GRANULOMATOUS REACTION TO RED PIGMENT, AFTER PERMANENT DECORATIVE TATTOO – CLINICAL CASE

Abstract

Tattoos have been used for over 2000 years. Nowadays, the frequency of tattoos has been growing, especially among young people. In many countries, more than 25% of the population has a tattoo. Lately, the medical world is trying to increase the awareness concerning tattoos and the multiple risks they carry, like allergic reactions, lichenoid reactions, sarcoidosis, scleroderma-like reactions, viral, bacterial and fungal infections, benign tumors, pseudolymphomas, chronic lymphoid hyperplasia. Rarely, malignant tumor can develop on the tattoo surface. Clinical case: A 25 year old male has been admitted in our clinic presenting infiltrative, erythematous, scaly plaques, with yellow crusts on the surface, placed on the left arm and right leg, on the surface of two tattoos, only on the areas with red pigment. The patient had these symptoms for over one year. The tattoos were made two years before coming to the hospital. The cutaneous lesions were surgically removed and a histopathological exam was performed, revealing chronic granulomatous inflammatory infiltrate, with giant cells and eosinophilic necrosis areas. Discussions: In order to make a tattoo, body artists use multiple pigments, by themselves or in different combinations. The red pigment used in tattoos can be organic (santal wood, Caesalpinia echinata – both vegetal dyes) or inorganic (cadmium, mercury, selenium, sienna, the last one is an iron hydrate). There are several cutaneous reactions to the pigments found in tattoos: inflammatory reactions, allergic reactions, granulomatous reactions, lichenoid reactions and pseudolymphomatous reactions. Conclusions: 1) The granulomatous reaction is a complication that occurs frequently after red pigment tattoos; and 2) The patients need to be thoroughly investigated in order to rule out a foreign body reaction, sarcoidosis, an infectious disease (tuberculosis, mycobacteria infections, leprosy, leishmaniasis, and fungal infections), granuloma annulare, and iatrogenic granulomatous disease after the use of ribavirin, interferon, anti-TNF alfa medication, ipilimumab. Key words: permanent tattoo, post-tattoo granulomatous reaction, red pigment. Cite this article : Virgil Patrascu, Bianca Adela Cismaru-Iancu, Raluca Niculina Ciurea. Granulomatous reaction to red pigment, after permanent decorative tattoo – clinical case. RoJCED 2017;4(4): 218-223. https://doi.org/10.26574/rojced.2017.4.4.218