Guerrillero Heroico--a lasting impression

What once was simply a cultural tradition is fast becoming a popular phenomenon amongst Western tourists. Temporary henna tattoo designs performed by street or beach vendors are prevalent throughout the Middle East and Asia, particularly in holiday resorts. The public may be mistaken in thinking that the fashionable trend comes without significant risk. The main ingredient in the temporary tattooing method is henna (Lawsonia inermis), a flowering plant with dyeing properties that takes only several hours to be absorbed but provides an effect lasting around ten to fifteen days on the recipient's skin. The side effects of henna tattoos are well documented in the literature, although it is not clear whether the side effects directly relate to the henna ingredient or the additives used to prolong the designs. The most commonly noted complications include allergic contact dermatitis, infection, hypertrophic and keloid scarring and temporary or permanent hypo- or hyperpigmentation. In very rare cases, type 1 hypersensitivity reactions (angioedema and anaphylaxis) have been reported. The following case report highlights several of these complications and the relevant management.