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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 9  |  Issue : 3  |  Page : 208-210

Multiple organ failure after a topical application of henna on a newborn


1 Deparment of Pediatrics, Dicle Univercity of Medicine, Diyarbakır, Turkey
2 Department of Dermatology, Bezmialem Univecity of Medicine, Istanbul, Turkey

Date of Submission14-Jun-2019
Date of Decision29-Mar-2020
Date of Acceptance03-Apr-2020
Date of Web Publication07-Aug-2020

Correspondence Address:
Prof. Selahattin Katar
Dicle University of Medicine, Department of Pediatrics, No:8, Diyarbakir
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcn.JCN_71_19

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  Abstract 


Henna is a popular cosmetic product that can be used for different purposes in our country (South-East Anatolia). Local and systemic side effects have been reported after the topical use of henna. These side effects include nephrotoxicity, hemolytic anemia, rhabdomyolysis, and multiple organ failure. Here, we present a case of a newborn who was diagnosed with multiple organ failure after receiving a topical henna application.

Keywords: Henna, multiple organ failure, newborn


How to cite this article:
Katar S, Demirel BG. Multiple organ failure after a topical application of henna on a newborn. J Clin Neonatol 2020;9:208-10

How to cite this URL:
Katar S, Demirel BG. Multiple organ failure after a topical application of henna on a newborn. J Clin Neonatol [serial online] 2020 [cited 2020 Sep 28];9:208-10. Available from: http://www.jcnonweb.com/text.asp?2020/9/3/208/291649




  Introduction Top


Henna made by compressing the leaves of the Lawsonia alba plant is used for cosmetic purposes in the Middle East and Asia. The active ingredient of Henna is 2-hydroxy-1,4-naphthoquinone.[1] When henna is applied topically, severe reactions may occur with systemic toxicity.[2],[3] Oral ingestion of para-phenylenediamine (PPD) can result in severe edema in the face and throat, and in some cases, can cause respiratory distress that requires urgent tracheostomy. It can also cause rhabdomyolysis, myoglobinuria, and acute kidney failure in patients.[4],[5] Here, a newborn is presented with respiratory distress and multiple organ failure after extensive henna application to the body after a few hours.


  Case Report Top


Our patient was born vaginally and birth weight was 2600 g. He was discharged 1 day after birth. İn Turkey of the southeast is widely applied henna to the skin of newborn babies because it is believed to lead a healthier life to the child's future. Following this tradition, topical henna was applied to the patient 3 days after birth. A few hours after applying henna, the patient's spontaneous activity decreased, followed by cyanosis and respiratory distress. The patient was in critical condition when he applied to the emergency room. A physical examination was performed, the patient had hypotonic, heart rate was 128/min, blood pressure was 63/36 mmHg, and it was noted that the patient's skin was orange due to henna on the abdomen and lower extremities [Figure 1]. The patient was evaluated to have respiratory failure and emergency tracheal intubation was performed.
Figure 1: Both lower extremities and abdominal skin are colored in orange due to the application of henna

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Blood gas analysis PH 7.10, PCO2 71 mmHg, HCO3 24 mmol/L and BE-5 mmol/L, lactate 11 mmol/L were detected. Complete blood count analysis was performed: Leukocytes 18.900/mm3, platelets 132.000/mm3 and hemoglobin 13.5 g/dl, biochemical tests were carried out: Urea 154 mg/dl, creatinine 1.7 mg/dl, AST 139 U/L, ALT 20 U/L, calcium 8.9 mg/dl, and CRP 0.4 g/dl. Peripheral smear was taken, and hemolysis was observed. The number of reticulocytes was 14%. G6PD level was normal in the patient. Two units of fresh frozen plasma were given to the patient with prothrombin time 45 g/dl, activated partial thromboplastin time 105 g/dl, international normalized ratio 6.08, and D-dimer level 2452. A chest X-ray and cranial tomography scan (CT scan) were applied to the patient. There was no abnormality on chest radiography, but subarachnoid hemorrhage was detected when a CT scan was performed intravenous fluids were got to the patient, and he had convulsions and phenobarbital was started. After that, the convulsion did not stop, and phenytoin was added to the treatment. Kidney failure, respiratory failure, and hematological failure developed. In addition, the treatment continued for a long time due to the effect of the central nervous system. The patient was discharged after being treated in the hospital for 40 days.


  Discussion Top


Henna is used not only in our country, but especially in the Middle East, India, Sri Lanka, North America, and Africa. Since ancient times, Anatolian people have been used in traditional ceremonies for henna and various cosmetic purposes, such as coloring their hands, feet, and hair. It has been reported that henna for headache, eye pain, sputum, ulcer, scar tissue, diarrhea, leprosy, fungus, and eczema have been used throughout the history of Turkish and folk remedies. Normally, it is very rare for pure henna to have side effects. However, complications involving allergic contact dermatitis, some systemic diseases such as kidney failure, respiratory distress, and even death may occur due to the use of PPD additives that have recently darkened henna color and shortened the processing time.[5] The first case of toxicity associated with PPD have been reported to the client in a barber applying the hair color, and then several systemic toxicities have been reported.[6],[7] Oral PPD intake is often associated with suicide. Reactions similar to the reactions taken when taken orally can occur when PPD is absorbed in the skin after the intensive application of henna.[7] In this case, systemic poisoning of the newborn probably occurred due to the poor development of the skin barrier and large area applied to henna. There are different symptoms of PPD poisoning. It has been reported that vomiting occurs in patients receiving oral PPD, and edema develops in the face, pharynx, larynx, or upper respiratory tract. It is reported that tracheostomy is required in patients with respiratory distress.[4],[8] In our case, we think that apnea is caused by laryngeal edema. The patient's respiratory functions were normalized by intubation and mechanical ventilation.

When patients receive high doses of PPD, pain in the limbs, rhabdomyolysis, and acute oliguric kidney failure may develop. Hemodialysis was required in patients who developed acute renal failure, as described by Sir Hashim et al. Kidney failure is generally associated with rhabdomyolysis and intravascular hemolysis.[9],[10] In the previously reported publications, hemolysis has been reported to be associated with G6PD deficiency in PPD exposure.[3] In addition, some animal model studies have shown that the active ingredient of pure henna, 2-hydroxy-1, and 4 naphthoquinone may cause oxidative damage in erythrocytes.[11],[12] Although our patient's G6PD blood level was normal, hemolysis findings were detected. Other reported features of PPD poisoning include liver failure, changes in consciousness, convulsions, gastrointestinal symptoms, pure motor neuropathy, and chronic kidney failure.[5] A 9-year-old female patient with subarachnoid hemorrhage due to black henna poisoning has been reported.[13] We think that our patient may be the first newborn patient to develop subarachnoid hemorrhage as a result of the topical henna application.

Treatment of PPD poisoning is more supportive. Currently, there is no known antidote for PPD poisoning.[1] Although pure henna is a weak sensitizer, when other ingredients are added, it can lead to symptoms with serious systemic involvement. It should be considered as henna toxicity in patients with respiratory distress, rhabdomyolysis, and acute renal failure.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Qurashi HE, Qumqumji AA, Zacharia Y. Acute renal failure and intravascular hemolysis following henna ingestion. Saudi J Kidney Dis Transpl 2013;24:553-6.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Kang IJ, Lee MH. Quantification of para-phenylenediamine and heavy metals in henna dye. Contact Dermatitis 2006;55:26-9.  Back to cited text no. 2
    
3.
Hueber-Becker F, Nohynek GJ, Dufour EK, Meuling WJ, de Bie AT, Toutain H, et al. Occupational exposure of hairdressers to [14C]-para-phenylenediamine-containing oxidative hair dyes: A mass balance study. Food Chem Toxicol 2007;45:160-9.  Back to cited text no. 3
    
4.
Averbukh Z, Modai D, Leonov Y, Weissgarten J, Lewinsohn G, Fucs L, et al. Rhabdomyolysis and acute renal failure induced by paraphenylenediamine. Hum Toxicol 1989;8:345-8.  Back to cited text no. 4
    
5.
Anuradha S, Arora S, Mehrotra S, Arora A, Kar P. Acute renal failure following para-phenylenediamine (PPD) poisoning: A case report and review. Ren Fail 2004;26:329-32.  Back to cited text no. 5
    
6.
Nott H.W. Systemic poisoning by hair dye. Br Med J 1924;1:421-2.  Back to cited text no. 6
    
7.
Hashim M, Hamza YO, Yahia B, Khogali FM, Sulieman GI. Poisoning from henna dye and para-phenylenediamine mixtures in children in Khartoum. Ann Trop Paediatr 1992;12:3-6.  Back to cited text no. 7
    
8.
Yagi H, el Hind AM, Khalil SI. Acute poisoning from hair dye. East Afr Med J 1991;68:404-11.  Back to cited text no. 8
    
9.
Minoo F, Nouri M, Dashti-Khavidaki S. Possible nephrotoxicity after topical application of a natural herb, henna. Iran J Kidney Dis 2014;8:349-51.  Back to cited text no. 9
    
10.
Devecioǧlu C, Katar S, Doǧru O, Taş MA. Henna-induced hemolytic anemia and acute renal failure. Turk J Pediatr 2001;43:65-6.  Back to cited text no. 10
    
11.
Munday R, Fowke EA, Smith BL, Munday CM. Comparative toxicity of alkyl-1,4-naphthoquinones in rats: Relationship to free radical production in vitro. Free Radic Biol Med 1994;16:725-31.  Back to cited text no. 11
    
12.
Kheir A, Gaber I, Gafer S, Ahmed W. Life-threatening haemolysis induced by henna in a Sudanese child with glucose-6-phosphate dehydrogenase deficiency. East Mediterr Health J 2017;23:28-30.  Back to cited text no. 12
    
13.
Şık G, Çıtak A. Fatal paraphenylenediamine poisoning due to black henna. Turk J Pediatr 2016;58:301-4.  Back to cited text no. 13
    


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