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Sethy M, Behera B, Dash S, Palit A, Nayak AK, Ayyanar P. Clinicodermoscopic and immunopathological profile of non-infectious non-eczematous inflammatory tattoo reactions: A retrospective study from a tertiary care centre of East India. Indian J Dermatol Venereol Leprol 2022:1-10. [DOI: 10.25259/ijdvl_85_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 07/01/2022] [Indexed: 11/05/2022]
Abstract
Introduction
Tattoo-associated complications are on the rise due to the popularity of decorative tattoos in recent years. The exact pathogeneses of various tattoo reaction patterns are still unclear, and their dermoscopic details are sparsely reported.
Aim
We aimed to retrospectively study the clinical, dermoscopic and immunopathological details of patients with non-infectious, non-eczematous inflammatory tattoo reaction patterns in a tertiary care centre of East India.
Method
The clinical, dermoscopic and pathological details of all the patients who had non-infectious, non-eczematous inflammatory tattoo reactions were collected. In all the cases, immunohistochemistry was done for CD1a, CD3, CD4, CD8, FoxP3, CD20 and CD56.
Results
A total of five patients of skin phototypes IV and V and six tattoo reactions were analysed. Five lesions had reactions at the site of a black tattoo, and one at the site of red tattoo. Clinically, the patients presented with erythematous or blue-grey flat-topped to verrucous papules and plaques. Dermoscopic features were dominated by a central white to pink-white structureless area, a peripheral grey-white to bluish-white structureless area, white scales, comedo-like opening with keratotic plugging, milia-like cysts and shiny white structures. Pathologically, except for one lesion that only showed a lichenoid reaction pattern in the red tattoo, all had a combination of reaction patterns. Immunohistochemistry showed increased epidermal and dermal Langerhans cells, predominantly CD8 positive T cells in the epidermis and dermis, sparse dermal B cells and CD4 positive T cells, reduced T regulatory cells and a complete absence of CD56 positive NK cells.
Limitations
Small sample size was the limitation of the study.
Conclusion
The clinical morphology and dermoscopy may not differentiate between various types of non-infectious non-eczematous inflammatory tattoo reactions. The immunological profile supports a delayed hypersensitivity reaction due to contact sensitisation to tattoo pigment, and CD8 positive T cells play a central role in executing various pathological reaction patterns, both in the epidermis and dermis.
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Affiliation(s)
| | | | - Siddhartha Dash
- Department of Dermatology, AIIMS, Bhubaneswar, Odisha, India
| | - Aparna Palit
- Department of Dermatology, AIIMS, Bhubaneswar, Odisha, India
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Portilla Maya N, Kempf W, Perez Muñoz N, Rodríguez-Martínez P, Posada R, Fernández-Figueras MT. Histopathologic Spectrum of Findings Associated With Tattoos: Multicenter Study Series of 230 Cases. Am J Dermatopathol 2021; 43:543-553. [PMID: 34276026 DOI: 10.1097/dad.0000000000001695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IMPORTANCE Reactions to tattoo may simulate common dermatosis or skin neoplasms. Histopathology allows diagnosis and helps determining the level and degree of inflammation associated, consequently orientating treatment. OBJECTIVE To describe the histological features found in biopsies of cutaneous reactions to tattoo. DESIGN This study was designed as a multicenter case series. SETTING All consecutive histopathological samples of tattoos referred from 1992 to 2019 to the Hospital General de Catalunya, Hospital Germans Trias i Pujol, and a private practice, all in Barcelona, Spain, and from the Kempf und Pfaltz Histologische Diagnostik in Zurich, Switzerland were retrieved from the files. PARTICIPANTS AND EXPOSURE The inclusion criteria were all cosmetic/permanent makeup, artistic/professional, and traumatic tattoos associated with either inflammatory reactions alone and/or with tumors and/or infections. Exclusion criteria were cases without any associated pathologic finding in the place of the ink, amalgam tattoos, and medical or temporary tattoos. MAIN OUTCOMES AND MEASURES In all patients, clinical features (age, sex, location, tattoo color, and presentation) were recorded. Histological features evaluated included ink color, associated tumors or infections, and inflammatory reaction pattern. Inflammation was graded in low to moderate or severe. RESULTS From 477 biopsies diagnosed as tattoos, 230 cases from 226 patients met the inclusion criteria. Samples corresponded to 107 male and 120 female subjects and 3 of unknown gender. Median age was 39 years (ranging from 9 to 84 years). Fifty-three samples were referred from centers in Spain and 177 from the center in Switzerland. The series was analyzed in 2 parts: tattoos associated only with inflammatory reactions (117/230) and tattoos associated with tumors or infections (113/230). The most common form of inflammatory pattern associated with tattoo was the fibrosing reaction (79/117, 68%), followed by granulomatous reaction (56/117, 48%), lichenoid reaction (33/117, 28%), epithelial hyperplasia (28/117, 24%), pseudolymphoma (27/117, 23%) and spongiotic reaction (27/117, 23%). Combined features of 2 or more types of inflammatory patterns were seen in 64% cases. CONCLUSIONS AND RELEVANCE Our series confirms that cutaneous reactions to tattoos are polymorphous. Inflammation tends to present with combined patterns. Infections are tending to decline, and pathologic findings are not specific to ink color or clinical features.
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Affiliation(s)
- Nataly Portilla Maya
- Dermatologist, Dermatology Department, Clínica Erasmo LTDA. Valledupar, Colombia
| | - Werner Kempf
- Dermatopathologist, Pathology Department, Kempf und Pfaltz Histologische Diagnostik, Zurich, Switzerland
| | - Noelia Perez Muñoz
- Pathologist, Pathology Department, Hospital Universitari General de Catalunya (HUGC), Sant- Cugat del Vallès, Spain; and
- Pulmonologist, Pathology Department, Hospital University German Trias I Pujol, Barcelona, Spain
| | | | - Rodolfo Posada
- Pathologist, Pathology Department, Hospital Universitari General de Catalunya (HUGC), Sant- Cugat del Vallès, Spain; and
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van der Bent S, Oyen E, Rustemeyer T, Jaspars L, Hoekzema R. Histopathology of Red Tattoo Reactions. Am J Dermatopathol 2021; 43:331-337. [PMID: 32732691 DOI: 10.1097/dad.0000000000001751] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Despite popularity of tattoos, complications may occur. In particular, red tattoo reactions due to allergic reactions are the most frequent chronic tattoo reactions. However, little is known about its histopathology and underlying pathomechanisms. OBJECTIVE The aim of this article is to analyze the histopathology of red tattoo reactions for diagnostic purposes and to acquire more insight into pathogenesis. METHODS A retrospective cross-sectional study was conducted by reviewing the histopathology of 74 skin biopsies of patients with allergic red tattoo reactions. Histopathological findings, such as inflammation patterns, inflammatory cells and pigment depth and color, were semi-quantified with an in-house validated scoring system by 2 independent senior investigators. RESULTS Histiocytes and lymphocytes were both present in >93%. Histiocytes were the predominant inflammatory cells in 74.3%, but well-defined granulomas were mostly absent (78.0%). Eosinophils were uncommon (8.1%) The predominantly histiocytic reaction combined with interface dermatitis was the main inflammation pattern (37.9%). Most biopsies showed more than one reaction pattern. Interface involvement was observed in 64.8%, despite the intended depth of standard tattoo procedures, in which pigment is placed deeper, in the upper- and mid-dermis. Statistical analyses showed a significant association between inflammation severity and pigment depth (P = 0.024). In 6 cases (8.1%) pigments could not be retrieved histologically. CONCLUSIONS In this cohort we demonstrated that cutaneous reactions to red tattoo ink are frequently characterized by the combination of dermal predominantly histiocytic infiltrates and epidermal interface dermatitis. Allergic reactions to red tattoo pigments probably represent a combination of a subtype IVa and IVc allergic reaction. Clinicians should be aware of the specific histopathology of these reactions and therefore the importance of taking a diagnostic skin biopsy.
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Affiliation(s)
- Sebastiaan van der Bent
- Academic Tattoo Clinic Amsterdam, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands ; and
| | - Ellen Oyen
- Academic Tattoo Clinic Amsterdam, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands ; and
| | - Thomas Rustemeyer
- Academic Tattoo Clinic Amsterdam, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands ; and
| | - Lies Jaspars
- Department of Pathology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Rick Hoekzema
- Academic Tattoo Clinic Amsterdam, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands ; and
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4
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Kluger N, Andraud M, Lartigau-Roussin C, Sultan-Bichat N. The Koebner phenomenon on tattoos and piercings in a patient with cutaneous lupus: a case report and review of the literature. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2021. [DOI: 10.15570/actaapa.2021.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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5
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Ronchi A, Sica A, Vitiello P, Franco R. Dermatological Considerations in the Diagnosis and Treatment of Marginal Zone Lymphomas. Clin Cosmet Investig Dermatol 2021; 14:231-239. [PMID: 33727844 PMCID: PMC7954031 DOI: 10.2147/ccid.s277667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/23/2021] [Indexed: 12/16/2022]
Abstract
Primary cutaneous marginal zone lymphoma (PC-MZL) is a B-cell lymphoma arising in the skin. Although it is a rare disease, PC-MZL accounts for 20–40% of all primary cutaneous B-cell lymphoma in Western Countries. The aetiology and the pathogenesis of PC-MZL are poorly understood, as it generally lacks the chromosomal translocations most typically present in marginal zone lymphomas of other sites. The diagnosis of PC-MZL may be challenging, due to the rarity of the disease, and needs the competence of different professional figures, including the dermatologist and the pathologist. Furthermore, the management of the patient after the diagnosis is complex and involves the dermatologist, the haematologist, the surgeon, the radiotherapist and the radiologist. The aim of this review is to describe the clinical and histological findings for the diagnosis of PC-MZL, and the state of art for the management of the patient.
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Affiliation(s)
- Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, 80138, Italy
| | - Antonello Sica
- Oncology and Haematology Unit, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, 80131, Italy
| | - Paola Vitiello
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, 80131, Italy
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, 80138, Italy
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Luetkemeier MJ, Allen DR, Huang M, Pizzey FK, Parupia IM, Wilson TE, Davis SL. Skin tattooing impairs sweating during passive whole body heating. J Appl Physiol (1985) 2020; 129:1033-1038. [PMID: 32881627 DOI: 10.1152/japplphysiol.00427.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Tattooing of the skin involves repeated needle insertions to deposit ink into the dermal layer of the skin, potentially damaging eccrine sweat glands and the cutaneous vasculature. This study tested the hypothesis that reflex increases in sweat rate (SR) and cutaneous vasodilation are blunted in tattooed skin (TAT) compared with adjacent healthy skin (CON) during a passive whole body heat stress (WBH). Ten individuals (5 males and 5 females) with a sufficient area of tattooed skin participated in the study. Intestinal temperature (Tint), skin temperature (Tskin), skin blood flow (laser Doppler flux; LDF), and SR were continuously measured during normothermic baseline (34°C water perfusing a tube-lined suit) and WBH (increased Tint 1.0°C via 48°C water perfusing suit). SR throughout WBH was lower for TAT compared with CON (P = 0.033). Accumulated sweating responses during WBH (area under curve) were attenuated in TAT relative to CON (23.1 ± 12.9, 26.9 ± 14.5 mg/cm2, P = 0.043). Sweating threshold, expressed as the onset of sweating in time or Tint from the initiation of WBH, was not different between TAT and CON. Tattooing impeded the ability to obtain LDF measurements. These data suggest that tattooing functionally damages secretion mechanisms, affecting the reflex capacity of the gland to produce sweat, but does not appear to affect neural signaling to initiate sweating. Decreased sweating could impact heat dissipation especially when tattooing covers a higher percentage of body surface area and could be considered a potential long-term clinical side effect of tattooing.NEW & NOTEWORTHY This study is the first to assess the reflex control of sweating in tattooed skin. The novel findings are twofold. First, attenuated increases in sweat rate were observed in tattooed skin compared with adjacent healthy non-tattooed skin in response to a moderate increase (1.0°C) in internal temperature during a passive whole body heat stress. Second, reduced sweating in tattooed skin is likely related to functional damage to the secretory mechanisms of eccrine sweat glands, rendering it less responsive to cholinergic stimulation.
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Affiliation(s)
| | - Dustin R Allen
- Applied Physiology and Wellness, Southern Methodist University, Dallas, Texas.,Health Sciences, Boston University, Boston, Massachusetts
| | - Mu Huang
- Applied Physiology and Wellness, Southern Methodist University, Dallas, Texas.,Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Faith K Pizzey
- Applied Physiology and Wellness, Southern Methodist University, Dallas, Texas
| | - Iqra M Parupia
- Applied Physiology and Wellness, Southern Methodist University, Dallas, Texas
| | - Thad E Wilson
- Department of Physiology, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Scott L Davis
- Applied Physiology and Wellness, Southern Methodist University, Dallas, Texas.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas
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Tatouage et réaction sarcoïdosique. BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2020; 204:611-615. [PMID: 32322103 PMCID: PMC7172666 DOI: 10.1016/j.banm.2020.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/10/2020] [Indexed: 11/24/2022]
Abstract
La pratique du tatouage se développe de plus en plus dans le monde entier. Les infections sont connues, mais les réactions inflammatoires chroniques ont souvent donné lieu à des manifestations cliniques variées. À côté des réactions allergiques, les réactions non allergiques prévalent dans les tatouages noirs et se manifestent sous la forme de lésions « papulo-nodulaires ». L’importance de la biopsie des lésions papulo-nodulaires pour confirmer le diagnostic doit être soulignée. Les nanoparticules de noir de carbone s’agglomèrent dans le derme avec le temps pour former des granulomes sarcoïdosiques. Granulome à corps étranger lié au pigment et sarcoïdose sont souvent difficiles à distinguer. La couleur noire semble la plus fréquente. D’autres étiologies que le pigment sont évoquées, tel que le rôle d’un agent infectieux, mais à ce jour aucun n’a été identifié, un terrain génétique particulier, qu’il reste à définir. Des localisations systémiques étant possible, le bilan d’extension est important à réaliser. Le traitement est le même que la sarcoïdose classique. Certains médicaments favoriseraient le développement d’une sarcoïdose sur tatouage. Ils doivent donc être recherchés systématiquement. Il est aussi important à titre préventif, que les sujets et leur médecin traitant soient informés de ce risque potentiel lié à ces médicaments indiqués dans des pathologies graves spécifiques.
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8
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Bagot M. [Complications of tattoos: Clinical and pathological classification, pathophysiology, particle kinetics]. BULLETIN DE L ACADEMIE NATIONALE DE MEDECINE 2020; 204:607-610. [PMID: 32322105 PMCID: PMC7172802 DOI: 10.1016/j.banm.2020.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/10/2020] [Indexed: 11/24/2022]
Abstract
Les tatouages sont de plus en plus fréquents et leur surface est en augmentation. Ils sont également de plus en plus colorés. Les complications sont fréquentes et réalisent des tableaux cliniques et histologiques très variés. Les encres, dont la composition n’est pas toujours connue, contiennent de nombreux pigments dont les produits de dégradation peuvent entraîner des allergies chroniques. Les effets à long terme de la présence de produits carcinogènes et de nanoparticules justifient la réalisation d’études prospectives. Le public devrait être informé de ces complications et des difficultés du détatouage.
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Affiliation(s)
- M Bagot
- Unité Inserm U976, service de dermatologie, université de Paris, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France
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9
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Drozd B, Messer AM, Klimas NK, Jahan‐Tigh RR. The true color of red tattoo: Use of unstained slides to determine pigment color. J Cutan Pathol 2019; 46:709-710. [DOI: 10.1111/cup.13481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 03/26/2019] [Accepted: 04/09/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Brandy Drozd
- Department of Dermatology, University of Texas Health Science Center at Houston McGovern Medical School Houston Texas
| | - Alison M. Messer
- Department of Dermatology, University of Texas Health Science Center at Houston McGovern Medical School Houston Texas
| | - Natasha K. Klimas
- Department of Dermatology, University of Texas Health Science Center at Houston McGovern Medical School Houston Texas
| | - Richard R. Jahan‐Tigh
- Department of Dermatology, University of Texas Health Science Center at Houston McGovern Medical School Houston Texas
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Rodríguez-Avila JO, Ríos y Valles-Valles D, Hernández-Ayuso I, Rodríguez-Reyes AA, Morales Cantón V, Cernichiaro-Espinosa LA. Conjunctival tattoo with inadvertent ocular globe penetration and vitreous involvement: Clinico-pathological correlation and scanning electron microscopy X-ray microanalysis. Eur J Ophthalmol 2019; 30:NP18-NP22. [DOI: 10.1177/1120672119850076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose: The aim is to report a case of conjunctival tattooing with inadvertent injection of tattoo ink into the vitreous cavity and its consequences, the scanning electron microscopy X-ray microanalysis of the ink components, and the microscopic findings of the affected conjunctiva and vitreous. Methods: Descriptive case report. Results: A 32-year-old man complained of ocular pain and blurred vision after undergoing a subconjuctival red ink tattoo in his left eye. Ophthalmologic examination revealed best corrected visual acuity of 20/80 and intraocular pressure of 26 mmHg. Pain was elicited with eye movements. The bulbar conjunctiva was colored intense red. In the anterior chamber, pigment granules and filaments were suspended on the aqueous humor, and lens capsule was also stained red. Ultrasonography showed high-density non-mobile echoes in the conjunctiva; anterior chamber and vitreous cavity revealed high-density mobile echoes corresponding to pigment particles. Conjunctival tattoo with inadvertent globe penetration was the clinical diagnosis. The patient received medical and surgical treatment. Histopathological examination of the conjunctiva showed red pigment globular deposits within the stroma, and neutrophils and sparse histiocytes with similar intracytoplasmic pigment granules were seen. No granulomatous foreign body reaction was noticed. Vitreous material contained pigment granules; no inflammatory cells were observed. Scanning electron microscopy X-ray microanalysis of the tattoo red ink revealed significant signals of iron, barium, and copper. Conclusion: Conjunctival tattoo is a new form of body decoration gaining worldwide popularity. This procedure is performed by untrained professionals causing severe ocular complications including blindness. Safety regarding tattoo ink needs further study as the composition varies among colors. Strict regulations on this matter should be considered.
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Affiliation(s)
- J Oswaldo Rodríguez-Avila
- Asociación para Evitar la Ceguera en México, IAP, Hospital “Dr. Luis Sánchez Bulnes,” Mexico City, Mexico
| | - Dolores Ríos y Valles-Valles
- Ophthalmic Pathology Service, Asociación para Evitar la Ceguera en México, IAP, Hospital “Dr. Luis Sánchez Bulnes,” Mexico City, Mexico
| | - Ivette Hernández-Ayuso
- Ophthalmic Pathology Service, Asociación para Evitar la Ceguera en México, IAP, Hospital “Dr. Luis Sánchez Bulnes,” Mexico City, Mexico
| | - Abelardo A Rodríguez-Reyes
- Ophthalmic Pathology Service, Asociación para Evitar la Ceguera en México, IAP, Hospital “Dr. Luis Sánchez Bulnes,” Mexico City, Mexico
| | - Virgilio Morales Cantón
- Retina and Vitreous Surgery Department, Asociación para Evitar la Ceguera en México, IAP, Hospital “Dr. Luis Sánchez Bulnes,” Mexico City, Mexico
| | - Linda A Cernichiaro-Espinosa
- Retina and Vitreous Surgery Department, Asociación para Evitar la Ceguera en México, IAP, Hospital “Dr. Luis Sánchez Bulnes,” Mexico City, Mexico
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Marom EM, Ofek E, Bekker E, Onn A. Tattoo-Induced False-Positive FDG PET/CT Interpretation while Staging for Lung Cancer. J Thorac Oncol 2018; 13:585-586. [PMID: 29355616 DOI: 10.1016/j.jtho.2018.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/23/2017] [Accepted: 01/04/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Edith Michelle Marom
- Diagnostic Imaging Department, The Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel.
| | - Efrat Ofek
- Pathology Department, The Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Elena Bekker
- Diagnostic Imaging Department, The Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Amir Onn
- Pulmonary Department, The Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
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Abstract
A 31-year-old man developed a fast-growing tumor on the right upper arm within a black tattoo, which could be classified histologically as pilomatrixoma. While the age of the patient and the rapid growth of the tumor cannot be regarded as typical findings of pilomatrixomas, the localization on the upper arm is one of their predilection points. Despite the wide spread use of tattoos in the last few decades, tumor development in tattooed skin is rarely reported. It is still controversial whether the ingredients of the tattoo agents can be responsible for tumor induction.
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Affiliation(s)
- G Wagner
- Klinik für Dermatologie, Allergologie und Phlebologie, Klinikum Bremerhaven Reinkenheide, Postbrookstr. 103, 27574, Bremerhaven, Deutschland.
| | - V Meyer
- Klinik für Dermatologie, Allergologie und Phlebologie, Klinikum Bremerhaven Reinkenheide, Postbrookstr. 103, 27574, Bremerhaven, Deutschland
| | - M M Sachse
- Klinik für Dermatologie, Allergologie und Phlebologie, Klinikum Bremerhaven Reinkenheide, Postbrookstr. 103, 27574, Bremerhaven, Deutschland
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13
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HPV-47-Induced and Tattoo-associated Verrucae Planae: Report of a Case and Review of the Literature. Dermatol Ther (Heidelb) 2017; 7:549-554. [PMID: 28836173 PMCID: PMC5698197 DOI: 10.1007/s13555-017-0197-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Indexed: 01/23/2023] Open
Abstract
The human papillomavirus (HPV), of which more than 200 different types have so far been identified, is an infectious disease impacting skin and mucous membranes. Several genera exist with distinct clinical impact. However, with ornamental tattoos increasing in popularity, a number of mostly cutaneous side effects have also been reported, such as infections, allergic reactions, or even a rise of malignant tumours within the tattoo. We report the first case of a β1-HPV-type infection in cutaneous lesions in terms of verrucae vulgares near a tattoo in an immunocompetent adult without pre-existing conditions, and discuss possible relationships and etiologic concerns of this association.
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Ayanlowo OO, Gold-Olufadi SA, Akinkugbe AO, Otrofanowei E, Nga CN, Olumide YM. Growing trend of tattooing and its complications in Nigeria. Int J Dermatol 2017; 56:709-714. [PMID: 28138959 DOI: 10.1111/ijd.13521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 08/21/2016] [Accepted: 10/30/2016] [Indexed: 11/26/2022]
Abstract
Tattoo, a Polynesian word meaning 'to mark', is a form of body modification done by inserting indelible ink into the dermis to change its pigmentation. Tattoos are done for social, cultural, and religious purposes. It has been in existence since the 18th century and was associated with sailors, lower class individuals, and criminals. However, since the late 20th century, tattooing has undergone a redefinition and shifted to an acceptable form of expression all over the world, including Nigeria, cutting across almost all age groups and socioeconomic class. This review is aimed at highlighting the indication, complications arising from the procedure as well as removal, and how to manage them. The dermatological complications associated with tattoos can occur either during inking or attempts at removal. Most times, tattoos are obtained through unsafe means by unauthorized personnel, and this is associated with numerous health risks. Of particular importance to the dermatologists are the hypersensitivity reactions, granulomatous skin disease, and formation of both keloid and hypertrophic scars. Treatment options vary and include use of silicone gel and intralesional steroids for hypertrophic and keloid scars, topical medication for hyperpigmentation, and use of LASER for tattoo removal. In conclusion, the trend of tattooing has become a widely accepted form of social expression all over the world and is gradually gaining ground in Nigeria. Patients frequently present to the dermatologists and physicians for solutions to the complications. It is important to proffer solutions and educate patients on the various health risks associated with tattooing.
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Affiliation(s)
- Olusola O Ayanlowo
- Department of Medicine, Faculty of Clinical Sciences, University of Lagos, Lagos University Teaching Hospital (LUTH), Lagos, Nigeria
| | | | - Ayesha O Akinkugbe
- Department of Medicine, Faculty of Clinical Sciences, University of Lagos, Lagos University Teaching Hospital (LUTH), Lagos, Nigeria
| | - Erere Otrofanowei
- Department of Internal Medicine, Lagos University Teaching Hospital (LUTH), Lagos, Nigeria
| | - Charles N Nga
- Department of Medicine, University of Uyo Teaching Hospital, Akwa-Ibom, Nigeria
| | - Yetunde M Olumide
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
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Houhoulis K, Lewis K, Fasone R, Benham BE. Tattoos and administration of regional anesthesia: a comprehensive systematic review protocol. ACTA ACUST UNITED AC 2016; 14:48-63. [PMID: 27846115 DOI: 10.11124/jbisrir-2016-003153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The review question is what is the impact of tattoos on the administration of regional anesthesia?The quantitative objective is to identify and quantify the risks to a patient when advancing a needle through tattooed skin for the purpose of administering a regional anesthetic.The qualitative objective is to investigate anesthesia providers' perceptions and experiences when presented with a patient and/or a surgeon requests for a regional anesthetic that would require needle trespass through tattooed skin. An additional qualitative objective is to identify the thoughts, opinions and biases related to the administration of a regional anesthetic through tattooed skin from the perspective of the patient, anesthesia provider, surgeon or other affected parties (e.g. patient families, hospital or clinic administrators or insurance providers).
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Affiliation(s)
- Kathryn Houhoulis
- 1US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, USA 2The Center for Translational Research: a Joanna Briggs Institute Centre of Excellence, Fort Worth, USA
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Frew JW, Nguyen RTD. Tattoo-associated mycobacterial infections: an emerging public health issue. Med J Aust 2016; 203:223-3e.1. [PMID: 26852055 DOI: 10.5694/mja15.00098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 07/17/2015] [Indexed: 11/17/2022]
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Islam PS, Chang C, Selmi C, Generali E, Huntley A, Teuber SS, Gershwin ME. Medical Complications of Tattoos: A Comprehensive Review. Clin Rev Allergy Immunol 2016; 50:273-86. [DOI: 10.1007/s12016-016-8532-0] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
BACKGROUND Tattoos are regarded as body jewelry and have become widespread in all parts of society. Despite introduction of the tattooing agents' regulation (Tätowiermittelverordnung) in Germany in 2009, consumer protection is incomplete. OBJECTIVES Prevalence of tattoos and their legal basis, ingredients of tattooing agents, clinical findings of adverse reactions, pathogenesis and therapy. METHODS The work is based on a selective literature search in PubMed and on the clinical experience of the authors. RESULTS Adverse reactions by tattooing are a particular problem, because the causing substances are not biodegradable within the tissue. In addition to an agonizing pruritus, the clinical picture is characterized by erythematous plaques. Histopathology reveals different patterns of inflammation, including pseudolymphomatous reactions. Treatment is problematic. In many cases, extensive surgical excision is necessary, which is associated with cosmetic consequences. CONCLUSION A regulation to assess the safety of tattooing does not exist.
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Pinto A, Wieshmann H, Triantafyllou A, Shaw R. Tattoo-pigmented cervical lymph node that masqueraded as the sentinel lymph node in oral squamous cell carcinoma. Br J Oral Maxillofac Surg 2015; 53:886-7. [PMID: 26188933 DOI: 10.1016/j.bjoms.2015.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 06/15/2015] [Indexed: 11/25/2022]
Abstract
We describe a case of a pigmented cervical lymph node mimicking the sentinel node during sentinel lymph node biopsy (SLNB) on a patient with oral squamous cell carcinoma (OSCC). The patient had extensive tattoos on his neck. This pigmented lymph node was not identified to be the sentinel lymph node using static and dynamic lymphoscintigraphy. Subsequent histological analysis revealed tattoo pigment within this lymph node. It is important during cervical SLNB to be aware that cutaneous tattoos can pigment lymph nodes.
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Høgsberg T, Thomsen BM, Serup J. Histopathology and immune histochemistry of red tattoo reactions. Interface dermatitis is the lead pathology, with increase in T-lymphocytes and Langerhans cells suggesting an allergic pathomechanism. Skin Res Technol 2015; 21:449-58. [PMID: 26031754 DOI: 10.1111/srt.12213] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND The majority of tattoo reactions are affiliated to red pigmented areas and often suspected to be allergic in nature. A sizeable series of biopsies of such reactions has not previously been performed. The aim of this study was to type and grade epidermal and dermal changes in tattoo reactions to red/red nuances by microscopy and immunochemistry relevant for the assessment of a possible allergic pathomechanism. METHODS Skin biopsies were taken from red tattoo reactions, graded by conventional microscopy and stained for T and B-lymphocytes, Langerhans cells, macrophages and tumour necrosis factor (TNF)-α. RESULTS The study included 19 biopsies from 19 patients. The culprit colours were red/pink (n = 15) and purple/bordeaux (n = 4). Interface dermatitis was clearly the lead pathology found in 78% of samples, overlapped with granulomatous (in 32%) and pseudolymphomatous reaction patterns (in 32%). Epidermal hyperkeratosis (in 89%) was common as was leakage of red pigment across the dermo-epidermal junction, with transepidermal elimination (in 28%). The dermal cellular infiltration was dominated by T-lymphocytes (in 100%), Langerhans cells (in 95%) and macrophages (in 100%). TNF-α was common. CONCLUSION The predominant histological pattern of chronic tattoo reactions in red/red nuances is interface dermatitis. T-lymphocytes and Langerhans cells are increased suggesting an allergic pathomechanism. TNF-α may contribute to reactions. In many cases, overlapping reactive patterns were identified.
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Affiliation(s)
- T Høgsberg
- Department of Dermatology, Bispebjerg University Hospital, Copenhagen NV, Denmark
| | - B M Thomsen
- Department of Pathology, Bispebjerg University Hospital, Copenhagen NV, Denmark
| | - J Serup
- Department of Dermatology, Bispebjerg University Hospital, Copenhagen NV, Denmark
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Brady BG, Gold H, Leger EA, Leger MC. Self-reported adverse tattoo reactions: a New York City Central Park study. Contact Dermatitis 2015; 73:91-9. [DOI: 10.1111/cod.12425] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 04/13/2015] [Accepted: 04/27/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Bobbi G. Brady
- Department of Medicine; Norwalk Hospital; Norwalk CT 06850
| | - Heidi Gold
- Department of Medicine; Maimonides Medical Center; Brooklyn NY 11219
| | - Elizabeth A. Leger
- Department of Natural Resources and Environmental Science; University of Nevada; Reno NV 89557 USA
| | - Marie C. Leger
- Ronald O. Perelman Department of Dermatology; New York University; New York NY 10016 USA
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Simunovic C, Shinohara MM. Complications of decorative tattoos: recognition and management. Am J Clin Dermatol 2014; 15:525-36. [PMID: 25385257 DOI: 10.1007/s40257-014-0100-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Tattooing is an ancient practice that enjoys continued popularity. Although a modern, professionally performed tattoo is generally safe, complications can occur. A skin biopsy of all tattoo reactions is recommended as some tattoo reactions have systemic implications. Tattoo-related infections are seen days to decades after tattooing, and range from acute pyogenic infections to cutaneous tuberculosis. In particular, non-tuberculous mycobacterial infections happen in tattoos with increasing frequency and are introduced at the time of tattooing through contaminated ink or water used to dilute inks. Despite a transition in tattoo pigments from metal salts to industrial azo dyes, hypersensitivity reactions also persist, and include eczematous, granulomatous, lichenoid, and pseudoepitheliomatous patterns (among others). Granulomatous tattoo reactions can be a clue to cutaneous or systemic sarcoidosis, particularly in the setting of interferon use. Pseudoepitheliomatous tattoo reactions have substantial overlap with squamous cell carcinoma and keratoacanthoma, making diagnosis and management difficult. Other malignancies and their benign mimics can occur in tattoos, raising questions about the safety of tattoo ink and its role in carcinogenesis.
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Hutton Carlsen K, Serup J. Patients with tattoo reactions have reduced quality of life and suffer from itch. Skin Res Technol 2014; 21:101-7. [DOI: 10.1111/srt.12164] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 03/08/2014] [Indexed: 11/30/2022]
Affiliation(s)
- K. Hutton Carlsen
- Department of Dermatology; the ‘Tattoo Clinic’, Bispebjerg University Hospital; Copenhagen Denmark
| | - J. Serup
- Department of Dermatology; the ‘Tattoo Clinic’, Bispebjerg University Hospital; Copenhagen Denmark
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Carson HJ. The medium, not the message. How tattoos correlate with early mortality. Am J Clin Pathol 2014; 142:99-103. [PMID: 24926092 DOI: 10.1309/ajcpdoi32fwqlueo] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES At autopsy, tattoos are recorded as part of the external examination. An investigation was undertaken to determine whether negative messages that are tattooed on a decedent may indicate a predisposition to certain fatal outcomes. METHODS Tattooed and nontattooed persons were classified by demography and forensics. Tattoos with negative or ominous messages were reviewed. Statistical comparisons were made. RESULTS The mean age of death for tattooed persons was 39 years, compared with 53 years for nontattooed persons (P = .0001). There was a significant contribution of negative messages in tattoos associated with nonnatural death (P = .0088) but not with natural death. However, the presence of any tattoo was more significant than the content of the tattoo. CONCLUSIONS Persons with tattoos appear to die earlier than those without. There may be an epiphenomenon between having tattoos and risk-taking behavior such as drug or alcohol use. A negative tattoo may suggest a predisposition to violent death but is eclipsed by the presence of any tattoo.
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Manganoni AM, Sereni E, Pata G, Ungari M, Pavoni L, Farisoglio C, Calzavara-Pinton PG, Farfaglia R. Pigmentation of axillary sentinel nodes from extensive skin tattoo mimics metastatic melanoma: case report. Int J Dermatol 2013; 53:773-6. [PMID: 24372317 DOI: 10.1111/ijd.12417] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The relationship between the occurrence of skin diseases and skin tattoos remains unclear. Dermatologic disorders have been reported to occur in about 2% of cases. In addition, tattoo pigment can migrate to the regional lymph nodes through the lymphatic vessels and subsequently mimic metastatic disease from melanoma. METHODS A 23-year-old Caucasian man presented with a pigmented lesion on the left scapular region, which had slowly enlarged over time. The patient exhibited an extensive tattoo on the left upper arm, left shoulder, and part of the upper back. His medical history was unremarkable. The pigmented lesion was excised. Histology confirmed malignant melanoma. Ultrasound examination of the abdomen, neck, and inguinal and axillary lymph nodes and a total body computed tomography scan showed no sign of disease. A re-excision with 2-cm margins and sentinel lymph node biopsy (SLNB) were performed. Two grossly enlarged, black sentinel lymph nodes (SLNs) highly suggestive of melanoma metastases were removed. RESULTS No evidence of melanoma metastasis was found in any of the sampled tissues. Large amounts of pigment were present within the subcapsular space and sinusoid areas of the two clinically suspicious lymph nodes. Immunohistochemical analysis was negative. CONCLUSIONS Sentinel lymph node biopsy is widely performed in cutaneous melanoma. Histologic confirmation of any enlarged, pigmented SLN is essential prior to radical surgery, especially when pigmented SLNs are found near a tattoo. Tattoo pigments may deposit in the regional lymph nodes and may clinically mimic metastatic disease. A history of tattooing should be considered in all melanoma patients eligible for SLNB. In a finding of darkly pigmented nodes during SLNB, radical lymphadenectomy should be withheld until immunohistologic confirmation of metastasis in the SLN is obtained.
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Conaglen PD, Laurenson IF, Sergeant A, Thorn SN, Rayner A, Stevenson J. Systematic review of tattoo-associated skin infection with rapidly growing mycobacteria and public health investigation of a cluster in Scotland, 2010. Euro Surveill 2013; 18:20553. [DOI: 10.2807/1560-7917.es2013.18.32.20553] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Sporadic cases and outbreaks of tattoo-associated skin infection with rapidly growing mycobacteria have been reported although they often contain few details of public health investigations and have not previously been systematically collated. We present the details of the public health investigation of a cluster of cases, which occurred in Scotland in 2010. Investigation of the cluster involved case finding, environmental investigation of the tattoo studio and pathological and microbiological investigation of possible cases and tattoo ink. Mycobacterium chelonae was isolated from one case and three probable cases were identified. M. chelonae was grown from an opened bottle of ink sourced from the studio these cases had attended. In addition, in order to identify all published cases, we conducted a systematic review of all reported cases of tattoo-associated skin infection with rapidly growing mycobacteria. A total of 25 reports were identified, describing 71 confirmed and 71 probable cases. Mycobacteria were isolated in 71 cases and M. chelonae was cultured from 48 of these. The most frequently postulated cause of infection was the dilution of black ink with tap water. Reports of tattoo-associated rapidly growing mycobacterial skin infection are increasing in frequency. Interested agencies must work with the tattoo industry to reduce the risk of contamination during tattoo ink manufacture, distribution and application.
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Affiliation(s)
- P D Conaglen
- NHS Fife, Department of Public Health, Cameron House, Leven, United Kingdom
| | - I F Laurenson
- NHS Lothian, Scottish Mycobacteria Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - A Sergeant
- NHS Lothian, Department of Dermatology, Lauriston Building, Edinburgh, United Kingdom
| | - S N Thorn
- NHS Lothian, Department of Public Health, Waverley Gate, Edinburgh, United Kingdom
| | - A Rayner
- NHS Lothian, Scottish Mycobacteria Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - J Stevenson
- NHS Lothian, Department of Public Health, Waverley Gate, Edinburgh, United Kingdom
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Matsika A, Srinivasan B, Gray JM, Galbraith CR. Tattoo pigment in axillary lymph node mimicking calcification of breast cancer. BMJ Case Rep 2013; 2013:bcr-2013-200284. [PMID: 23929611 DOI: 10.1136/bcr-2013-200284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A tattoo is defined as the intentional or accidental deposit of pigment into the skin. The phenomenon of skin tattooing is on the rise worldwide and complications of tattooing are increasingly being recognised in diagnostic and clinical medicine. We describe a case of calcification-like changes on mammography resembling that of breast malignancy as a result of tattoo pigment deposition in an axillary lymph node. Recognition of such changes in routine breast screening is crucial to avoid further unnecessary invasive investigations and surgery in such patients.
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Affiliation(s)
- Admire Matsika
- Department of Anatomical Pathology, Pathology Queensland, Herston, Queensland, Australia.
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