Black henna tattoos should be avoided, especially during foreign travel, UK doctors warn in BMJ Case Reports.

Researchers from the University of Sheffield, Sheffield, UK report on the treatment of a 10-year-old boy who developed an allergic reaction to a tattoo painted on his arm while vacationing in Spain. The young boy presented with redness, itching, and small inflammatory irritated spots on his partially crusted skin lesion, which followed the outline of the tattoo on his right upper arm. The surrounding skin was red, hot and painful to touch.

The rash had started four days after application of a temporary black henna tattoo. The reaction may have been caused by paraphenylenediamine (PPD), a textile dye that is commonly added to henna to blacken the pigment and speed up drying time. The combination together is called black henna. PPD is a known contact allergen, and can lead to a reaction based on its concentration and the duration of exposure.

The boy was treated with antibiotics, and topical corticosteroid, local anesthetic and moisturizing creams. An improvement was noted after 48 hours with rapid resolution of surrounding inflammation, the researchers report.

"Skin tattoos with black henna should be avoided, especially during foreign travel, as this can make the tracing of the vendor and any subsequent public health management challenging," the doctors conclude.

The FDA Chimes In

The U.S. Food and Drug Administration (FDA) is seeing an increase in reports of people developing infections from contaminated tattoo inks. In response, Linda Katz, M.D., M.P.H., director of FDA’s Office of Cosmetics and Colors, urges individuals to consider these seven important questions before they ink.