Super Vasmol [paraphenylenediamine], a cheap, freely-available, hair dye in rural areas is emerging as a major cause of suicidal poisoning in India [1]. However, it is rare in children. It causes serious multisystem toxicity with significant morbidity and mortality in children and clinical manifestations and outcome are similar to those in adults [2]. The predominant clinical manifestations is early onset (usually within six hours) severe cervico-facial edema and asphyxia often requiring an emergency tracheostomy. Later (within days or weeks); dark urine, oliguria, renal failure and rhabdomyolysis occurs [1]. Out of 150 adults, angioneurotic edema was encountered in all patients and 60% had ARF [3]. In a study from Egypt, cervicofacial and laryngeal edema was the dominating feature in 72% of adults [4]. Out of 1020 adults, typical cervicofacial edema was present in 73% and brown color urine in 52.82%, and mortality was 23.92% [5]. Out of 17 Sudanese children, 76.4% had attempted suicide and clinical manifestations are dominated by cervical and upper respiratory tract edema, rhabdomyolysis and acute renal failure. Out of them, 47% required tracheostomy for severe angioneurotic edema and 71% developed ARF [2]. Death is usually caused by angioneurotic edema or cardiac involvement and is dose- dependent [1,4]. Poor prognostic factors are late presentation, no gastric lavage, requiring intubation, and ventilation or dialysis [1]. The classical presentation that has been described of cervicofacial edema was evident in our child. Our child was brought to emergency in time within one hour and underwent gastric lavage, the most important intervention. Cases usually survive if they present to hospital within 4 hour of dye ingestion [5]. There is no specific diagnostic test or antidote for paraphenylene diamine poisoning.

1. Chrispal A, Begum A, Ramya I, Zachariah A. Hair dye poisoning an emerging problem in the tropics: an experience from a tertiary care hospital in South India. Trop Doc. 2010;40: 100-3.

2. Abdelraheem MB, El-Tigani MA, Hassan EG, Ali MA, Mohamed IA, Nazik AE. Acute renal failure owing to paraphenylene diamine hair dye poisoning in Sudanese children. Ann Trop Paediatr. 2009;29:191-6.

3. Suliman SM, Fadlalla M, Nasr ME, et al. Poisoning with hair-dye containing paraphenylene diamine: ten years experience. Saudi J Kidney Dis Transpl. 1995;6:286-9.

4. Shalaby SA, Elmasry MK, Abd-Elrahman AE, Abd-Elkarim MA, Abd-Elhaleem ZA. Clinical profile of acute paraphenylenediamine intoxication in Egypt.Toxicol Ind Health. 2010;26:81-7.