J. Cosmet. Sci., 68, 68–73 ( January/February 2017) 68 Address the epidemic of p-phenylenediamine sensitization and aid marginal farmers in a changing climate CATHERINE CARTWRIGHT-JONES, TapDancing Lizard LLC. THE EFFECT ON THE HAIR DYE INDUSTRY OF THE EPIDEMIC OF P-PHENLYLENEDIAMINE SENSITIZATION There is a global epidemic of sensitization to p-phenylenediamine (PPD) (1). The popularity of using black hair dye to create “black henna” temporary tattoos as vacation souvenirs for Westerners as well as for Muslim and Hindu weddings and social occasions has exposed millions of people to highly sensitizing doses of PPD. Of these people, 50% become allergic to oxidative hair dye and 20% become severely allergic (2). The most commonly used materials for black henna tattoos are 15–40% PPD black hair dye powders (3) as well as chunks of 90% + pure industrial PPD (4). The ornate black henna patterns cover large skin surface areas and the black henna paste is left in place for half an hour or more intro- ducing a dangerously high dose of PPD to the body. Substitution of PPD for safe traditional henna body art began in east Africa in the 1970s when Bigen and Peacock home hair dye kits were marketed in the region. This practice spread and became fashionable in Saudi Arabia, Egypt, Pakistan, and India by the early 1980s (5). Women used high PPD content black oxidative chemical hair dye powders for body art instead of henna because PPD produces black stains on skin quickly the fi nely powdered chemical dye can be manipulated into more complex patterns than roughly sifted local henna. PPD was applied to skin of brides and their wedding guests, and was used for social celebrations. Many were sensitized by the fi rst time their skin was painted with PPD if they were not sensitized in the fi rst application, subsequent celebrations with black henna for Eids, Karva Chauth, and Diwali sensitized them. Five or fewer applica- tions of 10% PPD in a patch test will sensitize 100% of subjects (6) black henna contains 15–60% PPD. Some were unaware that PPD sensitization would affect their health in the future others regarded the blisters that arose after application to be of little concern, regarded as “suffering for beauty.” They felt black patterns were more beautiful on darker skin as well as more convenient. As these women mature, they may decide to dye their hair with oxidative hair dye. For these women, the hypersensitivity reaction can be severe anaphylaxis may be fatal (7). Forty women have died in recent years in Libya from PPD sensitization (8), and offi cials have called for a ban on oxidative hair dye. There has been Address all correspondence to Catherine Cartwright-Jones at reverndbunny@earthlink.net.

EPIDEMIC OF p-PHENYLENEDIAMINE SENSITIZATION 69 a similar call in Egypt and the United Kingdom (9). Khartoum (10) and Karachi (11) average hundreds of admissions to the main hospital per year from PPD sensitization. There is a solution to this problem: at the fi rst sign of sensitization, immediately transi- tion the person to pure henna, cassia, and indigo from oxidative hair dye. They cannot be transitioned to compound henna or adulterated henna without risking a destructive chemical reaction between the metallic salts in compound henna and the activators in oxidative dye: hair may break, turn an unexpected color, or in the worst case, incinerate. Pure henna, cassia, and indigo, in differing proportions and techniques, can produce the complete range of natural human hair colors from blond through red, brunette, and black (12). These methods were used across Arabia, the Middle East, the Levant, South Asia, and Africa for centuries, but are now regarded as “old fashioned.” It is going to require persis- tent marketing and education to dispel the notion that henna is inferior, that it destroys hair, is fi lthy, and can only make hair orange. Pure henna is not inferior to chemical dyes it is simply a different technology. Pure henna does not harm hair it strengthens hair, protects it from ultraviolet and desiccation. If skillfully applied, henna is no less tidy than chemical dye. Though the lawsone molecule is orange, it can be manipulated through a range of color, and with two other plants, can mirror the entire range of human hair and completely cover gray. Henna must be reframed as a safe, versatile, beautiful, and healthy approach to hair care. Salons and customers must be helped to adjust to and embrace the experience of a slow, nuanced art of women’s self-care and beauty. IMPROVING AND INCREASING THE PRESENT SUPPLY OF HENNA, INDIGO, AND CASSIA TO MEET RISING DEMAND Improving the quality of henna products is crucial to gaining market acceptance and saving lives. It is entirely feasible to scale up production of henna and improve quality over the next 15 years to meet the demand of the epidemic of PPD sensitization. The present leader in the production of henna is Rajasthan, India. The government of India provides substan- tial support for the henna industry, partly to prevent the expansion of the eastern Thar Desert boundary into Punjab farmland (13). This support has made the Punjab the world’s dominant henna producer. Henna production and exporting increased from 4500 to 7600 tons per annum during the period 1988–1993 to 24,000 tons in 2004 (14). In 2006, henna leaves (54,750 metric tons) were registered through Krishi Upaj Mandi, the gov- ernment board of agricultural produce, in Sojat city, Rajasthan (15). Demand for Rajasthani henna production and export is strong and has a steady growth rate of 9% per year. About half of the crop is exported to the United States and Europe. Scaling up production requires time to plant and grow small trees, but with foresight, it is possible. Scaling up indigo and cassia production is more straightforward these are tropical annual and perennial plants. Henna, cassia, and indigo.