Hair-Dye-Related Accidental Poisoning and Death

Para phenylenediamine (PPD) is a common component of hair dye as well as temporary tattoos and is a well-known cause of type 4 hypersensitivity reactions from topical exposure. While there have been several cases reported in the literature describing toxicities following ingestion, there are a paucity of reports of severe systemic disease following topical exposure. Cases of PPD ingestion have been reported to present with angioedema-like reactions, often progressing to rhabdomyolysis and renal failure. To our knowledge, there have only been two reported cases of severe reactions following topical exposure to PPD. We present a case of a 59-year-old man with topical exposure to hair dye who presented with an angioedema-like reaction shortly after topical exposure to PPD containing hair dye that rapidly progressed to rhabdomyolysis, renal failure, and eventually death.