Granulomatous tattoo reaction and erythema nodosum in a young woman: common cause or coincidence?

Abstract

Tattooing has become quite popular in Western countries. With the increasing prevalence, there is also an increased risk of adverse effects. We describe a 17-year-old female patient with a black and red-colored tattoo, who developed immediately after red tattooing general malaise with fever, nausea, and vomiting. A bullous reaction was temporarily seen within the red part of her tattoo. The reaction later shifted to a subacute dermatitis with bacterial superinfection. Two months later, she felt ill again. She developed painful tender nodules on the anterior aspect of both lower legs identified as erythema nodosum without sarcoidosis. Is this is a unique case of adverse reaction to tattoo pigments with a type I and a type IV reaction, or is this a coincidence? The treatment was initiated with systemic and topical corticosteroids and topical antibiotics combined with compression bandages for the legs. After 3 weeks of treatment, the erythema nodosum completely resolved and did not reappear during a 1-year follow-up. The treatment of the local reactions, however, was unsatisfactory without complete response. There is an indispensable need for regulation of tattoo pigments and tattooing to improve consumer safety.

Severe adverse events related to tattooing: An retrospective analysis of 11 years

“…[12–14] We observed long-term problems with edema formation or erythema nodosum development. [5] Laser treatment in such cases may increase the risk of further adverse effects. [15]…”

Cutaneous allergic reactions to tattoo ink

“…Granulomatous and lichenoid hypersensitivity reactions may also occur but both are less common than eczematous reactions 7 . Granulomatous reactions are most commonly associated with mercury (red pigment) 8 and consist of a collection of epithelioid cells, lymphocytes, and a few giant cells.…”

“…Granulomatous and lichenoid hypersensitivity reactions may also occur but both are less common than eczematous reactions. 7 Granulomatous reactions are most commonly associated with mercury (red pigment) 8 and consist of a collection of epithelioid cells, lymphocytes, and a few giant cells. Unlike eczematous hypersensitivity tattoo reactions which have patch tests that may be positive, granulomatous and lichenoid tattoo reactions are more commonly associated with negative patch test results.…”

Nodular skin reactions in eyebrow permanent makeup: two case reports and an infection by Mycobacterium haemophilum

“…A localized granulomatous reaction along a cosmetic permanent lip liner was reported after intense sunlight exposure in a 47‐year‐old woman 1 year after application 3 . Disseminated granulomatous reactions have been observed after body tattoos only 6,7 …”

“…3 Disseminated granulomatous reactions have been observed after body tattoos only. 6,7 Noninfectious granulomatous reactions can be treated by laser (to remove or destroy pigment), oral allopurinol, or topical corticosteroids as shown in case #1. 8 Rarely, a spontaneous resolution has been documented as in a 27-year-old woman 4 years after vermillion border makeup.…”