What hematologic toxicity may result from the use of henna?
A recent case describes profound hemolysis in an elderly gentleman who had been prescribed henna powder dissolved in water for a GI ailment. Subsequent testing after recovery demonstrated normal G6PD activity.
Naturally occurring henna products come from Lawsonia inermis, the henna tree. The active component is lawsone (2-hydroxy-1,4-napthoquinone). Traditional uses have included dying skin and hair, as well as other materials. Previous cases have described hemolysis in G6PD deficient individuals, even following topical use.
Para-phenylenediamine, a coal tar derivative, is a potent hemolytic agent and allergen that has been substituted for, or added to henna, as it more rapidly dyes skin. PPD is a potent sensitizing agent and, as an amine, an oxidizing agent in its own right. In the cited case report there was no confirmatory testing for either lawsone or to rule out adulteration with PPD.
Asgari S, Esfandbod M, Haghshomar M. Henna-induced Hemolysis and Acute Kidney Injury in an 85-year-old Man; a Case Report. Arch Acad Emerg Med. 2020 Oct 14;8(1):e82. PMID: 33244517; PMCID: PMC7682624.
Submitted by: Michael Hodgman MD on behalf of the Herbal and Dietary Supplement Section