Lichenoid Reaction To Colored Professional Tattoo Of Skin.

Abstract

The modern colorful permanent tattoos are usually performed by professional tattooist. Solid pigment/ink particles injected through the epidermis into deep dermis can cause multiple adverse reactions.We report the case of 46 years old women that was admitted to the plastic surgery outpatient clinic with ulcerative skin lesions on her right ankle's tattoo. According to her history, 2.5 years previously dual color tattoo (black bracelet with three red hearts in it) was performed in a professional tattoo clinic. On physical examination, the patient had a circular black tattoo pattern with 3 heart shape ulcerated skin lesions interposed in the tattoo on her ankle. Under local anesthesia the largest, central lesion was excised. Histology examination of the skin specimen revealed combined lichen planus reaction in the center of the lesion and peripheral granulomatous sarcoid type reaction. CASE REPORT We report a case of combined lechenoid and granuloumatous reaction developed in the red part of the 2.5 years old tattoo on the patient's right ankle. A 46-year-old woman admitted to plastic surgery outpatient clinic due to slow growing lesions on her right ankle tattoo. According to her history 2.5 years ago dual colored tattoo bracelet (black circumferential pattern with three red interposed hearts) was performed in a professional tattoo clinic. The lesions had been growing for 7 months. The dye used for the tattoo was “Millennium colorworks inc. Monthly red”. The main ingredients of the red pigment according to manufacturer annotation was CI#12475 (4-[[4(aminocarbonyl) phenyl]azo]-N-(2-ethoxyphenyl)-3hydroxy2-Naphthalene Carboxamide) combined with glycerin, water and alcohol. There were no signs of local inflammation of the surrounding skin or regional lymph node involvement. The patient is a heavy smoker, suffers from epilepsy, currently treated with Topiramate and Phenytoin. She does not have any known allergies. She has another two tattoos on her chest and abdomen (blue shark). She had an episode of deep vein thrombosis and pulmonary embolism in the past. The lesions on her ankles were previously treated by a dermatologist with local antihistamines and steroids injections for few months without any improvement. The local findings on her ankle were a black tattooed bracelet with 3 heart shaped, ulcerated skin lesions on red background of the tattoo, resembling Squamous cell carcinoma (figure 1). The biggest lesion measured 15 x 10 mm, restricted exclusively to the red part of the tattoo and was excised under local anesthesia by plastic surgeon preserving the main design of the tattoo. The wound had healed well with normal linear scar. Histological examination (hematoxylin eosin staining) revealed inflammatory response of the tattooed skin resembling hypertrophic lichen planus reaction in the center of the lesion and peripheral granulomatous reaction (sarcoid type). Lichenoid Reaction To Colored Professional Tattoo Of Skin. 2 of 3 Figure 1 Figure 1+2. Skin lesion resembling SCC on the red part of tattoo.