Pseudoepitheliomatous Epidermal Hyperplasia in Tattoos

Kluger, Nicolas; Durand, L; Minier-Thoumin, Catherine; Plantie, Françoise; Cotten, H.; Berteloot, Elisabeth; Blatiere, Véronique; Dereure, O.

doi:10.2165/00128071-200809050-00009

Cited by 55 publications

(46 citation statements)

References 14 publications

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“…Also, in accordance with the medical literature, the study confirmed that the traditional histopathological patterns often overlap and provide little help in discriminating different clinical entities, with sarcoid granuloma and sarcoidosis being the exception [31,[36][37][38][39] . There is no histopathological hallmark of allergy.…”

Section: Discussionsupporting

confidence: 73%

Classification of Tattoo Complications in a Hospital Material of 493 Adverse Events

Serup¹,

Sepehri

Carlsen³

2016

Dermatology

115

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Background/Aims: Tattooing is a global trend. Clinical knowledge of complications is based on case reports collected over a century. Larger cohorts reflecting complications associated with contemporary trends are lacking. Methods: The study was a retrospective review of a consecutive cohort of patients with tattoo complications diagnosed in the “Tattoo Clinic“ of Bispebjerg University Hospital in Copenhagen, Denmark, from 2008 to 2015, based on patient history and systematic clinical examination. Results: A total of 493 tattoo complications in 405 patients were studied. Overall, 184 (37%) presented allergic reactions with plaque elevation in 32.2%, excessive hyperkeratosis in 3.7%, and ulceration in 1.4%, predominantly observed in red tattoos and nuances of red; 66 (13%) presented papulo-nodular reactions, mainly observed in black tattoos (considered non-allergic) and due to pigment agglomeration; 53 (11%) had bacterial infections; 46 (9%) were psycho-social complications; 144 (30%) belonged to several specific diagnostic entities, including photosensitivity, pain syndrome, and lymphopathy. We found no cases of cutaneous or other malignancies. Sarcoidosis was primarily seen in black tattoos and was a common associated disease, found in 23 reactions (5%), compared to the background population. Conclusion: The study introduces a new concept of classification of tattoo complications based on simple tools such as patient history and objective findings supplemented with histology. The study reflects complications originating from presently used tattoo inks, often with organic pigments. The introduced classification has been submitted to the World Health Organisation (WHO) as a proposal to the 11th revision of the International Classification of Diseases.

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Section: Discussionsupporting

confidence: 73%

Classification of Tattoo Complications in a Hospital Material of 493 Adverse Events

Serup¹,

Sepehri

Carlsen³

2016

Dermatology

115

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“…The histological pattern can mimic squamous cell carcinoma or PH. This latter condition has been previously reported in tattoos, [3][4][5][6][7] and distinguishing between PH and KA can be so difficult for the pathologist that a precise and definite diagnosis cannot always be made. 6 There is, moreover, a trend in some countries to regard KA as a variant of squamous cell carcinoma.…”

Section: 13mentioning

confidence: 71%

“…These reactions are mainly lichenoid, granulomatous, sarcoidosis-like or pseudolymphomatous 1,2 and their development is highly variable, ranging from immediately to 45 years later. 3 Pseudoepitheliomatous hyperplasia (PH) [3][4][5][6][7] and morphea 8,9 have also been reported in a limited number of cases. Reports of keratoacanthoma (KA) occurring after tattooing are scarce.…”

Section: Clinical Casementioning

confidence: 99%

Keratoacanthoma occurring within the red dye of a tattoo

Kluger

Minier-Thoumin²,

Plantier

2008

J Cutan Pathol

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Keratoacanthoma (KA) is a common keratinizing squamous cell neoplasm of unknown origin characterized by rapid growth and spontaneous involution. Trauma‐induced forms have been observed with various types of skin injury. To our knowledge, reports of KA arising at tattoo sites are scarce in the literature. A 41‐year‐old woman with no medical history presented for a rapidly growing nodule confined to the red part of a tattoo located on the scapula. Histology showed a keratin‐filled cuplike crater with an epithelial proliferation (hyperkeratosis, parakeratosis, no keratinocyte atypia). An inflammatory infiltrate in the dermis composed of lymphocytes and histiocytes intermixed with red ink‐related exogenous pigments was noted. Lack of papillomatosis and viral inclusions ruled out the diagnosis of viral wart, absence of granulomatous reaction ruled out deep fungal or mycobacterial infection and lack of cytological atypia and frank architectural abnormalities did not favour a squamous cell carcinoma. KA should be included in the list of cutaneous complications related to tattooing. Diagnosis can be challenging as differential diagnoses include pseudoepitheliomatous hyperplasia and squamous cell carcinoma. Removal of the entire area, thorough histological examination and careful follow up are mandatory.

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“…Goldberg in 1959 (18), as multiple verrucous papules forming exclusively in the area of red tattoo ink. A few more cases of pseudoepitheliomatous hyperplasia were described later, where the authors reported various ways of adverse reaction development from the moment of ink application, lasting from four days to 12 months, with the process localization on forearms, back, and lower limbs (9,10,(19)(20)(21). The trigger effect of solar radiation on pseudoepitheliomatous hyperplasia development was observed (20,22,23).…”

Section: Introductionmentioning

confidence: 98%