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Review Article CODEN: IJPRNK ISSN: 2277-8713 R. Shankar, IJPRBS, 2015; Volume 4(3): 409-414 IJPRBS

Available Online at www.ijprbs.com 409

HAIR DYE (SUPER VASMAL – 33) POISONING – A CASE REPORT

DR. K. TAMILMANI1, DR. R. SHANKAR2

1. Assistant Professor of Forensic Medicine, Thanjavur Medical college, Thanjavur, Tamilnadu.

2. Associate Professor, Department of Forensic Medicine, Kurnool Medical College, Kurnool, Andhra Pradesh.

Accepted Date: 23/06/2015; Published Date: 27/06/2015

Abstract: Hair dye poisoning has been emerging one of the important cause of intentional self harm in the developing world, which is vastly available in the domestic market as Hair Dye[pic.1]. It has potent chemical substance like Paraphenylene diamine (PPD)[pic.2&3], Propylene glycol, resorcinol and other chemical which can cause sensitization/ rash , Angioneurotic edema, severe metabolic Acidosis Rhabdomyolysis & Acute renal failure

Keywords: Hair dye, Angioneurotic edema, Paraphenylene Diamine, Acute renal failure

INTERNATIONAL JOURNAL OF

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Corresponding Author: DR. R. SHANKAR

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R. Shankar, IJPRBS, 2015; Volume 4(3): 409-414



INTRODUCTION

More than one lakh lives lost every year due to suicide in India. The suicide rate in India is

10.3% in the last three decades the suicide rate has increased by 43%. In India pesticides

poisoning is one of the leading causes of death and which preventable tragedy . Recently hair

dye poisoning is emerging as an important etiological factor. This reveals the Forensic

importance of hair dye poisoning.

CASE REPORT:

A 21yr old Female came with the casualty with history of alleged ingestion of hair dye (super

vasmol 33). She preserved with conscious state, difficult to breathing and complained of throat

pain.

There was no addiction of any substances & no other co morbid condition. On general

examination patient was conscious, oriented, a febrile BP:120/70 mm hg, PR:90/min,

RR:16/min along with absence of pallor, ictirus, edema, clubbing, cardio vascular system , heart

sounds were heard, respiratory system bilateral air entry present, abdomen soft after 12hrs she

developed difficult to breathing then emergency Tracheostomy was done. Also noted coloured

urine and tachycardia then she has been treated with steroids, diuretics and antibiotics, soda

bicarbonate in spite of medial efforts she died.

Pic. 1& 2 : of the deceased and therapeutic tracheostomy.

AUTOPSY FINDINGS:

Moderately nourished body of a female shows finger and toe nails are blue.

Tracheostomy [Pic.1] wound in the front of neck. No external injury. On dissection, Laryngeal

edema [Pic. 3 & 4] is present. Heart normal, coronary vessels patent, Hyoid bone intact,

Stomach contains 50ml of dark brown colour fluid, no specific smell and mucosa congested [Pic.



5]. Small intestine contains 30ml of dark colour fluid with no specific smell and mucosa is

congested, Bladder contains 10ml of urine. Uterus is normal and is empty.

Pic. 3 & 4: showing laryngeal edema.

Pic. 5: Gastric mucosal congestion & hemorrhages.

Viscera report:

Reveals presence of PARAPHENYLENE DIAMINE.

DISCUSSION:

Hair dyes were used by Egyptians as early as 5000yrs B.C. Major Categories of colorings agent.

1) Temporary (Acid dyes). (Water soluble dyes with stored for one time shampooing).

2) Semi permanent (direct dyes).

3) Gradual colorants (Anti oxidant and Metallic dyes).

4) Natural dyes (Henna).

5) Demi permanent.



6) Permanent (Oxidation dyes) (Progressive hair dyes).

The performed dyes is 2 – nitro – P – Phenyl Diamine ( R’=CH2 CH2OH R2=R3=R4) and the

intermediate form is P – Phenyl Diamine the final chemical component is Para Phenylene

Diamine (PPD) which is oxidation product of BRANDROWSKIS base. The hair dye (Super vasmol

– 33) contain Para Phenylene Diamine, propylene glycol, resorcinol, M- Aminophenol, alpha

napthol, 5 amino ‘o’ cresol, 2 Hydroxyl ethylamine phenol etc. The Para Phenylene Diamine is

allergic [Pic. 8 & 9], mutagenic, lightly toxic characteristic features severe angioneurotic edema,

rhabdomyolysis release of calcium , iron from smooth endoplasmic reticulation followed by

cutaneous contraction, irreversible changes in muscle structure , Hypovolemia due to direct

effort of PPD or its metabolites on the Kidney. Respiratory failure due to secondary to

inflammatory edema of cricopharynx and larynx, acute renal failure due to direct effect on

kidneys leading to Acute Renal Tubular Necrosis [pic 6 & 7] and rhabdomyolysis changes. PPD

directly act over the heart & leads myocarditis which produce arrhythmia and death.

Pic. 6 & 7: Histo Pathology of Acute Renal Tubular Necrosis

Propylene glycol:

It produce renal damage, hyper osmolarity, anion gap metabolic acidosis, CNS depression,

arrhythmia, acute tubular necrosis and proximal renal tubular swelling. Resorcinol produce

renal toxicity.

CLINICAL FEATURES:

Cervicofacial edema (79%), chocolate brown colored urine (74%), upper airway tract edema,

(79%) oliguria (36.8%), muscular edema (26.3%), shock (26.3%), rhabdomyolysis, metabolic

acidosis, acute renal failure (47.3%) and hyperkalemia (26.3%). In study of 374 case analysis,

rhabdomyolysis and acute renal failure were main causes of mortality (21%).



Pic. 8 & 9: showing contact dermatitis with PPD dyes.

TREATMENT:

Hair dye poison is medical emergency, symptomatic treatment like gastric lavage,

corticosteroids, endotracheal intubation, soda bicarbonate, haemodialysis and peritoneal

dialysis are modality of treatment.

CONCLUSION:

Hair dye ingestion is uncommon cause of attempted suicide in Tirunelveli District and hair dye is

available in several forms and commonest and cheap form is supervasmal 33 in 20gm packs

which produce characteristic triad of strider due to upper airway edema, rhabdomyolysis and

acute renal failure. Early clinical diagnosis and interventions is the cornerstone of management.

In autopsy room to look for laryngeal edema, stomach contents and its colour, and mucosal and

other organ congestion, chemical analysis report. Awareness about hair dye poisoning is helpful

to reduce and prevent to attempt suicide.

Consumption of Super Vasmol 33 endangers the life of individual as it contains paraphenylene

diamine. Hence it can be categorized in THE DRUGS AND COSMETIC RULES: 1945 under

Schedule H Drugs .

CONFLICT OF INTEREST: NIL.

REFERENCES:

1. Poucher’s – perfumes cosmetics and soaps 10th edition – Kuluwer academic publishers.

(Page 307 – 324).

2. Encyclopedia – clinical toxicology, a comprehensive guide and reference by Irving S.Rossoff.

(Page – 843).



3. Medical toxicology, diagnosis and treatment of human poisoning by Mathew J.Ellenborn

Donald. G Barceloux. (Page 906 – 908 & 1512).

4. Ellenborn’s Medical toxicology Diagnosis and treatment of human poisoning Mattew

J.Ellenborn – 2nd edition (Page 1121 & 1811)

5. J.E.Merj Trama shock 2009 May – Aug 2(2) 129 – 131.

6. Boldoc C.Shapiro J.Hair case products waving straithaining condition and colorings clinical

Dermatology 2001, 19: 431 – 6 (Pub med).

7. Bensalama A.moutaouakvil, S.Majahed, E1Mohknia, M.Lahbil D, Fadel H syndrome

intermediate hair dye poison and introduction algue paule 1998 27, 7, 13 – 5 (Pub med).

8. Ram R.Swarnalatha G.Prasad N.Dhashinamoorthy, K.V.Paraphenylene diamine ingestion.

Uncommon cause of acute renal failure J.Post grad Med 2007 :181.2(Pubmed).

9. Sampath kumar, K.Sooraj, YS. Mahaldar Ar. Ajeshkumar Rs. Muthiah R.Hair dye poisoning, An

emerging threat Indian J.Crit case Med 2007 11: 212 – 214.

10. P.K.Jain, Navneet Agrwal, Aroadhesh Kr.sharma and Asif Akfat prospective study of

ingestional hair dye poisoning in northern India (prohina) J.Clinical Medicine & Research Vol

3(1) PD – 9 – 19 Jan – 2011.

11. Vijaya kumar L.Indian research on suicide Indians J.Psychiatry 2012 Feb 24 52:291 – 6.

12. Reddy K.S.N, The Essentials of Forensic Medicine and Toxicology, 23rd Edition, The Health

Sciences Publishers, New Delhi , 2014 . 499.

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