinguished.” The term “silver fox” is used predominately to describe mature, attractive men. Younger men in white-collar professions have even been told that adding some gray into their hair may help their appearance and rapport with clientele [9]. The brand Touch of Gray promises to dye men’s hair while leaving just enough gray to maintain that distinguished, mature image. While traditional concepts of masculinity once idealized the perfect man as rough and rugged, the increase of educated and white-collar careers caused a gradual shift to the image of a clean-cut, well-groomed, professional man, whose power comes from his professional success and wealth, and his ability to attract women [9], [10], [11].

The products on the left all contain PPD. They are marketed toward men, or claim to be “natural.”
The image on the right shows the warning and patch test advisory on Just For Men dye.

Many men do dye their scalp hair and facial hair to mask their grays. The popular brand, Just for Men, directly targets men with its very name. Grooming products marketed toward men attempt to both reinforce the masculine ideal, and present self-grooming as a valid, masculine behavior. Marketing focuses on how the product will augment a man’s ability to attract women, or his image of professional success. By re-framing the use of hair and beauty products as a masculine behavior, companies can increase their number of male consumers.

Men’s use of hair dye is increasing, and the age of the average hair dye user is decreasing. More and more young people are using hair dye as a means of beauty and self expression, rather than for masking gray [22]. This shift in the demographic will lead to higher rates of sensitization and at younger ages, for both men and women.

Dyeing Beards

Facial hair is rather unique to men. Biologically, higher levels of androgen hormones lead to thicker, longer facial hair. While women also have facial hair, it is traditionally minimized through plucking, shaving, or bleaching. Few women have the biological ability to grow thick beards.  Just as scalp hair can be cut, dyed, and styled to express a person’s identity, so can facial hair. Because it is mostly men who have noticeable facial hair, the use of dyes on facial hair and the repercussions are a uniquely male issue.

Facial skin is thin and sensitive. Facial hair, on the other hand, is coarser and more resistant to dye [12]. Those who dye their beards might choose stronger, more concentrated products, or leave the dye on for longer periods of time. This increases the chances of becoming sensitized to PPD. Additionally, a person who dyes their facial hair most likely also dyes their scalp hair, and possibly dyes both at the same time for the sake of convenience. Those who are already sensitized may experienced more severe reactions when the compound comes in contact with their face. The proximity to the nose and mouth leads to further risks. 

Because facial hair grows quickly, a person wishing to mask gray roots will have to dye frequently. Men who use beard dye do so as frequently as once every five days [12], [13]. Men who keep their scalp hair short will also show gray roots more quickly. Repeated exposures both increase the chances of becoming sensitized to PPD, and worsen symptoms for those who are already sensitized.

Furthermore, PPD sensitization can lead to cross-reactions with several structurally similar compounds, including those found in synthetic fragrances. If a man later chooses to shave their facial hair, the process of doing so can create cuts and micro-abrasions that leave the skin vulnerable to reactions from soaps, lotions, and aftershaves [14].

This man is in the hospital for a severe reaction to beard dye. Source: Consumer Affairs

Ethnicity, Culture, and Class in PPD Allergy Variability

A population’s variation in PPD allergy prevalence rates is dependent on several factors, such as behavior, the accessibility of PPD products, and the concentrations within those products. Demographics and geography play into these factors. In many European countries, laws have limited the maximum concentration of PPD allowed in hair dyes, and a related compound, para-toluenediamine (PTD) is often used instead [2]. (Side note: PTD is believed to be less sensitizing than PPD, but those who are already sensitized to PPD are likely to experience a cross-reaction with PTD. We’ll save that can of worms for another time.) In countries where PPD concentration in hair dye is restricted, or where PTD is more commonly used, sensitization rates to PPD are lower [4]. The same goes for countries with greater light-haired populations [1].

Conversely, in countries with less restriction on PPD concentration, and with larger dark-haired populations, we see higher sensitization rates. In many Asian countries, hair dyes with high PPD concentrations are easily available. Popular hair dye brands can contain up to 80% PPD.  “Henna stone,”  which is solid industrial PPD, is widely sold for use in hair dye and body art [6], [7]. The median prevalence rate in Asia is 4.3%, but ranges from 2-12% within regions and sub-groups [13].

 In Saudi Arabia, and among Arabic men regardless of their location, growing and coloring beards is common practice. The prevalence rate for facial dermatitis from dye is high among this population [12]. A Korean study found that about 64% of adults with gray hair had experience using hair dye, and of that group, about 24% experienced a reaction [15].

A study conducted by the Cleveland Clinic investigated sensitization rates in white and black racial groups, and found that rates were similar among both groups for all allergens except PPD. Black people overall showed much higher rates of PPD sensitization than white people (10.6% vs. 4.5% respectively), and black men had much higher sensitization rates than black women (21.2% vs. 4.2% respectively) [16]. This is likely influenced by a combination of hair dye use/exposure, occupation, and genetic differences.

Black hair care is nearly a multi-billion dollar industry. Black women spend more money on cosmetics than non-black women. However, this alone does not explain why black men have significantly higher sensitization rates than black women. One factor could be that black men who dye their beards must do so frequently, and with high PPD concentrations, similar to the phenomenon seen in Arabic men.  One class-action lawsuit against the Just For Men hair and beard dye brand claims that JFM unfairly targeted African American men in their marketing of a product that contained higher levels of PPD.

Various iterations of Just For Men “Jet Black” hair and beard dyes all feature black men on the packaging. Source: Amazon

Additionally, there may be a higher proportion of black men (in comparison to non-black men, and black women) in industries which handle PPD and related compounds, such as fur/leather/textile dyeing, and the manufacture and handling of black rubber products in rubber and automotive industries.

One can look at a statistic for PPD sensitization in, say, North America for example, and make an assumption that all of the population is at equal risk. This is far from the truth; sensitization rates vary greatly between sub-groups. More research needs to be done on specific populations to determine these sub-groups, and the factors which lead to higher rates of sensitization. Hair dye and “black henna” use, as well as occupation cause significant variation. More nuanced demographic data will create a clearer picture of the populations that might require additional attention.

Help-Seeking Behavior, Education, and Prevention

Sociological studies in men’s help-seeking behavior affirm that men are less likely than women to use medical services. Studies have focused on mental help and addiction, as well as common physical ailments such as headache and backache [17], [18]. There has yet been a study specifically regarding the help-seeking behaviors of men and women who experience a reaction to “black henna” tattoos, or PPD hair dye. However, one can infer from the general trend of help-seeking reluctance that there is a large population of men who are sensitized to PPD, who are entirely unaware of the allergy or how to manage it.

Overall, most people who become sensitized to PPD from a “black henna” tattoo are not aware that the sensitizing agent, PPD, is the same compound used in hair dye. Numerous case reports have described patients seeking medical care for reactions to hair dye, who reported having gotten a “black henna” tattoo in the past [1-8], [13], [19-22]. It is estimated that, of those who experience a severe reaction to hair dye, only 10-30% of cases will be seen by a doctor, and even fewer by a dermatologist. [19], [20]. In a survey of 521 Korean adults with graying hair, a whopping 74% of those who reported experiencing a reaction to hair dye said that they did not visit a medical professional. The primary reasons were that they did not feel the reaction was severe enough (44.6%), and that they saw the side effects as a normal part of dyeing their hair (39.3%) [15]. Another article estimated that only 15% of people with a hair dye allergy seek treatment, and only a fraction of these people are patch-tested for allergies [22].

Societal influences cause men in particular to choose to “tough out” medical problems rather than seeking help. If a man experiences a reaction to PPD and chooses not to seek medical help, he deprives himself of crucial information related to his sensitization. Most likely, he will think it was a one-time fluke. He might not learn that “black henna” and conventional hair dyes both contain PPD. He might not learn that PPD sensitization can lead to cross-reactions with other products such as black rubber, fabric dyes, photographic developer and lithography plates, photocopying and printing inks,  oils, greases and gasoline.

Without consulting a dermatologist or allergist, someone who is sensitized may never learn how to properly manage their new allergy, putting them at risk for repeated exposure and worsening symptoms. Furthermore, PPD sensitization can limit prospective occupations, or force workers to leave their jobs due to continuing and worsening reactions to the materials involved. This would affect people in cosmetology, fur and textile industries, rubber industries, automotive industries, work that involves printing and photo development, and numerous other fields [2].

Studies suggest that men’s help-seeking choices are influenced by the perceived potential for embarrassment, as well as the perceived normality of a problem. If an issue is ego-centric, meaning that it may affect a person’s self-image, men are less likely to seek help. The same goes for if a man perceives a problem as abnormal [17]. Advertisements for erectile dysfunction medications have focused on normalizing ED, as well as reinforcing the notion that the embarrassment of ED is worse than the embarrassment of consulting a doctor. This is an example of an attempt to normalize a medical issue and decrease the help-seeking behavior’s threat to a man’s self-esteem.

This ad for Viagra affirms traditional masculine ideology. Source: Outsource Marketing

While statistics show that few people seek medical treatment for reactions to hair dye, additional factors may cause men to do so even less. First, men are less likely to seek medical help than women. Second, because traditional masculine ideals enforce the belief that preoccupation with beauty, especially hair, is a feminine behavior, many men may be hesitant to seek help for reactions to hair dye. Doing so requires admitting to the use of hair dye, which can create a blow to a masculine self-image. While PPD is one of the most common allergens (named Allergen of the Year by the American Contact Dermatitis Society in 2006), people remain largely unaware of its risks. Women are more familiar with hair dye reactions than men. Men may perceive a reaction to hair dye to be both non-normal and a threat to self-image. Thus, it is essential that efforts be made to increase awareness about PPD sensitization, focusing on its severity, high likelihood, and prevalence.

Just for Men Class-Action Suit

The hair dye brand, Just For Men, is currently at the center of several class-action lawsuits. Users reported experiencing adverse reactions to the products on their scalp hair and/or facial hair. Some suits claim that the patch test advised in the packaging was not sufficient for determining how the product would affect the skin on the scalp and face. In fact, conducting a patch test may increase sensitization. As mentioned earlier, other suits claim that the company intentionally and unfairly targeted black men in their marketing of their Jet Black hair dye, which the legal group claims to contain 17 times more PPD than other dyes from the same company.

If you are a man who has experienced an allergic reaction to Just for Men, consider looking to find if there is a legal group with an open suit in your area.

This series of class action suits is a positive move forward in demanding stricter regulation and more responsibility on the part of hair dye companies. Such legal action has rarely occurred against companies marketing hair dye to women, and fewer acts have been successful. Overwhelmingly, users of hair dye see adverse effects as a “normal” part of the hair dyeing process, and even choose to continue using products that cause reactions because the thought of going gray is worse than enduring contact dermatitis symptoms [15].


Because women make up the majority of hair dye users, there is a paucity of research specific to men’s use of hair dye. It is likely that more men are sensitized to PPD than current numbers suggest. Data taken from medical databases and case reports only include those people who seek medical attention or make themselves available to researchers. Surveys depend on honest self-reporting of behaviors. Men’s help-seeking behaviors may have cause research numbers to be lower than the reality

Based on available data, men make up a smaller proportion of the PPD sensitized population, in comparison to women. There is an exception in the case of black men in the United States. While hair dye allergies are often framed in the context of the female consumer, it is critical that the male population not be forgotten. The use of dye on beards is unique to men and poses special risks. Studies on help-seeking behavior suggest that men are less likely to seek medical attention if they were to experience a reaction. The idea of self-grooming as a gendered behavior further prevents men from openly discussing their use of hair dye.

Young boys who get a “black henna” tattoo on vacation, while at an amusement park, or in other tourist settings, are at risk of experiencing a reaction later on in life if they choose to use oxidative dyes. “Black henna” tattoos contribute significantly to the number of people who have PPD sensitization. In the future, we will see an increase of both men and women who develop severe reactions to hair dye.  As societal ideals of beauty, self-grooming, and gender norms change, hair dye use may increase among men. Already there is a shift in the use of hair dye as tool for masking age, to an avenue of self-expression in younger populations [22].

In order to ensure that both men and women are properly educated about the risks and prevalence of PPD sensitization, continued efforts must be made in raising awareness. Consumers should be aware that PPD is highly sensitizing, and that reactions from hair dye are quite common. Steps must be taken to prevent PPD sensitization before the onset. This includes continuing to raise awareness about “black henna” body art, pushing for stricter regulation of products containing PPD, and presenting safe alternatives for altering hair color and masking grays.

To learn more about PPD sensitization, visit the following links.

The Henna Page: Black Henna Warnings

Catherine Cartwright-Jones’ PhD Dissertation, “The Geographies of the Black Henna Meme Organism and the Epidemic of Para-phenylenediamine Sensitization: A Qualitative History”

AncientSunrise.Blog: What You Need to Know About Para-Phenylenediamine

To learn how to use plant dyes as a safe and effective alternative for coloring hair and masking grays, read the Ancient Sunrise® Henna for Hair E-Book and visit www.HennaforHair.com, and  www.Mehandi.com.


[1]             Mukkanna, Krishna Sumanth, Natalie M. Stone, and John R. Ingram. “Para-phenylenediamine allergy: current perspectives on diagnosis and management.” Journal of asthma and allergy 10 (2017): 9.

[2]             Hamann, Dathan, Carsten R. Hamann, Jacob P. Thyssen, and Carola Lidén. “p‐Phenylenediamine and other allergens in hair dye products in the United States: a consumer exposure study.” Contact Dermatitis 70, no. 4 (2014): 213-218.

[3]             Redlick, Fara, and Joel DeKoven. “Allergic contact dermatitis to paraphenylendiamine in hair dye after sensitization from black henna tattoos: a report of 6 cases.” Canadian Medical Association Journal 176, no. 4 (2007): 445-446.

[4]             Schuttelaar, Marie-Louise Anna, and Tatiana Alexandra Vogel. “Contact Allergy to Hair Dyes.” Cosmetics 3, no. 3 (2016): 21.

[5]             Goldenberg, Alina, and Sharon E. Jacob. “Is the Use of PPD in Black Henna Tattoo Criminal or Remiss?.” International Journal of Integrative Pediatrics and Environmental Medicine 1 (2014): 22-26.

[6]             ‘Black Henna’ and the Epidemic of para-Phenylenediamine Sensitization: Mapping the Potential for Extreme Sensitization to Oxidative Hair Dye, Presentation at Society of Cosmetic Chemists’ 70th Annual Scientific Meeting, December 10, 2015, Catherine Cartwright-Jones PhD

[7]             Presentation to USFDA June 30, 2016: ‘‘Black Henna’ and the Epidemic of para-Phenylenediamine Sensitization: Awareness, Education and Policy, Catherine Cartwright-Jones PhD

[8]             Smith V, Clark S, and Wilkinson M. “Allergic contact dermatitis in children: trends in allergens, 10 years on. A retrospective study of 500 children tested between 2005 and 2014 in one U.K. centre.” British Association of Dermatologists’ Annual Conference. Leeds Teaching Hospitals NHS Trust, Leeds, U.K. (2015).

[9]             Synnott, Anthony. “Shame and glory: A sociology of hair.” The British journal of sociology 38, no. 3 (1987): 381-413.

[10]          Ricciardelli, Rosemary. “Masculinity, consumerism, and appearance: a look at men’s hair.” Canadian Review of Sociology/Revue canadienne de sociologie 48, no. 2 (2011): 181-201.

[11]          Barber, Kristen. “The well-coiffed man: Class, race, and heterosexual masculinity in the hair salon.” Gender & Society 22, no. 4 (2008): 455-476.

[12]          Hsu, Te-Shao, Mark DP Davis, Rokea el-Azhary, John F. Corbett, and Lawrence E. Gibson. “Beard dermatitis due to para-phenylenediamine use in Arabic men.” Journal of the American Academy of Dermatology 44, no. 5 (2001): 867-869.

[13]          Handa, Sanjeev, Rahul Mahajan, and Dipankar De. “Contact dermatitis to hair dye: an update.”  Indian Journal of Dermatology, Venereology, and Leprology 78, no. 5 (2012): 583.

[14]          Jensen, Peter, Torkil Menné, Jeanne D. Johansen, and Jacob P. Thyssen. “Facial allergic contact dermatitis caused by fragrance ingredients released by an electric shaver.” Contact dermatitis 67, no. 6 (2012): 380-381.

[15]          Kim, Jung Eun, Hee Dam Jung, and Hoon Kang. “A survey of the awareness, knowledge and behavior of hair dye use in a Korean population with gray hair.” Annals of dermatology 24, no. 3 (2012): 274-279.

[16]          Dickel, Heinrich, James S. Taylor, Phyllis Evey, and Hans F. Merk. “Comparison of patch test results with a standard series among white and black racial groups.” American Journal of Contact Dermatitis 12, no. 2 (2001): 77-82.

[17]          Addis, Michael E., and James R. Mahalik. “Men, masculinity, and the contexts of help seeking.” American psychologist 58, no. 1 (2003): 5.

[18]          Hunt, Kate, Joy Adamson, Catherine Hewitt, and Irwin Nazareth. “Do women consult more than men? A review of gender and consultation for back pain and headache.” Journal of health services research & policy 16, no. 2 (2011): 108-117.

[19]          Søsted, H., T. Agner, Klaus Ejner Andersen, and T. Menné. “55 cases of allergic reactions to hair dye: a descriptive, consumer complaint‐based study.” Contact dermatitis 47, no. 5 (2002): 299-303.

[20]          de Groot, Anton C. “Side‐effects of henna and semi‐permanent ‘black henna’tattoos: a full review.” Contact dermatitis 69, no. 1 (2013): 1-25.

[21]          Jacob, Sharon E., and Alina Goldenberg. “Allergic.”

[22]          McFadden, John P., Ian R. White, Peter J. Frosch, Heidi Sosted, Jenne D. Johansen, and Torkil Menne. “Allergy to hair dye.” BMJ: British Medical Journal 334, no. 7587 (2007): 220.

What You Need to Know about Para-Phenylenediamine (PPD)

This article serves as the introduction to a series on Para-phenylenediamine (PPD): its health risks, history, and politics. In the coming weeks, articles will be published which explore each section in greater detail.

              Para-phenylenediamine, or a chemically related -diamine is an ingredient used in virtually all oxidative hair dyes, both store-bought and used in salons. The oxidative dye process is formulated to quickly penetrate and stain the hair strand any color, including lightening hair by removing the pigment from the core of the hair and dyeing over it.  Brunette and black hair dyes contain higher concentrations of PPD, though all colors can contain PPD.

              Para-phenylenediamine can present a multitude of health risks if it is inhaled or if it comes in contact with skin. Despite a well-documented history of allergic reaction, sensitization, increased risk of cancer, and other serious health risks, it continues to be allowed in hair dyes at a maximum of 6% concentration in the United States.  

              The rate of PPD sensitization is increasing, but many doctors, hairstylists, and consumers remain unaware or apathetic. A lack of knowledge about PPD leads to continuation of serious reactions for people who use products containing PPD and related ingredients. It also allows companies which manufacture and sell products containing PPD to do so with relatively no regulation nor legal repercussion.

              Educating consumers about the dangers of PPD and safer alternatives is becoming an increasingly important mission at Ancient Sunrise®.

The molecular structure of Para-Phenylinediamine.

1. PPD is highly sensitizing, and studies link it to lupus, non-Hopkins lymphoma and asthma.  Allergic reactions can cause severe injuries, and can be fatal.

The hazards of para-phenylenediamine have been known since its introduction for use as an industrial fur dye, and in personal hair dyes. Academic articles from as early as 1915 warn against it. Symptoms of allergic reactions to para-phenylenediamine may include itching, swelling, hives, blistering, depigmentation, and permanent scarring; the reaction is a delayed hypersensitivity reaction, often occurring 3 to 30 days after application, so they are frequently misdiagnosed.

 There have been an increasing number of fatal anaphylaxis reactions to PPD hair dye in recent years, particularly when people have previously had a PPD ‘black henna’ temporary tattoo. The allergic reactions often require emergency treatment to keep airways open, and further treatment in an ICU or burn ward.  A person may additionally experience difficulty breathing and swelling of body parts near the site of exposure. In the case of hair dye use, this means swelling of the face, eyes, and throat. Reactions near the eyes can cause damage and loss of sight.

This woman experienced a severe reaction to a hair dye claiming to be henna, but which contained PPD. Article here.

In countries where products with high PPD levels are easily accessible, ingesting hair dye is a known method of suicide and murder; women can generally purchase hair dye without arousing suspicion. Ingestion of PPD can lead to respiratory distress, rhabdomyolysis (muscle death), and renal failure.

PPD exposure has been linked to increased chances of certain cancers as well as asthma and non-Hodgkins lymphoma. Despite all this, PPD is legal for use on hair within the United States at up to a 6% concentration. Cosmetics companies continue to tout PPD as a safe ingredient despite decades of research, case studies, and hospitalizations.

2. There is no requirement to disclose the concentration percentage of PPD in products manufactured in the US.

Regulation of PPD varies greatly by country. The United States limits PPD to up to a 6% concentration in hair dye. The FDA differentiates between products used for hair coloring, and products applied directly on the skin because hair dyes are supposed to be used off the scalp and washed away after a period of time. In reality, those who apply hair dye at home will apply the product to the scalp, and will not always follow processing time instructions.

 Even when these products are applied correctly, there is no guarantee that the customer will not develop a sensitization or a reaction. The dye may drip onto the scalp, face, neck or ears during processing time. For some, this brief contact with a low concentration may be all that it takes.

Other countries have a higher limit or no limit at all on concentration levels. These products are easy enough to purchase over the internet. They can also be found at international grocery stores. When hair dye is sold in powder form, concentration is directly dependent on the amount of water mixed with the powder. One study found that packages of black hair dye manufactured in India and China (often sold as black henna) contained 12.5% to over 30% PPD, far in excess of legally allowed levels. Other samples have been found to have as high as 60% PPD.

3. “Black Henna” body art is not henna. It is illegal, but laws are not well enforced.

“Black henna” appeared in the United States and flourished seemingly overnight in the 90’s, spurred by Madonna’s “Frozen” music video released in 1998. in the video, her hands are decorated with black henna patterns.  These were done with Bigen black hair dye at the Ziba salon in Los Angeles. Based on first injury reports, it can be estimated that henna artists from South Asia have been using high PPD black hair dye since the 1980’s as “black henna.” Pop-up stalls in tourist locations offered temporary body art that stained the skin black very quickly, and lasted for two to four weeks. “Black henna” created the illusion of a real tattoo without the permanence or pain (unless one experiences a reaction). Black henna body artists were transient and often unaware of the dangers of their own materials.

This person experienced a reaction and now has permanent scarring from a “black henna” tattoo gotten while on vacation.

Within the United States and most countries, PPD is illegal for direct use on skin unless it is for cultural purposes. While imported shipments of “black henna” body art products are regularly seized by customs, it is easy enough to purchase hair dyes containing PPD, which are not subject to seizure, and to use them on the skin.  Dyes from countries with more lenient laws may report only “color powder” as an ingredient. Some international brands of popularly used for “black henna” body art contain as high as 30% PPD concentration, more than enough to sensitize an unsuspecting client in one exposure. A solid form of pure PPD is sold as “henna stone” from the banks of the Nile River, which creates instant black results for body art. This leads uninformed buyers to believe that a) the product is natural and safe; and b) that natural henna produces a black stain.

“Henna stone” is not natural. It is a solid piece of industrial grade PPD, at up to 90% concentration.

The use of high concentrations of PPD for henna-like body art gained popularity first in East Africa in the 1970’s. The product was less expensive and required an easier preparation than natural henna. It provided instant, black results which mimic the look of a permanent tattoo, and are more visible on darker skin tones. This practice then moved into Western countries, especially in high tourism areas.

Darker areas show where “black henna” is used as part of tourism; gray areas show where vacationers return home.

Enforcing laws against the use of PPD on skin would require law enforcement officials to patrol  high tourism areas such as beach fronts and piers where stalls are often set up. These stalls are transient, closing and opening in new locations. A solo artist could set up and work out of a toolbox, moving throughout the day. As mentioned earlier, many products containing high concentrations of PPD are not properly labeled, making it even more difficult to enforce bans.

In many cases, by the time a customer experiences a reaction to their “black henna” body art, the artist has long moved on to a new location, making it near impossible for health professionals to acquire a sample of what was used on the customer’s skin.

  Www.mehandi.com sells Temptu professional-grade skin paint, which does not stain the skin and does not contain PPD, but which is water-resistant and can mimic the look of a black tattoo for up to seven days.

This design was done with Temptu paint. You can find it here and learn how here.

For more information about “black henna” tattoos and their dangers, visit http://www.hennapage.com/henna/ppd/index.html.

4. PPD sensitization can happen to anyone.

Research has shown that with enough exposures to high enough concentrations of PPD, anyone will develop a sensitization to PPD. In a well known study, 100% of subjects exposed to 10% concentrations of PPD developed a reaction within five patch tests. Rate of sensitization varies greatly among individuals. For some, it may take only one exposure to a lower concentration. Though the oxidative hair dye industry claims that fewer than 3% of people are allergic to hair dye, many studies have shown that number to be higher, and coroner Geoff Fell estimates that 14% of people are allergic to oxidative hair dye.

“Black henna” artists use a mixture that is 15% PPD or more. The chances of becoming sensitized to PPD after getting a “black henna” tattoo is about 50% Once sensitized, a person will experience a reaction the next time they come in contact with PPD.  Of the people who are sensitized to PPD from a “black henna” tattoo, about 40% will experience a severe reaction upon their next exposure. This might be another “black henna” tattoo, or it could be years later, when that person decides to dye their hair. Even if the first exposure did not cause any reaction, the body can still have become sensitized. The next time this person comes in contact with PPD, they may experience a severe reaction without any understanding of the cause.

People who work in professions that require frequent contact with PPD can quickly develop sensitivities. Hair stylists who become PPD sensitive can no longer work at a traditional salon without experiencing reactions. PPD was once also used in fur-dyeing, leading to high rates of sensitization in fur industry workers.

5. Those who develop sensitivities to PPD may experience worsening symptoms with each exposure.

Reactions are not always immediate and severe. Oftentimes, reaction symptoms start out mild and worsen each time a person makes contact with the compound. A person who has dyed their hair using an oxidative dye for several years may at first experience no reaction, then one day notice some itching or burning, or have puffy eyes after applying hair dye. The next application might cause more painful symptoms. Before long, that person could require emergency hospital care for a reaction that has caused intense swelling to the entire face and head, and difficulty breathing.

Actor Pauley Perette had a typical progression of reaction: she had dyed her blonde hair black for twenty years, and the allergic reactions presented progressively until it was life-threatening. Follow the link here for additional news articles about PPD reactions.

Image source: IMDb and NYDailyNews

In 2012, a woman in the UK died after experiencing a reaction to an over-the-counter hair dye. Further investigation discovered she had previously gotten a “black henna” tattoo, which likely had sensitized her to future encounters with PPD. While this is an extreme case, it is not at all uncommon for people to become sensitized via exposure to a high concentration of PPD from a “black henna” tattoo, and go on to later use a dye containing PPD. People can become sensitized without experiencing an initial reaction. Those who do experience a reaction from “black henna” tattoos are usually unaware that commercial hair dyes contain the same ingredient.

One study discovered that even after participants were determined by way of patch test to have a PPD sensitivity, more than half continued to use hair dyes anyway. These participants were ones who experienced more mild reactions; those with severe reactions reported stopping hair dye. This shows that the average patient does not take their sensitization seriously, and is willing to endure a mild reaction for the sake of maintaining their desired hair color.

6. PPD sensitization can lead to cross-sensitization to related compounds.

Para-phenylinediamine is an aromatic amine in the benzodiamine family. Studies have shown that those with PPD sensitizations may also be sensitive to other benzodiamines, toluenediamines, analgesics such as benzocaine and lidocaine, azo-dyes, and PABA (para-aminobenzoic acid). The FDA lists examples of cross-sensitization here.

              Hair dyes that are labeled “PPD free” may contain para-toluenediamine, a compound similar enough to elicit reactions for those who have PPD sensitivities, causing “PPD free” hair dyes to be just as problematic.

 Unless tested in a clinical setting, it is unlikely that the average person who is sensitized to PPD will be aware of cross-sensitizations. This leaves them vulnerable to reactions from other sources, such as fabric dyes, cosmetics, black rubber (like that used to create car tires) pain relieving and numbing agents both administered in a hospital and bought over-the-counter, and even sunblock lotion.

Those who experience reactions from cross-sensitization may be frustrated and confused as to what is causing their allergies, and what products to avoid. A doctor may recognize a PPD sensitization and recommend their patient to stop using hair dyes containing PPD; however, if a patient has an unknown cross-sensitization, they may continue to present with similar symptoms without realizing the link.

7. The rate of PPD sensitization is growing.

The combination of an increased use in hair dye among younger people, and the explosion of the “black henna” industry in tourists areas has allowed for a jump in the rate of PPD sensitization. The most common source of sensitization for children and young adults is “black henna” tattoos. As mentioned above, the concentration of PPD in products used for “black henna” is extremely high, leading to a higher likelihood of sensitization in comparison to exposure to lower concentrations. This creates a population of youth who have already become sensitized prior to their first use of oxidative hair dye.

Studies have shown that people are using hair dye at younger ages and at higher frequencies. While hair dye was once more commonly used to mask gray hairs that came with age, it is now a common cosmetic tool to change hair color on a whim, regardless of age.

It is projected that by 2030, about 16% of middle class people in the UK, US, Australia, Korea, Japan, and Europe will be sensitized to PPD. The majority of this sensitization will have been caused by “black henna” tattoos gotten while on vacation. Rates will be higher in the Arabian Peninsula, East Africa, Muslim populations in Africa, and South Asia, where black henna has been used in weddings and for Eid. As the younger, “black henna” sensitized population reaches the age for graying hair, there will be a dramatic increase of PPD-related injury from hair dyes.

Dark areas indicate where black henna is used to decorate the skin for events such as weddings, Eids, religious and cultural celebrations. Gray areas indicate where the practice has spread.

8. International “henna” for hair, and “natural” hair dye products are loosely regulated, and can contain PPD regardless of labeling.

Standards for ingredient disclosure vary depending on the country of origin. In countries like India, manufacturers are not required to disclose their full list of ingredients on products such as hair dye. Henna for hair products can be labeled as “pure” and “all natural” but in reality include PPD, metallic salts, and other chemical adulterants. Some products labeled “henna” can include little to no henna at all. “Henna” becomes a vague, catch-all term for supposedly natural hair products, regardless of the existence of lawsonia inermis plant powder contained therein. These compound hennas are then mistaken for safe BAQ henna.

              It is an incorrect assumption that a product originating from South Asia, the Middle East, or other regions in which henna grows is automatically safe and natural. It is often the case that these products are the most adulterated.

These brands of hair dye contain high concentrations of PPD. Note that some are called “henna.”

9. Cosmetics companies that use PPD have little legal responsibility for PPD-related injuries.

US-based and international cosmetic giants which manufacture oxidative hair dyes containing PPD are relatively safe from litigation. They are required by the FDA to advise customers to conduct a patch test before using their products, and to avoid use if one has an allergy to “black henna.” This warning, along with the sheer size and strength of these companies, prevents successful legal action against them in the case of PPD-related injury. The lobbying power of these companies prevent the government from passing more stringent legislation on PPD. Current law does not require that injuries caused by hair dye reported to the manufacturer be made public, as this is regarded as financially sensitive information.

Dupont, the patent holder, explicitly absolves itself from harm done by any use that involves contact with skin.

“DuPont does not recommend and will not knowingly offer or sell p-phenylenediamine (PPD) for uses involving prolonged skin contact. Such uses may involve, but are not limited to, products formulated with henna for tattoo applications or other skin coloration effects. This use of PPD in prolonged skin contact application has the potential to induce allergic skin reactions in sensitive individuals.

Persons proposing to use PPD in any formulation involving any more than incidental skin contact must rely on their own medical and legal judgment without any representation on our part. They must accept full responsibility for the safety and effectiveness of their formulations.”

10. 100% pure henna is a safe, effective, and permanent alternative to oxidative hair dyes.

More and more people are seeking safer, natural cosmetic alternatives regardless of whether or not they have a sensitivity to ingredients in commercial products. Consumers are concerned about the environment and their own bodies. Using henna and related plant dye powders to dye hair is a process that requires more patience and knowledge than picking up a box of oxidative dye at the local store, but will yield permanent results without damage to the hair or body. It is essential that consumers insist on only henna products of the highest quality and purity. This means products that have been tested for PPD, metallic salts, and other harmful adulterants.

Ancient Sunrise® Henna for Hair products are made of 100% pure plant powder.
They can be used on all types of hair, and produce virtually any natural shade.

              The practice of using plant powders to color the hair is centuries old. The knowledge of their use was once as commonplace as knowing how to drive a car is now. This can become the case again. It requires the availability of quality product, accurate information, and the dissemination of that information within and across communities through direct relationships and social networking. A common reason for being hesitant about using henna is that it seems complicated and time-consuming, but a great number of henna-users report that it becomes second nature, that they enjoy the process, and that the results are superior to boxed dyes.

Learn how to mix your own safe and natural hair dye and never worry about PPD again!

              Ancient Sunrise® provides quality products, information based in research, and a team of customer service representatives that are available through several avenues of communication. We have thousands of customers all over the world. We look forward to helping you on your journey to beautiful hair and healthier practices.


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