Atypical koebner phenomenon on a tattoo

Tammaro, Antonella; Chello, Camilla; Magri, Francesca; Gelormini, Enza; Parisella, Francesca Romana; Daniele, Alessandra; SIGNATI, Federica; Persechino, Severino; Raffa, Salvatore

doi:10.1111/jocd.13147

Cited by 1 publication

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“…Red pigments are the most reported cause of cutaneous reaction to tattoos [ 2 ]. Cinnabar red, the pigment containing mercury sulphate and a well-known allergen implicated in delayed hypersensitivity reactions, is reported to be the cause in presentations of PEH secondary to red [ 2 , 13 , 15 , 16 , 17 ]. Recently, inorganic dyes in red tattoos such as cinnabar have been replaced by organic ones, such as azo pigments, quinacridone and polycyclic-compounds; however, this has not reduced the presentation of PEH or SCC secondary to red ink [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Pathogenesis, Diagnosis and Management of Squamous Cell Carcinoma and Pseudoepithelial Hyperplasia Secondary to Red Ink Tattoo: A Case Series and Review

Rahbarinejad

Guio-Aguilar

et al. 2023

JCM

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The increasing popularity of tattooing has paralleled an increase in associated cutaneous reactions. Red ink is notorious for eliciting cutaneous reactions. A common reaction is pseudoepitheliomatous hyperplasia (PEH), which is a benign condition closely simulating squamous cell carcinoma (SCC). Differentiating PEH from SCC is challenging for pathologists and clinicians alike. The exact pathogenesis of these lesions secondary to red ink is not known, and there are no sources outlining diagnostic and treatment options and their efficacy. We present four study cases with different pathologies associated to red ink tattoos including lichenoid reaction, granulomatous reaction, PEH, and an SCC. Additionally, an extensive review of 63 articles was performed to investigate pathogenesis, diagnostic approaches, and treatment options. Hypotheses surrounding pathogenesis include but are not limited to the carcinogenic components of pigments, their reaction with UV and the traumatic process of tattooing. Pathogenesis seems to be multifactorial. Full-thickness biopsies with follow-up is the recommended diagnostic approach. There is no evidence of a single universally successful treatment for PEH. Low-dose steroids are usually tried following a step up in lack of clinical response. For SCC lesions, full surgical excision is widely used. A focus on clinicians’ awareness of adverse reactions is key for prevention. Regulation of the unmonitored tattoo industry remains an ongoing problem.

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