EXPOSURE TO PARAPHENYLENEDIAMINE (PPD) IN PREGNANCY

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(Date of issue: August 2013, Version: 1)

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

Summary

Paraphenylenediamine (PPD) is an aniline derivative used in the textile and photographic industries.  PPD is also commonly used as an ingredient in semi-permanent and permanent hair dyes.  PPD may be added to black henna to produce a longer lasting deeper pigment in temporary tattoos. 

PPD is a contact allergen, and in sensitised individuals hypersensitivity reactions may occur following exposure.  Hypersensitivity reactions can be unpredictable and although rare, may occur following contact with a PPD-containing product used previously without adverse reaction.  The available data regarding PPD use in human pregnancy are limited to only a few case reports of acute PPD poisoning via ingestion, and therefore not suitable to assess the risks of congenital malformations or fetal loss following maternal exposure to PPD. 

Although use of PPD-containing products by pregnant women is likely to occur relatively commonly, there are no published studies of pregnancy outcome following maternal ingestion or topical contact with PPD, in the absence of poisoning, and it is therefore unknown whether exposure in this context poses any risk to the fetus. 
 
No published data assessing the risk of low birth weight, preterm delivery, neurodevelopmental effects or carcinogenicity following in utero exposure to PPD were located.

As with all chemicals, exposure should be avoided during pregnancy.  Where occupational exposure is unavoidable, precautions should be taken to ensure that exposure is well within the recommended exposure limits and not associated with toxic symptoms.  In cases of acute exposure, maternal toxicity is likely to be the major determinant of fetal toxicity.  Treatment should be as for the non-pregnant patient.  For current guidelines regarding treatment of PPD toxicity please refer to TOXBASE®.

There are insufficient data to provide evidenced-based advice on whether exposure to PPD in pregnancy warrants additional fetal monitoring, and a case-by case assessment of fetal risk is advised.  Other factors may also be present which independently increase the risk of adverse pregnancy outcome.  Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.  Discussion with UKTIS is recommended. 

Note: This document has been archived and will not be routinely updated. If up-to-date information is required please contact UKTIS.

This document is regularly reviewed and updated. Only use full UKTIS monographs downloaded directly from TOXBASE.org to be sure you are using the most up-to-date version. The summaries of these monographs are openly available on UKTIS.org.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to health care professionals at www.toxbase.org.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to ensure you are using the most up-to-date version.