Hair dye
What is hair dye?
•Hair Dye or Hair Color: is
a chemical tool that is used
to change the color of a
person's hair.
• used mostly to change
gray hair; a sign of an
advanced age.
• Younger people that used
hair dye use it as a fashion
About our Hair:
•Human hair is made of keratin, water and dead cells
•Each strand of hair is made up of three layers;
Cuticle ,Cortex& Medulla
•Cuticle is made up of scale-like, overlapping
protein cells which protect the
cortex
•A healthy hair: when the cuticle lie flat
around the hair shaft.
•A damaged hair is when the cuticle of the
hair is raised.
•Natural black hair
color is due to melanin
clusters of dispersed
within the colorless
keratin-based cortex
of hair.
• French researchers have found that
Egyptians, Greek and Romans were using to
dye their hair several thousands years ago
• Since the Greco-Roman period, organic hair
dyes obtained from plants such as henna
have been used, but other unusual formulas
based on lead compounds which generated
lead sulfide (PbS) nanocrystals with a
diameter of only 5
nanometers .
history of hair dye
Pharaoh Ramesses II ,reddish-yellow
colour of the mummy's hair had been
brought about by its being dyed with a
dilute henna solution;
They found that the treated hair showed the
presence of galena nanocrystals(under 5 nm). but
these blackening PbS particles are much smaller than
melanin clusters by 4-5 orders of magnitude in
volume.
• In 1907, Eugè
ne Schueller, a young
French chemist,
developed an innovative
hair-colour formula. He
called his improved hair
dye Auréole. Schueller
formulated and
manufactured his own
products, which he then
sold to Parisian
hairdressers.
Who wants to dye too?
Types of Hair color
most common classifications
• Temporary
• Semi-Permanent
• Demi-Permanent:
– Oxidative Deposit -Only
• Permanent:
– Non-Oxidative
– Lift/Deposit
– Oxidative
1.Temporary :
• The pigment molecules
are large and cannot
penetrate the cuticle
layer. Instead, the color
particles remain
adsorbed (closely
adherent) to the hair
shaft and are easily
removed with a single
shampooing Dye molecules
Coating action(adsorbtion)
1.Temporary:
• There is a physical action (coating) on the hair,
not chemical action (penetrating).
• Does not lighten or change the structure of the
hair.
• These are the least hazardous of all dyes. (food
grade dyes )
• Spray-on temporary haircoloring that contain
metallic salts can build-up and can cause
adverse chemical reactions with future
chemical services.
• These dyes are flammable
2.Permanent hair colors:
• are the most popular hair dye
products
• Permanent hair-coloring dyes consist
of three components. They are:
• Primary intermediates & Couplers(the
color)
• Oxidants (Hydrogen peroxide )
• An alkali usually ammonia
• The primary intermediates form color on
oxidation.
• The modern permanent dyes consists of
solutions of paraphenylenediamine (PPD),
or similar “para” compounds.
• Couplers will react with the oxidized
products of the primary intermediates and
form dyes which are then applied to hair.
• Hydrogen peroxide is a major factor in
permanent hair coloring techniques
• Hydrogen peroxide
diffuses the melanin,
and lightens the
natural color of hair
Ammonia causes
cuticle to swell and
separate
Both agents called the
developer
Dye
molecules
2.Semi-Permanent Hair Colors
Also known as:
• Oxidation Tints
• Penetrating Tints
• Peroxide Tints
• Synthetic Organic Tints
• Para-dyes
• “Tints”
2-Semi-permanent hair
color:
• Uses smaller molecules than
temporary dyes, and is
therefore able to partially
penetrate the hair shaft.
• the color survives repeated
washing, 4-5 shampoos.
•Semi-permanents contain no,
or very low levels of developer,
peroxide or ammonia.
2-Semi-permanent hair color:
Chemicals of Concern :
• use Aniline Derivative Tints from Para-
Phenylediamines
• Darker dyes have more phenylediamine
Health Affects
• – Skin, eye, respiratory sensitizer
• – Severe allergies – e.g., facial and neck swelling
• – Dermatitis – e.g., rashes
• – Mutagenic when mixed with peroxide
A.Semi-Permanent
- Traditional
Azo Colors
• Derived from from
benzidine, a known
carcinogen.
• Can revert back to
benzidine in the body.
• Azo Direct Black 38 and
Direct Blue 6 are
carcinogenic in their own
right.
Mechanism of hair dyeing:
• Uses a medium size molecule.
• causes a slight alkaline reaction to swell the hair
shaft, causing the cuticle to rise.
• This allows some color molecules to enter the
cortex, and some to coat the cuticle.
• A neutral or slightly acid after-rinse is used to stop
the alkaline swelling reaction, allow the cuticle to
close, and trapthe color molecules inside.
• Less damaging than permanent dyes since it does
not lighten.
• Causes a mild chemical and physical change in the
hair shaft.
2.A. Semi-Permanent -
Traditional
• Less damaging than
permanent
dyes since it does not
lighten.
• Causes a mild
chemical and
physical change in the
hair shaft
Dye
molecules
B. Semi-Permanent - Polymer
• different chemical
composition.
• They combine many
molecules to form a
polymer. Polymers coat
the hair shaft rather
than penetrate. They
do not change the
melanin.
• Heat is used to deepen
the color penetration
rather than the use of
the chemical oxidation
process
3.Demi-Permanent :
(Oxidative Deposit-Only(
• Process falls between the semi-permanent and
permanent dye process.
• Uses a catalyst such as a 10% mild peroxide
developer with a non-ammonia alkali to swell
the cuticle, allow dye molecules to penetrate
into the cortex and deposit color inside the
hair shaft.
• A neutral or slightly acid after-rinse is used to
stop the alkaline swelling reaction, allow the
cuticle to close, and trapthe color molecules
inside.
• The mild chemical reaction does not lighten the
melanin and hardly changes the hair structure.
3.Demi-Permanent:
• Chemicals of Concern : Uses
mostly aniline derivative dyes.
• The alkali (high pH) used to
swell the cuticle is from either
monoethanolylamine (MEA) or
amino methyl propanol (AMP).
• MEA is a pH adjuster that can
release nitrosamines which
cause cancer in animals and can
cause severe eye irritation in
humans
dye
Demi-permanents : advantages over
permanent color:
• no lifting (removal) of natural hair color
• the final color is more natural looking.
• safer, especially for damaged hair,
• wash out over time (typically 20 to 28
shampoos), so root regrowth is less
noticeable ,
• if a change of color is desired, it is easier
to achieve.
4.Permanent :
Oxidative/Lift Deposit
These hair colors have the smallest molecule
which makes it easier for them to
penetrate the hair shaft and the scalp.
• This process has the greatest impact on
the hair structure, which is permanently
changed, and the cuticle remains slightly
shifted
• Formulas can have ranges of:
– Phenylediamine .08% to 6%
– Hydrogen Peroxide 3 – 10% 20 – 40%
• Ammonia • Resorcinol
Mechanism of hair dyeing
“Oxidative/Lift Deposit”
• An alkaline reaction(most often ammonia )
causes the cuticle to swell, allowing
hydrogen peroxide and dye to enter.
• The hydrogen peroxide “oxidizes”
(diffuses) the melanin, and “lifts”
(lightens) the color.
• The hydrogen peroxide also causes the
dye to “develop” and “deposit” color.
• A neutral or slightly acid after-rinse
stops the alkaline reaction, allows the
cuticle to
Close, and traps the color molecules inside
Dye deposited in
cortex
• Permanent color is truly permanent and will
not wash out, although it may fade. New
hair regrowth will obviously be in the
hair's natural color. .
• Permanent hair color is the only way to dye
dark hair into a lighter shade, and it must
be done in two parts: First, the hair is
lightened, then color is applied.
Permanent?
5.Permanent:
Non-Oxidative
Vegetable Tints:
• – Made from plant
materials and henna
• – Builds up layers in hair
shaft
Problems with Vegetable
Tints:
Henna – can trigger asthma
and other allergic reactions
Metallic Dyes:
– Contain metallic salts from lead acetate, lead,
copper, cobalt, silver nitrate
– Not used professionally .toys ,furs
Compound Dyes:
– Mix of vegetative tints and metallic dyes
– Not used professionally
Problems with Metallic Dyes
• Can cause headaches, scalp irritation, facial
swelling, contact dermatitis, lead poisoning,
and hair breakage, toxic,.
• Bottles of metallic dyes can explode
Hair dye poisoning
• one of the important causes of
accidental or intentional self harm in
the developing world.
• PPD is the most common constituent
of hair dye formulations. PPD is
commonly used in Africa, Middle East
and Indian subcontinent while it is
rarely used in the west,
Paraphenylene Diamine
(PPD(
paraphenylenediamine,
or
1,4-diaminobenzene,
or 1,4-phenylenediamine
PPD
• This derivative of aniline,
aromatic amine, is a
colourless solid when
pure but are partially
oxidized and appear
yellowish.
• Some misinformation has
led to PPD being
described as a black
mineral from the bank of
the River Nile. This gave
PPD an undeserved
distinction as being
natural. )PPD crystals(
Black stone dye
• PPD is a precursor
to aramid plastics
and fibers such as
Kevlar.
• dyeing furs
• Photochemical
measurements
• azo-dye
manufacturing
Kevlar (p-aramid fibre)
dyeings
uses
• as a hair dye
• mixed with ‘Henna’ to
color palms of hands and
soles of feet and to dye
hair a dark red shade .
• it was also used to kill
wild animals when added
to food .
Toxicity of PPD
• First case of PPD poisoning was reported in
a hairdresser in 1924 following exposure
due to PPD dye handling.
• PPD is readily absorbed on dermal contact.
Six children in a series of 31 Sudanese
children with PPD poisoning were reported
not to have ingested hair dye. An Arab
lady developed acute life threatening
pulmonary edema after she had painted
one hand with a henna mixture.
• PPD poisoning commonly by ingestion
• PPD is metabolized by
cytochrome P450 oxidase to
form a reactive metabolite
Bondrawski’s base ,a
compound reported to cause
anaphylaxis as well as being
strongly mutagenic and highly
toxic
• Excreted by kidneys
Clinical manifestations
• PPD intoxication is a life threatening
condition.
• Clinical outcomes rely on early recognition,
prompt referral, and aggressive supportive
treatment in collaboration with different
specialties.
• The toxicity of PPD is a multisystem
involvement.
• The initial presentation may be confusing
and most deaths occur within hours of
admission. A typical case is illustrated by
the following account:
• six-year old child presented with sore
throat, cough and anorexia followed by
severe dyspnoea caused by edema of the
tongue, pharynx and neck. He developed
AKI and metabolic acidosis. The initial
diagnosis was Ludwig’s angina. Despite
initiation of vigorous supportive therapy,
the child developed irreversible
ventricular fibrillation and died eight
hours after admission. It was discovered
later that the child and his dog ingested a
hair dye containing PPD, and the dog died
few hours later
• Another victim of PPD intoxication died
of cardiac complications, which
occurred 4 hours after admission
despite intensive supportive measures
• Clinical scenarios are variable and
range from a local skin reaction to
multisystem involvement
• . It is very important to obtain a
psychosocial history and evaluate the
home environment as many cases were
found to be precipitated by severe
psychiatric disturbances
Skin and eye manifestations
• . Nowadays, it is well
known that PPD cause
skin irritation, kerato-
conjunctivitis,
conjunctival swelling and
eczema of the eyelids.
Allergic reactions
causing dermatitis,
urticaria and asthma
have also been reported
Respiratory system and upper airway
manifestations
• One of the most severe
clinical manifestations
and the main cause of
death in PPD poisoning is
upper airway obstruction
(angio-edema)
manifesting with a hard
swollen protruding
tongue and edematous
bull neck.
• required tracheostomy
for upper airway
obstruction
Kidney manifestations
• The cardinal features of myoglobinuria
(dark-colored, chocolate-brown urine),
• The extent of renal involvement varies
between transient proteinuria and oliguric
ARI. ARI commonly develops a few days
after PPD exposure.
• The kidney injury :due to the direct toxic
effect of PPD, hypovolumia, hemolysis and
rhabdomyolysis with the deposition of
myoglobin casts within the renal tubules.
Neuromuscular toxicity
• Rhabdomyolysis, which in turn
contributes to AKI and the increased
likelihood of sudden cardiac death .
• skeletal and cardiac muscle necrosis
could be experimentally induced by
PPD. Scattered coagulative necrosis
of skeletal muscles was found in the
autopsy of a PPD victim .
•
• Increased free radical formation in PPD
poisoning may be responsible for the
deleterious tissue damage observed in animal
studies .
• Flaccid paraplegia, palato- pharyngeal and
laryngeal paralysis were also reported in
adults and children .
• Neurotoxicity causing mental alteration and
coma was also observed and was possibly
related to brain anoxia and severe metabolic
acidosis associated with AKI
Other manifestations
• Tender palpable liver with features of acute
hepatitis on liver biopsy was seen in many
patients.
• Cardiac toxicity causing arrhythmia, heart
block and sudden death was also reported in
some studies.
• It is commonly the direct cause of death in
children and adults with PPD poisoning.
Cardiac toxicity is mainly caused by the
direct toxic effect of PPD on the heart,
rhabdomyolsis of the cardiac muscle causing
severe damage and hyperkalemia
Diagnosis:
• The symptoms are considered to be dose
related and patients with ingestion of
larger amounts of PPD have higher
morbidity and mortality.
• Onset of symptoms after ingestion of the
dye is about 4-6 hours.
• The major early challenge to life is
asphyxia and renal failure at later stages
Diagnosis :
• The characteristic triad of
features encountered is early
angioneurotic edema with
stridor, rhabdomyolysis with
chocolate colored urine and
acute renal failure. When ever
this combination occurs in
poisoning, hair dye is a strong
suspect.
• Other reported features are leukocytosis,
anaemia secondary to hemolysis,
haemoglobinaemia and haemoglobinuria.
• Toxic features include methemoglobinaemia,
gastritis, hoarseness of voice, hepatitis,
convulsions, coma .
• Hypotensive shock
• markedly elevated creatinine phosphokinase
and lactate dehydrogenase, hyperkalemia,
hyperphosphatemia and hypocalcemia
Management
Hair dye ingestion is a medical emergency.
• Emergency measures should include gastric
lavage. Patients should be monitored for
respiratory distress and endotracheal
intubation has to be performed early if
laryngeal edema develops.
• Metabolic acidosis has to be corrected.
Early intervention with half normal saline
and soda bicarbonate infusion has been
shown to be beneficial in Rhabdomyolysis.
Management
• All modalities of dialysis:
hemodialysis, peritoneal dialysis and
continuous renal replacement therapy
have been tried and have been found
to be useful in acute renal failure.
• Antihistamines and steroids are
commonly used because of the
possibility of a hypersensitivity
reaction to PPD
•
• Alkaline diuresis using isotonic saline,
sodium bicarbonate and diuretics is
used in the management of
myoglobinuria
• There is no specific antidote
available,
• However, dialysis is an effective
supportive measure in case of oliguric
or anuric AKI .
• Mortality rates vary between 0.03%
and 60%.
Management
Thank you
Nashwa mostafa

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Hair dye presentation

  • 2. What is hair dye? •Hair Dye or Hair Color: is a chemical tool that is used to change the color of a person's hair. • used mostly to change gray hair; a sign of an advanced age. • Younger people that used hair dye use it as a fashion
  • 3. About our Hair: •Human hair is made of keratin, water and dead cells •Each strand of hair is made up of three layers; Cuticle ,Cortex& Medulla
  • 4. •Cuticle is made up of scale-like, overlapping protein cells which protect the cortex •A healthy hair: when the cuticle lie flat around the hair shaft. •A damaged hair is when the cuticle of the hair is raised.
  • 5. •Natural black hair color is due to melanin clusters of dispersed within the colorless keratin-based cortex of hair.
  • 6. • French researchers have found that Egyptians, Greek and Romans were using to dye their hair several thousands years ago • Since the Greco-Roman period, organic hair dyes obtained from plants such as henna have been used, but other unusual formulas based on lead compounds which generated lead sulfide (PbS) nanocrystals with a diameter of only 5 nanometers . history of hair dye
  • 7. Pharaoh Ramesses II ,reddish-yellow colour of the mummy's hair had been brought about by its being dyed with a dilute henna solution;
  • 8. They found that the treated hair showed the presence of galena nanocrystals(under 5 nm). but these blackening PbS particles are much smaller than melanin clusters by 4-5 orders of magnitude in volume.
  • 9. • In 1907, Eugè ne Schueller, a young French chemist, developed an innovative hair-colour formula. He called his improved hair dye Auréole. Schueller formulated and manufactured his own products, which he then sold to Parisian hairdressers.
  • 10. Who wants to dye too?
  • 11. Types of Hair color most common classifications • Temporary • Semi-Permanent • Demi-Permanent: – Oxidative Deposit -Only • Permanent: – Non-Oxidative – Lift/Deposit – Oxidative
  • 12. 1.Temporary : • The pigment molecules are large and cannot penetrate the cuticle layer. Instead, the color particles remain adsorbed (closely adherent) to the hair shaft and are easily removed with a single shampooing Dye molecules Coating action(adsorbtion)
  • 13. 1.Temporary: • There is a physical action (coating) on the hair, not chemical action (penetrating). • Does not lighten or change the structure of the hair. • These are the least hazardous of all dyes. (food grade dyes ) • Spray-on temporary haircoloring that contain metallic salts can build-up and can cause adverse chemical reactions with future chemical services. • These dyes are flammable
  • 14. 2.Permanent hair colors: • are the most popular hair dye products • Permanent hair-coloring dyes consist of three components. They are: • Primary intermediates & Couplers(the color) • Oxidants (Hydrogen peroxide ) • An alkali usually ammonia
  • 15. • The primary intermediates form color on oxidation. • The modern permanent dyes consists of solutions of paraphenylenediamine (PPD), or similar “para” compounds. • Couplers will react with the oxidized products of the primary intermediates and form dyes which are then applied to hair. • Hydrogen peroxide is a major factor in permanent hair coloring techniques
  • 16. • Hydrogen peroxide diffuses the melanin, and lightens the natural color of hair Ammonia causes cuticle to swell and separate Both agents called the developer Dye molecules
  • 17. 2.Semi-Permanent Hair Colors Also known as: • Oxidation Tints • Penetrating Tints • Peroxide Tints • Synthetic Organic Tints • Para-dyes • “Tints”
  • 18. 2-Semi-permanent hair color: • Uses smaller molecules than temporary dyes, and is therefore able to partially penetrate the hair shaft. • the color survives repeated washing, 4-5 shampoos. •Semi-permanents contain no, or very low levels of developer, peroxide or ammonia.
  • 19. 2-Semi-permanent hair color: Chemicals of Concern : • use Aniline Derivative Tints from Para- Phenylediamines • Darker dyes have more phenylediamine Health Affects • – Skin, eye, respiratory sensitizer • – Severe allergies – e.g., facial and neck swelling • – Dermatitis – e.g., rashes • – Mutagenic when mixed with peroxide
  • 20. A.Semi-Permanent - Traditional Azo Colors • Derived from from benzidine, a known carcinogen. • Can revert back to benzidine in the body. • Azo Direct Black 38 and Direct Blue 6 are carcinogenic in their own right.
  • 21. Mechanism of hair dyeing: • Uses a medium size molecule. • causes a slight alkaline reaction to swell the hair shaft, causing the cuticle to rise. • This allows some color molecules to enter the cortex, and some to coat the cuticle. • A neutral or slightly acid after-rinse is used to stop the alkaline swelling reaction, allow the cuticle to close, and trapthe color molecules inside. • Less damaging than permanent dyes since it does not lighten. • Causes a mild chemical and physical change in the hair shaft.
  • 22. 2.A. Semi-Permanent - Traditional • Less damaging than permanent dyes since it does not lighten. • Causes a mild chemical and physical change in the hair shaft Dye molecules
  • 23. B. Semi-Permanent - Polymer • different chemical composition. • They combine many molecules to form a polymer. Polymers coat the hair shaft rather than penetrate. They do not change the melanin. • Heat is used to deepen the color penetration rather than the use of the chemical oxidation process
  • 24. 3.Demi-Permanent : (Oxidative Deposit-Only( • Process falls between the semi-permanent and permanent dye process. • Uses a catalyst such as a 10% mild peroxide developer with a non-ammonia alkali to swell the cuticle, allow dye molecules to penetrate into the cortex and deposit color inside the hair shaft. • A neutral or slightly acid after-rinse is used to stop the alkaline swelling reaction, allow the cuticle to close, and trapthe color molecules inside. • The mild chemical reaction does not lighten the melanin and hardly changes the hair structure.
  • 25. 3.Demi-Permanent: • Chemicals of Concern : Uses mostly aniline derivative dyes. • The alkali (high pH) used to swell the cuticle is from either monoethanolylamine (MEA) or amino methyl propanol (AMP). • MEA is a pH adjuster that can release nitrosamines which cause cancer in animals and can cause severe eye irritation in humans dye
  • 26. Demi-permanents : advantages over permanent color: • no lifting (removal) of natural hair color • the final color is more natural looking. • safer, especially for damaged hair, • wash out over time (typically 20 to 28 shampoos), so root regrowth is less noticeable , • if a change of color is desired, it is easier to achieve.
  • 27. 4.Permanent : Oxidative/Lift Deposit These hair colors have the smallest molecule which makes it easier for them to penetrate the hair shaft and the scalp. • This process has the greatest impact on the hair structure, which is permanently changed, and the cuticle remains slightly shifted • Formulas can have ranges of: – Phenylediamine .08% to 6% – Hydrogen Peroxide 3 – 10% 20 – 40% • Ammonia • Resorcinol
  • 28. Mechanism of hair dyeing “Oxidative/Lift Deposit” • An alkaline reaction(most often ammonia ) causes the cuticle to swell, allowing hydrogen peroxide and dye to enter. • The hydrogen peroxide “oxidizes” (diffuses) the melanin, and “lifts” (lightens) the color. • The hydrogen peroxide also causes the dye to “develop” and “deposit” color. • A neutral or slightly acid after-rinse stops the alkaline reaction, allows the cuticle to Close, and traps the color molecules inside
  • 30. • Permanent color is truly permanent and will not wash out, although it may fade. New hair regrowth will obviously be in the hair's natural color. . • Permanent hair color is the only way to dye dark hair into a lighter shade, and it must be done in two parts: First, the hair is lightened, then color is applied. Permanent?
  • 31. 5.Permanent: Non-Oxidative Vegetable Tints: • – Made from plant materials and henna • – Builds up layers in hair shaft Problems with Vegetable Tints: Henna – can trigger asthma and other allergic reactions
  • 32. Metallic Dyes: – Contain metallic salts from lead acetate, lead, copper, cobalt, silver nitrate – Not used professionally .toys ,furs Compound Dyes: – Mix of vegetative tints and metallic dyes – Not used professionally Problems with Metallic Dyes • Can cause headaches, scalp irritation, facial swelling, contact dermatitis, lead poisoning, and hair breakage, toxic,. • Bottles of metallic dyes can explode
  • 33. Hair dye poisoning • one of the important causes of accidental or intentional self harm in the developing world. • PPD is the most common constituent of hair dye formulations. PPD is commonly used in Africa, Middle East and Indian subcontinent while it is rarely used in the west,
  • 35. PPD • This derivative of aniline, aromatic amine, is a colourless solid when pure but are partially oxidized and appear yellowish. • Some misinformation has led to PPD being described as a black mineral from the bank of the River Nile. This gave PPD an undeserved distinction as being natural. )PPD crystals(
  • 37. • PPD is a precursor to aramid plastics and fibers such as Kevlar. • dyeing furs • Photochemical measurements • azo-dye manufacturing Kevlar (p-aramid fibre) dyeings uses
  • 38. • as a hair dye • mixed with ‘Henna’ to color palms of hands and soles of feet and to dye hair a dark red shade . • it was also used to kill wild animals when added to food .
  • 39. Toxicity of PPD • First case of PPD poisoning was reported in a hairdresser in 1924 following exposure due to PPD dye handling. • PPD is readily absorbed on dermal contact. Six children in a series of 31 Sudanese children with PPD poisoning were reported not to have ingested hair dye. An Arab lady developed acute life threatening pulmonary edema after she had painted one hand with a henna mixture. • PPD poisoning commonly by ingestion
  • 40. • PPD is metabolized by cytochrome P450 oxidase to form a reactive metabolite Bondrawski’s base ,a compound reported to cause anaphylaxis as well as being strongly mutagenic and highly toxic • Excreted by kidneys
  • 41. Clinical manifestations • PPD intoxication is a life threatening condition. • Clinical outcomes rely on early recognition, prompt referral, and aggressive supportive treatment in collaboration with different specialties. • The toxicity of PPD is a multisystem involvement. • The initial presentation may be confusing and most deaths occur within hours of admission. A typical case is illustrated by the following account:
  • 42. • six-year old child presented with sore throat, cough and anorexia followed by severe dyspnoea caused by edema of the tongue, pharynx and neck. He developed AKI and metabolic acidosis. The initial diagnosis was Ludwig’s angina. Despite initiation of vigorous supportive therapy, the child developed irreversible ventricular fibrillation and died eight hours after admission. It was discovered later that the child and his dog ingested a hair dye containing PPD, and the dog died few hours later
  • 43. • Another victim of PPD intoxication died of cardiac complications, which occurred 4 hours after admission despite intensive supportive measures • Clinical scenarios are variable and range from a local skin reaction to multisystem involvement • . It is very important to obtain a psychosocial history and evaluate the home environment as many cases were found to be precipitated by severe psychiatric disturbances
  • 44. Skin and eye manifestations • . Nowadays, it is well known that PPD cause skin irritation, kerato- conjunctivitis, conjunctival swelling and eczema of the eyelids. Allergic reactions causing dermatitis, urticaria and asthma have also been reported
  • 45. Respiratory system and upper airway manifestations • One of the most severe clinical manifestations and the main cause of death in PPD poisoning is upper airway obstruction (angio-edema) manifesting with a hard swollen protruding tongue and edematous bull neck. • required tracheostomy for upper airway obstruction
  • 46. Kidney manifestations • The cardinal features of myoglobinuria (dark-colored, chocolate-brown urine), • The extent of renal involvement varies between transient proteinuria and oliguric ARI. ARI commonly develops a few days after PPD exposure. • The kidney injury :due to the direct toxic effect of PPD, hypovolumia, hemolysis and rhabdomyolysis with the deposition of myoglobin casts within the renal tubules.
  • 47. Neuromuscular toxicity • Rhabdomyolysis, which in turn contributes to AKI and the increased likelihood of sudden cardiac death . • skeletal and cardiac muscle necrosis could be experimentally induced by PPD. Scattered coagulative necrosis of skeletal muscles was found in the autopsy of a PPD victim . •
  • 48. • Increased free radical formation in PPD poisoning may be responsible for the deleterious tissue damage observed in animal studies . • Flaccid paraplegia, palato- pharyngeal and laryngeal paralysis were also reported in adults and children . • Neurotoxicity causing mental alteration and coma was also observed and was possibly related to brain anoxia and severe metabolic acidosis associated with AKI
  • 49. Other manifestations • Tender palpable liver with features of acute hepatitis on liver biopsy was seen in many patients. • Cardiac toxicity causing arrhythmia, heart block and sudden death was also reported in some studies. • It is commonly the direct cause of death in children and adults with PPD poisoning. Cardiac toxicity is mainly caused by the direct toxic effect of PPD on the heart, rhabdomyolsis of the cardiac muscle causing severe damage and hyperkalemia
  • 50. Diagnosis: • The symptoms are considered to be dose related and patients with ingestion of larger amounts of PPD have higher morbidity and mortality. • Onset of symptoms after ingestion of the dye is about 4-6 hours. • The major early challenge to life is asphyxia and renal failure at later stages
  • 51. Diagnosis : • The characteristic triad of features encountered is early angioneurotic edema with stridor, rhabdomyolysis with chocolate colored urine and acute renal failure. When ever this combination occurs in poisoning, hair dye is a strong suspect.
  • 52. • Other reported features are leukocytosis, anaemia secondary to hemolysis, haemoglobinaemia and haemoglobinuria. • Toxic features include methemoglobinaemia, gastritis, hoarseness of voice, hepatitis, convulsions, coma . • Hypotensive shock • markedly elevated creatinine phosphokinase and lactate dehydrogenase, hyperkalemia, hyperphosphatemia and hypocalcemia
  • 53. Management Hair dye ingestion is a medical emergency. • Emergency measures should include gastric lavage. Patients should be monitored for respiratory distress and endotracheal intubation has to be performed early if laryngeal edema develops. • Metabolic acidosis has to be corrected. Early intervention with half normal saline and soda bicarbonate infusion has been shown to be beneficial in Rhabdomyolysis.
  • 54. Management • All modalities of dialysis: hemodialysis, peritoneal dialysis and continuous renal replacement therapy have been tried and have been found to be useful in acute renal failure. • Antihistamines and steroids are commonly used because of the possibility of a hypersensitivity reaction to PPD •
  • 55. • Alkaline diuresis using isotonic saline, sodium bicarbonate and diuretics is used in the management of myoglobinuria • There is no specific antidote available, • However, dialysis is an effective supportive measure in case of oliguric or anuric AKI . • Mortality rates vary between 0.03% and 60%. Management