Granulomatous Tattoo Reaction: A Case Report

Resident Dermatology

Department of Dermatology, DVVPFs Medical College & Hospital, Ahmednagar

Assistant Professor

Department of Surgery, DVVPFs Medical College & Hospital, Ahmednagar

Resident Dermatology

Department of Dermatology, DVVPFs Medical College & Hospital, Ahmednagar

Resident Dermatology

Department of Dermatology, DVVPFs Medical College & Hospital, Ahmednagar

Abstract

Professor & Head

Department of Dermatology, DVVPFs Medical College & Hospital, Ahmednagar

Tattooing is a popular activity, secondary to growing interest of young generation for recent fashion trends, but recently it is also associated with increased cases of tattoo reactions too due to lack of awareness in general population and no strict supervision to prevent them in India. The most frequent skin reactions to tattoos are an acute inflammatory reaction, superficial to systemic infections, allergic contact dermatitis etc. We report a case, 21-year-old male presented with heart shaped firm well demarcated keratotic plaque, which was developed over heart shaped tattoo area made with red ink. Histopathology confirmed the diagnosis of granulomatous tattoo reaction.

Keywords

Tattoo, Tattoo pigment, Tattoo granuloma

Introduction

Tattooing is an age old procedure that includes injecting the desired colour of ink pigment into the dermis. Most societies around the world have it, and it is getting more and more prevalent in developing nations. In addition, it is spreading more quickly among Indian rural youth because of their growing interest for new fashion trends.

The Tahitian word "tattau," which meaning "to mark something," is the source of the English word tattoo.[1] Tattoos can be broadly categorised as either permanent (which lasts a lifetime) or temporary (which lasts for a few weeks). There are three different types of permanent tattooing: traumatic, cosmetic (decorative tattoos and permanent makeup), and medical/therapeutic.

[1] In dermatology, vitiligo is mostly treated by therapeutic tattooing. Young people enjoy getting cosmetic tattoos, which are mostly worn as decorative art. In India there are no laws governing these facilities, and the sterility of the procedures performed is in doubt. As a result, there are more unpleasant effects following tattooing. The most frequent skin reaction is a transient acute inflammatory reaction at the tattoo location, which manifests quickly and lasts a few days. Other reactions include systemic infections, allergic reactions, superficial and deep local infections, and skin conditions that are localised to the tattooed region, such as eczema, psoriasis, lichen planus and morphea.[1, 2]

Case Report

A 21-year-old male patient made a permanent tattoo of his name with green colored ink and a heart with red colored ink over left forearm. (Figure

1) After 4-months of tattoo he started itching and pain over red colored heart tattoo and gradually developed elevated lesion. (Figure 2) On local examination, single 2 × 2 cm heart shaped firm well demarcated keratotic plaque over heart shaped tattoo area which was made with red ink while remainder tattoo made with green ink was unaffected. On palpation, it was indurated, non-tender and did not exude any fluid. All routine blood investigations including HbsAg, HCV and HIV were unremarkable. Then performed an excisional biopsy of lesion for histopathological examination by keeping tattoo granuloma as provisional diagnosis. Histopathology confirmed the clinical diagnosis of Granulomatous tattoo reaction, with following findings such as foci of palisading granulomas showing central necrobiosis and peripheral granulomatous infiltrate consisting of lymphocytes, histiocytes and foreign body giant cells. Granular tattoo material is seen interspersed within the granulomatous infiltrates. (Figure 3) On follow up after 3 weeks of surgical excision the excised area shows cosmetically acceptable outcome. (Figure 4)