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Temporary Tattos:

Reactions to Indonesian Black Henna

A number of travelers in Indonesia have enjoyed the exotic creations of temporary tattoo artists, who can be found on nearly every main street of holiday hotspots as well as school fairs and other public gatherings.

The main ingredient used for these temporary tattoos and/or Mehndi (the traditional art of henna painting in India and the Middle East) is henna. Pure, natural henna provides a chocolate brown or deep mahogany red stain on the hands and feet. On other parts of the body, the stain can be tea-coloured with shades varying depending on the individual and other factors such as skin colour. Henna's dye component, hennotannic acid, does not pass through into the living cell layer (dermis) of the skin, but only stains the dead cells of the epidermis. Though it usually takes many hours to get a good stain on the skin, henna is relatively safe as allergic reactions and irritation are very rare. To make the dye, henna leaves are dried, finely ground and then filtered; the resulting fine powder is mixed with a plant oil such as eucalyptus or other liquids (lemon, water, or tea) to make a thick paste. The mixture may sometimes appear to be black when wet and freshly applied to the skin, but on closer inspection is unlikely to be so.

However, henna is not black. Most "black henna" is natural henna adulterated with a toxic chemical dye to change its color and speed up the dyeing process. More and more people are having skin reactions to this "black henna" due to the toxic dye used, known as para-phenylenediamine (PPD). When used by itself, PPD stains skin a very dark black within two hours that easily lasts up to two weeks. PPD penetrates deep into the skin, bypassing the dermis and entering the blood stream; this is only one of the dangers associated with its use.

While there are a few "black henna" products that use safer colorants than PPD, most "black henna" contains PPD. Individuals should always check the ingredients list of any "black henna" product to make an informed decision.

Skin reactions to PPD frequently resemble the photograph below that was kindly been provided by a friend. PPD can cause delayed hypersensitivity reactions on the skin where the mixture was applied. Sometimes the reaction is mild, with a raised, itchy area in the vicinity of application. More severe reactions include pustules, blisters, oozing sores, intense itching, and often leave long-term scars. The onset of symptoms generally begins from one day to three weeks after application. Blisters may appear while the black stain is still visible or afterwards. If someone experiences a hypersensitivity reaction to "black henna", it will be grow more severe with each subsequent exposure.

Don't bother "patch testing" a particular mixture , because reactions can occur up to 6 weeks after exposure. Even if there is no visible reaction to a mixture, PPD is still a transdermal toxin and could be harming your internal organs.

Although rare, severe cases of immediate hypersensitivity to PPD have been described where victims developed severe edema (swelling), irritation of the eyes and face and difficulty breathing.

PPD scarring may be permanent and post-inflammatory hypopigmentation (scar tissue) may remain at the tattoo site in the form of the application pattern.

"Black henna" containing PPD may be recognized through the following signs:

• If the paste is greenish and smells like spinach or a hay bale, it is probably natural henna. Reputable henna artists may add natural oils or herbs for fragrance that darken the mixture's color.
• If the paste is deep black or grayish, it is probably NOT natural henna and should be avoided. PPD paste is jet black.
• Ask how long it takes to stain and how long it lasts. If the answer is "just an hour or two", you should suspect PPD content and avoided that artist! Real traditional henna must stay on your skin much longer to properly stain (usually 6-12 hours). Real henna patterns will be a shade of reddish brown, not black.*
• Ask how long the design will last. If the answer is "a week or more" then you should strongly suspect PPD.
• Ask what colour the design will be. If the answer is "pure black", it's PPD. Real henna does NOT stain black. If the artist is offering "colored henna", ask to see a list of ingredients and decide for yourself if the product is safe for you.
• Ask to see an ingredients list. If the artist can't supply one, or you don't like what you see, walk away. You'll be glad you did!

*Note: An artist using real henna will tell you that the duration of the stain on your skin varies widely depending on your individual skin and the location chosen. The backs of hands may last about a week because of thinner skin, but thicker parts like the heels of palms and soles of feet may easily last over two weeks. A reputable henna artist won't promise a stain that lasts longer than three or four days, and they won't promise it will disappear in such a short time either. It really is very individual! You can have two different people using the same henna mixture on the palm of their hands within an hour of each other, and one design can disappear in 4 days while the other lasts over a week.

Tattoo artists may not know how much harm they are doing, and the vendors themselves certainly may be ruining their own health by handling PPD. If you believe that you are having a reaction to black henna, see a doctor and tell him about this possible reaction. The symptoms can usually be controlled, and if caught early on, scarring may be avoided.

Be aware also that the Australian Health authorities have issued a warning regarding traditional tattoos in Indonesia as they traced an HIV case to a tattoo parlor in Bali (2012).

See the USDA warning about temporary tattoos putting consumers at risk!

If you have medical-related questions about living in Indonesia to ask of medical professionals, see Ask the Experts.

We trust this information will assist you in making correct choices regarding your health and welfare. However, it is not intended to be a substitute for personalized advice from your medical adviser.

Our appreciation to International SOS, an AEA Company who has contributed this article to assist expatriate families in Indonesia.