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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 21  |  Issue : 4  |  Page : 335-336

Lichenoid reaction to red-inked tattoo – A known but forgotten problem


1 Department of Dermatology, Venereology and Leprosy, Dr. Ram Manohar Lohia Hospital and Postgraduate Institute of Medical Education and Research, New Delhi, India
2 Department of Pediatrics, Dr. Ram Manohar Lohia Hospital and Postgraduate Institute of Medical Education and Research, New Delhi, India
3 Department of Pathology, Dr. Ram Manohar Lohia Hospital and Postgraduate Institute of Medical Education and Research, New Delhi, India

Date of Submission12-Oct-2018
Date of Decision26-Nov-2018
Date of Acceptance26-Apr-2020
Date of Web Publication30-Sep-2020

Correspondence Address:
Dr. Niharika Dixit
Department of Dermatology, Venereology and Leprosy, Dr. Ram Manohar Lohia Hospital and Postgraduate Institute of Medical Education and Research, Baba Kharak Singh Marg, New Delhi - 110 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_136_18

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  Abstract 


Permanent tattooing has become a huge fascination among youngsters, and with increasing popularity, a wide variety of adverse reactions have been encountered. Herein, we report a case of lichenoid reaction localized to red-inked tattoo.

Keywords: Adolescent, black, lichenoid, reactions, red, tattoo


How to cite this article:
Dixit N, Sarswat S, Paliwal P. Lichenoid reaction to red-inked tattoo – A known but forgotten problem. Indian J Paediatr Dermatol 2020;21:335-6

How to cite this URL:
Dixit N, Sarswat S, Paliwal P. Lichenoid reaction to red-inked tattoo – A known but forgotten problem. Indian J Paediatr Dermatol [serial online] 2020 [cited 2020 Oct 22];21:335-6. Available from: https://www.ijpd.in/text.asp?2020/21/4/335/296848




  Introduction Top


Tattooing can result in a variety of rare complications, but their increasing incidence seems to follow the increasing popularity of tattooing, especially in young adults. Infectious diseases are clearly related to the tattooing procedure and may be avoided by education and training of tattoo professionals. However, complications related to hypersensitivity to ink components are often less predictable. Lichenoid reaction localized to red tattoo is the most common reaction. We describe a case of lichenoid eruption restricted to the red part of tattoo in a young male.


  Case Report Top


A 14-year-old male presented with complaints of itchy red raised lesions over a tattoo on the left side of his neck. The tattoo was injected 4 weeks back. The patient had no history of any tattoos injected in the past. On examination, shiny erythematous papules, nodules, and plaques with superficial scaling were seen limited to areas where the red ink was originally present. The red ink was completely masked by the lesions, whereas the black ink was unaffected [Figure 1]. Histopathological examination showed a dense band-like lichenoid infiltrate at the dermoepidermal junction with basal layer vacuolization [Figure 2].
Figure 1: Erythematous papulonodular lesions over red tattoo sparing black-inked areas

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Figure 2: Dense band-like lichenoid infiltrate at the dermoepidermal junction with basal layer vacuolization (H and E, ×200)

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  Discussion Top


Decorative permanent tattooing involves the introduction of exogenous pigments and/or dyes into the dermis to produce a permanent design.[1] It has been practiced for thousands of years for esthetic, religious, social, and cultural purposes. While tattooing is antediluvian, tattoo-associated cutaneous complications have only been reported since the last few decades. Reactions to tattoos were first described by Welander in 1893.[2] The introduction of a foreign substance into the skin can promote a toxic or an immunological response. Various histopathologic types of reactions have been described, including lichenoid, photoallergic, granulomatous, pseudolymphomatous, and sarcoidal.[3] Of these types, the lichenoid tissue reaction is the most commonly reported. These reactions are more common with red ink.[4] Inciting agents are mercuric sulfide, also known as “cinnabar,” which used to be the main causative agent in the days of yore and has been substituted by sienna red ocher (ferric hydrate), cadmium red (cadmium selenide), nickel, and organic vegetable dyes (sandalwood and brazilwood).[5],[6] Pathogenic mechanisms implicated in reactions to tattoo pigments include a localized, T-cell-mediated, delayed hypersensitivity response (lichenoid and sarcoidal reaction) and Type 1 and 3 hypersensitivity in allergic reactions.[7] Lichenoid reaction is usually localized to the tattoo area but can be generalized also.[8] Patch testing and intradermal tests can be done to determine the causative agent. Treatment includes topical steroids, steroid injections, topical tacrolimus, surgical removal (in case of small tattoos), and removal of tattoo using neodymium-doped yttrium aluminum garnet (YAG) laser, CO2, or erbium-YAG laser (risk of inducing generalized reactions), but management of the reactions is usually challenging as the treatment options are only suppressive, and as long as the culprit pigment remains in the dermis, the problem persists.[1],[8]

Tattooing is a fashion, but it can have many side effects. We should make efforts to educate adolescents and young adults about all the possible reactions which are associated with tattooing.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kluger N. Cutaneous complications related to permanent decorative tattooing. Expert Rev Clin Immunol 2010;6:363-71.  Back to cited text no. 1
    
2.
Welander E. Falle von Keloid. Nord Med Arkiv (Stockh) 1893;3:1.  Back to cited text no. 2
    
3.
Ortiz AE, Alster TS. Rising concern over cosmetic tattoos. Dermatol Surg 2012;38:424-9.  Back to cited text no. 3
    
4.
Taaffe A, Knight AG, Marks R. Lichenoid tattoo hypersensitivity. Br Med J 1978;1:616-8.  Back to cited text no. 4
    
5.
Yazdian-Tehrani H, Shibu MM, Carver NC. Reaction in a red tattoo in the absence of mercury. Br J Plast Surg 2001;54:555-6.  Back to cited text no. 5
    
6.
Corazza M, Zampino MR, Montanari A, Pagnoni A, Virgili A. Lichenoid reaction from a permanent red tattoo: Has nickel a possible aetiologic role? Contact Dermatitis 2002;46:114-5.  Back to cited text no. 6
    
7.
Aberer W, Snauwaert JE, Render UM. Allergic reaction to pigments and metals. In: De Cuyper C, editor. Dermatologic Complications with Body Art: Tattoos, Piercings and Permanent Makeup. 1st ed.. Belgium: Springer link; 2010. p. 66-73.  Back to cited text no. 7
    
8.
Litak J, Ke MS, Gutierrez MA, Soriano T, Lask GP. Generalized lichenoid reaction from tattoo. Dermatol Surg 2007;33:736-40.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2]



 

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