Inflammatory Complications Related to Tattooing

Abstract

: Although tattooing is an ancient practice, its increasing popularity and social acceptance, variability of tattoo ink composition, sporadic reports of novel tattoo reactions and advances in the field of tattoo removal techniques make it a topic of immense interest among dermatologists and pathologists alike. Since effective legislation governing the tattoo industry is largely lacking in most regions of the world, it is important to recognize the range of tattoo-related complications from a dermatopathological perspective. Using a pattern-based approach, this review details the broad spectrum of inflammatory reactions, which may be encountered in adverse reactions associated with tattooing. Awareness of the range of inflammatory tattoo reactions is crucial as some of these patterns of inflammation can be associated with systemic disorders and others may serve as important clues for an underlying infective condition.

Chemical characterization of inks in skin reactions to tattoo

“…In a critical review, Thum et al showed that inflammatory complications related to tattooing are associated with a wide spectrum of histological reaction patterns. Consistent with what they described, and probably because of the variety of chemical substances present in modern tattoo inks, we could not directly associate a type of histopathological reaction to a specific color (Thum & Biswas, 2015).…”

Lichenoid Reaction Pattern with Pseudoepitheliomatous Hyperplasia – A Rare Tattoo Reaction: A Case Report and Review of the Literature

“…Tattooing is a common practice performed for cosmetic appearance and cultural beliefs. Adverse reactions to tattooing can occur with different morphologies and histopathologic reaction patterns [11]. Delayed cutaneous reactions can also occur, usually due to red pigment, and include granulomatous, allergic, lichenoid, and pseudolymphomatous reactions [2].…”

Hypersensitivity to permanent tattoos: Literature summary and comprehensive review of patch tested tattoo patients 1997–2022

“…[38][39][40] Most frequently observed patterns were mixed and included fibrosis, interface activity and major signs of type IV reactions like spongiosis and acanthosis. 38,[40][41][42] Severe allergic reactions do usually not respond to medical treatment with corticosteroids and often need complete removal of the colorant from the skin, which can be achieved by surgical or CO 2 -laser removal. 43,44 In a small German case series, even superficial removal of affected tattoos was sufficient to provide cure and aesthetically acceptable results in three patients.…”

“…Histologically, tattoo complications are characterized by severe inflammation with a high share of lymphocytes, histiocytes and macrophages 38–40 . Most frequently observed patterns were mixed and included fibrosis, interface activity and major signs of type IV reactions like spongiosis and acanthosis 38,40–42 . Severe allergic reactions do usually not respond to medical treatment with corticosteroids and often need complete removal of the colorant from the skin, which can be achieved by surgical or CO 2 ‐laser removal 43,44 .…”