HAIR-DYEPOISONING

Dr.G.Bhargav kiran

Introduction In India, the most of the suicides are committed by ingestion of poisons, mainly

pesticides. Nowadays, hair dye has been established as a preferred means of suicide, particularly

in Females. In the Indian subcontinent, hair dye poisoning either suicidal or by toxic overuse has

been emerging as a very common poisoning due to its: Extensive Use Low Cost Easy Availability Without Any Difficulty.

All hair dyes irrespective of their brands and company contain PPD, as its key toxic component but can also be used for color enhancement

Types of Hair Dyes

Vegetable Hair dyes ( Henna) Temporary Hair dyes( water Soluble) Semi Permanent hair dyes Permanent hair dyes (PPD, Resorcinol)

Oxidation hair dyes Progressive Hair dyes ( lead acetate/

Bismuth citrate)

Poisonous Ingredients

Permanent Dyes: PARAPHENYLENE DIAMINE (PPD) Resorcinol Propylene glycol Ethylenediaminetetraacetic acid

(EDTA) sodium,

PARAPHENYLENE DIAMINE (PPD)(C6H4(NH2)2

It is an aromatic amine not found in nature It is available in the form of white crystals when pure and rapidly turns brown when exposed

to air. It is used in most of the hair dyeing preparations , in almost all commercially available dyes as it

Accelerates the dyeing process Enhances color Provides permanent results

It is also used in industrial products such as textile or fur dyes Dark colored cosmetics Temporary tattoos Photographic development

Clinical features of poisoning AngioEdema or Cervicofacial Edema

o Early manifestations of ORAL PPD intake ( usually within 4-6 hrs of ingestion ) include respiratory distress due to swelling of upper airway and angioedema

o Angioedema : it is defined as abrupt swelling of dermis and subcutis associated with occasional pain rather than pruritis and skin returning to normal usually with in 72 hrs

Angio edema is immunologically mediated anatomically limited non pitting edema

Pishoo Et Al : Stages Of Angioedema

Stage FeautureStage1 Facial and lip edemaStage 2 Soft palate edemaStage 3 Lingual edemaStage 4 Laryngeal edema

Rhabdomyolyisis Appearance of cola colored urine is the initial sign of rhamdomyolysis which is due to MYOGLOBINURIA Majority of the patients present with back pain limb pain and generalized myalgia Acute muscle necrosis is the cause of tenderness and local edema

of muscle apart from myalgia A positive urine dipstick test for heme , with absence of red cells on

microscopic examination confirms myoglobinuria Dissolution of striated muscle fibres occurs , with leakage of muscle

enzymes , myoglobin , potassium , calcium sometimes leads to adverse outcomes

CK levels are the most sensitive indicators of myocyte injury

Myocarditis It is Rhabdomyolysis of Myocardium It was reported in 15% of total cases with mortality rate of 29%

Renal failure It signifies severity of intoxication It occurs due to a combination of Hypovolemia, toxic injury &

Myoglobinuria

Management

There is NO specific antidote available for PPD Treatment is aimed at rapid identification of POTENTIALLY life

threatening complications and prevention of real failure Gastric lavage may be useful if the patient presents within 1 hour of

ingestion but contraindicated if airway protective reflex is lost Activated charcoal : because of low molecular weight and hydrophilic

nature of PPD , it has low adsorbability Airway protection is the most important consideration with

LARYNGEAL angioedema mainly done by Endotracheal Intubation or Tracheostomy

Medical treatment : Mainly by steroids and anti histamines In the event of life threatening reaction involving utricaria with laryngeal edema or

angioedema : EPINEPHRINE may be tried to stabilize patient

For Rhabdomyolysis : Aggressive fluid resuscitation with isotonic fluids to restore renal perfusion

and increased urine flow is necessary to prevent ACUTE KIDNEY INJURY In case of OLIGURIA , HEMODIALYISIS is the treatment

For Myocarditis : Continous cardiac monitoring is essential to prevent any arrhythmias

Other toxic Ingredients of Hair dyes Resorcinol:

Seizures, lethargy, coma and death o Nausea, dyspnea, hypotension, diaphoresis, salivation Methaemoglobinemia; Pulmonary edema

Propylene glycol: Anion gap metabolic acidosis; CNS depression; Arrhythmias Renal dysfunction

EDTA Sodium: Hypocalcemia (also due to rhabdomyolysis)

Summary Whenever the characteristic syndrome of stridor due to “upper

airway edema, rhabdomyolysis, and evidence of hemoglobinuria /myoglobinuria and ARF develops in a poisoning, hair dye should be considered.

Early interventions to secure an airway by endotracheal intubation and/or tracheostomy management of the cardiac arrhythmia by correction of the electrolyte

imbalance and acidosis alkaline diuresis, and dialysis are the key management strategies to salvage

the patient who is otherwise likely to die. Awareness about this condition is helpful in early intervention to reduce mortality Some of the countries considered PPD to be great hazard and its use in

hair dyes was banned and needs to be implemented in INDIA also

Hair Dyes are meant for “DYEING not DYING”

Thank You..