Perforating Granulomatous Dermatitis Reaction to Exogenous Tattoo Pigment

Abstract

: The majority of cutaneous hypersensitivity reactions to exogenous tattoo pigments can be histologically classified as lichenoid or granulomatous. The etiology is still uncertain but is generally accepted to be a delayed-type hypersensitivity reaction to either the pigment itself or its carrier solution. In this report, we review the literature concerning adverse reactions to tattoos. In addition, we describe the second case of a localized granulomatous dermatitis to the red dye within a tattoo that histologically resembled granuloma annulare. This is the first reported example of a perforating granuloma annulare-like reaction.

Tattoo reactions-An epidemic on the surge: A report of 3 cases

“…Recently, a perforating granulomatous reaction to tattoo pigment was described. [3] Pathogenic mechanisms implicated in reactions to tattoo pigments include a localized, T-cell mediated, delayed hypersensitivity response (lichenoid and sarcoidal reaction). In addition, allergic reactions have been observed in the form of type I and III reactions, according to Coombs and Gell classification.…”

Foreign Body Granulomas

“…Hypersensitivity reactions include the development of a diffuse lymphohistiocytic infiltrate involving the full thickness of the dermis, 10 lichenoid reactions (which seem to be more frequent with red pigments) (Fig. 2), 11 sarcoidal granulomas, 12 granuloma annulare-like reaction, 13 necrobiosis lipoidica, 14 perforating granulomatous dermatitis, 15 vasculitis, 16 a pseudolymphomatous pattern, 17 and a morphealike reaction. 18 The overlying epidermis is usually normal, although spongiosis and pseudoepitheliomatous hyperplasia have been described.…”

Cutaneous Deposits

“…Histopathologic patterns vary according to the composition of the used pigment. Hypersensitivity reactions include the development of a diffuse lymphohistiocytic infiltrate involving the full thickness of the dermis, 235 lichenoid reactions (which seem to be more frequent with red pigments), 236 sarcoidal granulomas, 237 granuloma annulare-like reaction, 238 necrobiosis lipoidica, 239 perforating granulomatous dermatitis, 240 vasculitis, 241 a pseudolymphomatous pattern, 242 and a morphea-like reaction. The overlying epidermis is usually normal, although spongiosis and pseudoepitheliomatous hyperplasia have been described.…”