Possible Nephrotoxicity After Topical Application Of A Natural Herb, Henna

Dear Editor, Herbal products are commonly used with the conception that they are natural and safe to use; however, there are several reports on their side effects including nephrotoxicity. Henna (Lawsonia inermis Linn) is used frequently as a hair dye in some countries including Iran. There are some reported cases of toxicity after the use of henna. Henna-induced toxicity is particularly attributed to paraphenylenediamine (PPD), an alanine derivative, which is added as a strong oxidizer and dying accelerator to henna powder. Paraphenylenediamineinduced systemic toxicities manifest as severe edema of the face, neck, tongue, pharynx, and larynx, which can be followed by anaphylaxis, intravascular hemolysis, rhabdomyolysis, and acute kidney injury (AKI). Paraphenylenediamine toxicities are reported usually after its ingestion; however, there are some cases of systemic toxicity after its local application as hair dye. We report a case of a woman who presented with nausea, vomiting, face edema, and rise in serum creatinine, possibly after application of henna to her hair.