Paraphenylenediamine Poisoning: Clinical Spectrum, Analytical Determination, and Challenges in Postmortem Interpretation.

Paraphenylenediamine (PPD), the principal ingredient of oxidative hair dyes, is a growing cause of acute poisoning in developing nations. This paper provides a comprehensive overview of published case reports, observational studies of PPD poisoning, clinical manifestations, current management strategies, analytical methods for PPD detection, and offers key clinical and post-mortem toxicology considerations. A literature search related to PPD poisoning was conducted from 1991 to 2025 across PubMed, Scopus, Web of Science, and Google Scholar. Publications encompassing 6,843 individual cases were reviewed, and data on demographics, dose, route, clinical features, laboratory parameters, treatment modalities, outcomes, and analytical approaches were analyzed. Angioedema, rhabdomyolysis, and acute renal failure form a characteristic clinical triad that is almost universal in moderate-to-severe cases, with mortality rates ranging up to 55.5% in hospital cases. Cardiac and hepatic injury are also common. PPD has no specific antidote, and treatment is completely supportive. Analytical methods ranging from colorimetric screening to confirmatory tandem mass spectrometry for PPD detection in biological and non-biological matrices are discussed. This review strongly suggests that PPD poisoning represents a significant public health concern in the developing world. Young women with low socioeconomic and rural backgrounds predominantly ingested PPD with suicidal intent. The highest fatality rates were observed in cases where treatment was delayed due to late diagnosis, primarily because no point-of-care test is currently available for the rapid detection of PPD. The combination of lethality, availability, and accessibility makes PPD an ideal agent for suicidal poisoning in populations with high rates of impulsive suicidal behavior. Early diagnosis can improve survival rates in PPD poisoning cases.