Tattoo artists use many compounds to create tattoo pigment and several allergic reactions can occur as a result of these additives. The compositions of many inks have been identified; however, as new mixtures are created it becomes difficult to identify the specific ingredients in a particular ink. Allergic reactions to a particular pigment can manifest in several ways including allergic contact dermatitis and photoallergic dermatitis. Subsequently, tattoo ink or pigment allergy reactions can be classified as acute inflammatory reactions, allergic hypersensitivities, and granulomatous, lichenoid, and pseudolymphomatous types of reactions. This paper will review the clinical manifestations and the most common compounds associated with cutaneous reactions to tattoo ink.

It is widely accepted that Q-switched lasers are the gold-standard treatment for the resolution of unwanted tattoo ink. Although much safer than other tattoo removal modalities, the treatment of tattoo ink with Q-switched devices may be associated with long-term adverse effects including undesired pigmentary alterations such as tattoo ink darkening. Darkening of tattoo ink is most often reported in cosmetic, flesh-toned, white, peach, and pink tattoos. In this paper, we briefly review a case of pink tattoo ink that initially darkened paradoxically but eventually resolved with continued Q-switched laser treatments.

Calciphylaxis is a rare disorder characterized by microcalcification of small- and medium-sized blood vessels causing cutaneous and soft tissue necrosis. Patients usually present with painful, violaceous skin discoloration in a livedo reticularis pattern. We present a case of a 59-year-old woman with end-stage renal disease (ESRD) who manifested signs and symptoms of inflammatory breast cancer. The patient underwent an open biopsy and subsequent mastectomy, with final pathology results of calciphylaxis. Due to recurrent hyperparathyroidism, she underwent a re-parathyroidectomy with reimplantation. To our knowledge, this is the first reported case of calciphylaxis recurrence after subtotal parathyroidectomy. We propose that those patients with ESRD who develop breast pathology consistent with inflammation and necrosis, and have no malignancy, be evaluated for secondary hyperparathyroidism. Total parathyroidectomy with reimplantation should be performed. Mastectomy should be performed for unresolving symptoms, necrosis or infection.

Q-switched laser treatment is a safe and very effective means of removing cosmetic mucosal tattoos on the inner lip and should be considered the criterion standard treatment option.

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