Poisoning with hair-dye containing paraphenylene diamine: ten years experience

Hair-dye containing paraphenylene diamine (PPD) is widely used and this compound is known to be toxic, when ingested, to several organs including the kidney. In this study, we reviewed 150 cases presenting to Khartoum Teaching Hospital with PPD poisoning over a period of 10 years. The clinical features commonly involved the gastrointestinal tract, skin and eyes. Nearly all the patients had angioneurotic edema and some cases developed flaccid paraplegia or paraperesis. With regards to the renal involvement, we observed that 90 of the 150 study cases (60%) developed acute renal failure (ARF) requiring dialysis. The mean period on dialysis was 15 days (range 1-42 days). All patients recovered normal renal function. In order to exclude permanent glomerular damage following overdose of PPD, 20 patients were subjected to renal biopsy following recovery from ARF. None had evidence of glomerular injury. On the other hand, three patients who had chronic (skin) contact with the dye and one patient who recovered from ARF a year earlier showed evidence of focal segmental glomerulosclerosis on renal biopsy. We conclude that hair-dye containing PPD can cause severe side effects particularly after oral ingestion. Its use should be discouraged and public attention should be drawn in this regard.