Emerging Trend of Self Harm by Using ‘Kala Pathar’ Hair Dye (Paraphenylene diamine): An Epidemiological Study

Abstract

Background: Poisoning due to Hair dye containing Paraphenylene diamine, famous with local name of ‘Kala Pathar’ is an emerging way of self harm in developing coun­tries. The substance produces toxic effects if ingested or when applied locally including angioedema, respiratory distress, rhabdomyolysis, acute renal failure and hepatic necrosis.        Objective: To study the demographic profile, clinical manifestations & outcome of the victims of ‘Kala Pathar’ hair dye (PPD) poisoning. Study Design, Setting & Duration: Prospective study was carried out in Bahawal Victoria Hospital, Bahawalpur (a tertiary care health institution) for the period from 1^st January 2016 to 10^th March 2016.         Methodology: The study conducted in 109 patients of Paraphenylene diamine poisoning admitted in B.V. Hospital Bahawalpur, through Accident & Emergency Department with history of ingestion of Kala Pathar hair dye. The patients were treated conservatively & tracheostomy was done as life saving measure in all cases having acute cervicofacial and laryngeal oedema. The patients were grouped according to the age, gender, clinical presentation and final outcome. The data cleaned, analyzed and results were expressed in tables & charts. Results: Out of the total109 patients, 12(11%) were male & 97(89%) females.  Majority 91 (83.48%) victim belonged to the age range of 11-30 years involving 83(76.15%) females and 26(23.85%) males.  One hundred & four (95.41%) patients were of lower socioeconomic class and rural dwellers. Suicidal intention was reported in all 109 (100%) cases who developed cervicofacial oedema associated with dysponea & strider and emergency tracheostomy was done in all those victims. Eighty Six(78.90%) patients were discharged in good condition and 23(21.10%) expired due to complications of Paraphenylene diamine poisoning.            Of those 23 fatalities, 19(82.60%) were females & 4(17.40%) males. Conclusion: ‘Kala Pathar’ Paraphenylene diamine poisoning is more common in females of younger age group belonging to rural areas & associated with high mortality. The cases could be managed by early diagnosis and prompt actions for supportive treatment because no specific antidote is available. As burden of such cases has been increasing, there is dire need for bringing awareness among the public regarding the toxic effects of hair dye (PPD). It is suggested that sale of ‘Kala Pathar’ should be legally restricted by the concerned authorities.