Authors: Beatrice Maxine A. Chan, MD, Melanie Joy Doria-Ruiz, MD, FPDS, Elizabeth Amelia V. Tianco, MD, FPDS


Tattooing has been practiced through the centuries as a form of artistic expression and cosmetic application. Currently, the tattoo industry is one of the most rapidly growing industries. However, it remains unregulated hence, the incidence of tattoo reactions is likewise expected to continue to rise. Reactions can be attributed to untrained tattoo artists, contaminated inks, and unhygienic practices. Direct causal relationship is hard to prove as a multitude of factors are often present simultaneously. Infections have always been the primary concern of the public. However, there are also other tattoo-induced reactions such as eczematous, granulomatous, lichenoid, or pseudolymphomatous reactions, which the public needs to be aware of.


Presented herewith is a case of 39-year-old male who developed a solitary 5 cm sun-shaped and three 1 cm star-shaped hyperkeratotic grayish red plaques superimposed on tattoo site of the right forearm, two months after his fourth tattoo procedure. He also had tattoo done on his left and right forearms depicting his name in cursive form in black and red ink last June 2013 and August 2013. His third tattoo depicting a horseshoe in black ink was done on his left shoulder last February 2015. These other tattoo sites of the patient were not noted to have developed similar lesions. Patient was asymptomatic with no history of fever, weight loss, or night sweats. Full clinical examination as well as laboratory and imaging tests were normal.  Histopathologic examinations were consistent with pseudolymphoma.  Most cases present with plum red indurated plaques or nodules often within red portions of tattoo. Diagnosis is made on a histological basis. It should be noted that some cases may show progression of pseudolymphoma to lymphoma.  Close follow up for changes and progression of lesions, repeat biopsy of new growths, and excision is recommended for these cases. Alternative treatment options are intralesional corticosteroid injection, laser treatment, or cryotherapy. Prevention of re-exposure to inciting agent is a key step to prevent recurrence of said condition.





cutaneous pseudolymphoma, tattoo, red ink

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