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

Mycobacterium haemophilum infection in immunocompetent adults: a literature review and case report

BACKGROUND

Mycobacterium haemophilum has been increasingly found in severely immunocompromised patients but is scarcely reported in immunocompetent adults.

METHODS

We systematically reviewed previous literature to identify studies on infection in immunocompetent adults. Articles reporting at least one case of M. haemophilum infection were included. We excluded articles involving patients who had immunosuppression-related diseases and routinely used glucocorticoids or immunosuppressants. We also reported a case of a young immunocompetent woman infected by M. haemophilum along the eyebrows, which was probably due to the use of an eyebrow pencil retrieved from a sink drain.

RESULTS

Twelve qualifying articles reporting M. haemophilum infection in immunocompetent adults were identified. Among them, most cases report skin lesions along the eyebrows, and the remaining had cervicofacial lymphadenitis, lesions on the arm or fingers, inflammation in the eyeballs, or ulceration in the perineal region. Most cases were caused by tattoos, make-up, injury, or surgical operation. For diagnosis, specialized tissue culture sensitivity was roughly 75%, and polymerase chain reaction (PCR) test sensitivity was approximately 89%. Triple antibiotic therapy for 3 to 24 months, or surgical excision was effective in controlling infection.

CONCLUSION

M. haemophilum infection should be considered if routine antibacterial and glucocorticoid treatments are ineffective against the disease, even in healthy adults. To definitively diagnose this infection, conditioned tissue culture or PCR testing is required. Treatment usually involves a combination of multiple antibiotics and, if necessary, surgical removal of infected tissue.

Mycobacterium haemophilum infection with cutaneous involvement: two case reports and an updated literature review: Mycobacterium haemophilum skin infection

Mycobacterium haemophilum (MH) is a slow-growing, non-tuberculous Mycobacterium that most commonly causes infections in immunocompromised patients. The skin is the most prevalent site of infection and can be an isolated presentation or part of a disseminated disease. Herein, we reported a case of isolated MH infection of the hand and a case of disseminated MH infection with multiple skin lesions. In addition, other MH cases with cutaneous involvement over the last 10 years, from 2011-2022, were reviewed and analyzed. Among the 79 included cases, the common skin findings in MH infections included nodules, ulcers, abscesses, swelling, and pustules. Middle-aged patients with iatrogenic immunosuppression from glucocorticoids, mycophenolate mofetil, cyclosporine, and cyclophosphamide are the most susceptible to MH infection, with a higher risk of dissemination to internal organs. Disseminated MH infections commonly present as tenosynovitis, arthritis/arthralgia, or osteomyelitis. There is a lack of strong evidence for treatment; however, triple therapy of quinolone, macrolides, and rifampicin is most often used in clinical practice. The overall prognosis is good. The presence of iatrogenic immunocompromised diseases, lesions involving the proximal limbs, and dissemination of MH infections are associated with worse clinical outcomes.

Hautbeteiligung bei Infektionen mit Mycobacterium haemophilum: Zwei Fallberichte und eine aktualisierte Literaturübersicht: Mycobacterium haemophilum infection with cutaneous involvement: Two case reports and an updated literature review

Mycobacterium haemophilum (MH) ist ein langsam wachsendes, nicht‐tuberkulöses Mykobakterium. Infektionen treten am häufigsten bei Patienten mit beeinträchtigtem Immunsystem auf; sie manifestieren sich meist an der Haut und kommen isoliert oder bei disseminierten Infektionen vor. Wir berichten hier über einen Fall mit isolierter MH‐Infektion an der Hand sowie über einen weiteren Fall von disseminierter MH‐Infektion mit multiplen Hautläsionen. Zusätzlich haben wir weitere Fallberichte über MH‐Infektionen mit kutaner Beteiligung aus den letzten zehn Jahren (2011–2022) ausgewertet. Die am häufigsten beobachteten Hautmanifestationen der insgesamt 79 Fälle waren Knötchen, Ulzera, Abszesse, Schwellungen und Pusteln. Patienten mittleren Alters mit iatrogener Immunsuppression durch Glucocorticoide, Mycophenolat‐Mofetil, Ciclosporin und Cyclophosphamid scheinen besonders anfällig für MH‐Infektionen zu sein und haben auch ein höheres Risiko für eine Dissemination in die inneren Organe. Disseminierte MH‐Infektionen manifestieren sich gewöhnlich als Tenosynovitis, Arthritis/Arthralgie oder Osteomyelitis. Derzeit gibt es keine starke Evidenz für bestimmte Therapeutika; in der Praxis wird am häufigsten eine Dreifachkombination aus Chinolon, Makroliden und Rifampicin eingesetzt. Die Prognose ist allgemein gut. Iatrogene Immunsuppression, Läsionen im proximalen Bereich der Extremitäten sowie disseminierte Manifestation sind mit schlechteren klinischen Verläufen assoziiert.

Micropigmentation

Micropigmentation and microblading is a popular technique now a days which is used as a semi permanent method for camoflaging various dermatological indications. This article will elaborate upon various indications of micropigmenation. Micropigmentation is used in variety of dermatological conditions like semi permanent make up and vitiligo (stable forms). In this technique, a thorough knowledge of the indication and colour theory is crucial to achieve near to natural output. Micropigmentation or medical tattooing is a novel and easy to learn technique to camouflage various dermatological conditions like stable vitiligo, alopecia (androgenetic alopecia or stable alopecia areata) as well as for semi permanent make up.

Microblading-Induced Granulomatous Reaction: Case Report and Review of the Literature

ABSTRACT

Microblading is a common cosmetic procedure that can modify the appearance of one's eyebrows. Although generally well-tolerated, the procedure can cause a number of dermatologic issues; on rare occasions, granulomatous reactions can manifest. We use this case to highlight a presentation of a nonsarcoidal granulomatous dermatitis and review the literature on granulomatous reactions secondary to microblading. Of the 21 cases included in our review, approximately half (10/21) were diagnosed with foreign-body granulomas and the other half with sarcoidosis (7 of 21 with systemic sarcoidosis and 4 of 21 with cutaneous sarcoidosis). Although microblading remains a commonplace cosmetic technique, it is not without risk. Much like other types of tattoos, microblading can cause granulomatous reactions for which we must be vigilant, and further workup for sarcoidosis might be considered in select patients.

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

We outline constituents of tattoo and permanent make-up ink with regard to inflammatory tattoo reactions and population-based confounders. The comprehensive review of patch-tested tattoo patients between 1997 and 2022 shows that tattoo allergy cannot be reliably diagnosed via patch testing with today's knowledge. Weak penetration and slow haptenization of pigments, unavailability of pigments as test allergens and a lack of knowledge concerning relevant epitopes hamper the diagnosis of tattoo allergy. Patch testing p-phenylenediamine and disperse (textile) dyes is not able to close this gap. Sensitization to metals was associated with all types of tattoo complications, although often not clinically relevant for the tattoo reaction. Binders and industrial biocides are frequently missing on ink declarations and should be patch tested. The pigment carbon black (C.I. 77266) is no skin sensitizer. Patch tests with culprit inks were usually positive with cheap ink products for non-professional use or with professionally used inks in patients with eczematous reactions characterized by papules and infiltration. Tape stripping before patch testing and patch test readings on Day 8 or 10 may improve the diagnostic quality. The meaningfulness of the categorical EU-wide ban of Pigment Green 7 and Pigment Blue 15:3 is not substantiated by the presented data.

Case report: Subcutaneous Mycobacterium haemophilum infection in an immunocompetent patient after lipolysis injections

Mycobacterium haemophilum is a slow-growing, aerobic mycobacterium that acts as a pathogen in immunocompromised adult patients and immunocompetent children. There are only a few rare cases in the literature describing this species as a cause of subcutaneous infections. Here, we describe a subcutaneous infection caused by M. haemophilum in an immunocompetent female after lipolysis injections at an unqualified beauty salon, suggesting that this bacteria can also be a potential causative agent of adverse events in medical aesthetics. In addition, M. haemophilum caused lesions not only at the injection sites and adjacent areas but also invaded distant sections through the subcutaneous sinus tracts. Thus, early diagnosis and appropriate treatment are vital to prevent further deterioration and improve prognosis.

Microbiological Survey of 47 Permanent Makeup Inks Available in the United States

In two previous surveys, the U.S. Food and Drug Administration (FDA) identified microbial contamination in 53 of 112 (47%) unopened tattoo inks and tattoo-ink-related products (e.g., diluents) from 15 manufacturers in the U.S. In this study, we primarily focused our microbiological survey on permanent makeup (PMU) inks. We conducted a survey of 47 unopened PMU inks from nine manufacturers and a comparative species-centric co-occurrence network (SCN) analysis using the survey results. Aerobic plate count and enrichment culture methods using the FDA's Bacteriological Analytical Manual (BAM) Chapter 23 revealed that 9 (19%) inks out of 47, from five manufacturers, were contaminated with microorganisms. The level of microbial contamination was less than 250 CFU/g in eight inks and 980 CFU/g in one ink. We identified 26 bacteria that belong to nine genera and 21 species, including some clinically relevant species, such as Alloiococcus otitis, Dermacoccus nishinomiyaensis, Kocuria rosea, and Pasteurella canis. Among the identified microorganisms, the SCN analysis revealed dominance and a strong co-occurrence relation of spore-forming extreme environment survivors, Bacillus spp., with close phylogenetic/phenotypic relationships. These results provide practical insights into the possible microbial contamination factors and positive selection pressure of PMU inks.

Complications and Adverse Effects of Periocular Aesthetic Treatments

The popularity and variety of temporary and permanent periocular aesthetic treatments has increased over the past decade. Patients frequently present to eye clinics with ocular complications and side effects following these treatments, their severity ranging from ocular irritation from dry eyes to visual loss from vascular occlusion. A careful, thorough history is essential, as many patients may not associate aesthetic procedures with ocular complications, and some may be embarrassed to disclose this information. All ophthalmologists should understand the potential ocular sequelae of these treatments and be able to initiate treatment in sight-threatening cases. Wesummarises the current literature on ophthalmic complications of the most common periocular aesthetic treatments.

[Complications of cosmetic piercings and tattoos in the head and neck region]

Piercings and tattoos have gained popularity across all cultural environments during the past century, and one in ten Europeans are now pierced. While tattoos are often restricted to the rest of the body, piercings are common at facial sites such as ears, nose, lips, and tongue. Complications following piercings are not uncommon. Infections can rapidly spread across the auricular cartilage and require antibiotic and often surgical treatment. Mild trauma (i.e., piercing the earlobe) can lead to excessive scar formation due to fibroblast proliferation. Keloids have a particularly high rate of recurrence and are therefore difficult to treat. Due to recent developments in the field of permanent makeup, tattooing techniques are also increasingly applied in the head and neck region. Here, complications such as infection or allergic reactions can occur. Topical medication or laser procedures are the usual therapeutic options.

Facial Skin Lesions in Children Caused by Nontuberculous Mycobacteria

BACKGROUND

Nontuberculous mycobacteria rarely cause facial skin lesions in immunocompetent children.

AIM

I describe the clinical features and treatment of nontuberculous mycobacteria facial lesions.

MATERIALS AND METHODS

The diagnosis of a facial nontuberculous mycobacteria infection was established using polymerase chain reaction.

RESULTS

Of 286 children with confirmed nontuberculous mycobacteria infection, 14 (4.9%; median age 50 mos, range 9-156 mos; 5 [36%] male, 9 [64%] female) had nontuberculous mycobacteria facial skin lesions. Six (43%) had lesions on the cheek and five (36%) in the medial eye corner. Polymerase chain reaction results confirmed the presence of Mycobacterium haemophilum in eight patients (57%) and Mycobacterium avium in six patients (43%). The facial lesions were treated using a combination of clarithromycin and rifabutin for 12 weeks, with a median healing time of 4 months.

CONCLUSION

Nontuberculous mycobacteria facial lesions are rare in immunocompetent children. The diagnosis requires a high index of suspicion. Nonsurgical treatment is preferable, because surgical excision of the cutaneous lesions might lead to undesirable visible facial scars.

Nontuberculous mycobacterial infections: a potential complication of cosmetic procedures

Interest in surgical and non-surgical cosmetic procedures has increased significantly over the last few decades. Billions of dollars are spent on these procedures annually. Although the associated risk is generally low, multiple cases of skin and soft tissue infections have been reported. Nontuberculous mycobacteria (NTM), in particular M. chelonae, M. fortuitum, and M. abscessus, have been increasingly identified as causative of numerous cosmetic procedure–related infections worldwide. This has therefore become a public health concern. Delays in diagnosis and appropriate management may occur given subtleties in diagnostic methods. The purpose of this review is to highlight the NTM-related skin and soft tissue infections associated with more common cosmetic procedures, describe methods of identification, and outline best treatment practices.

Mycobacterium haemophilum as the Initial Presentation of a B-Cell Lymphoma in a Liver Transplant Patient

A 66-year-old woman presented with pustular lesions of her face, trunk, and limbs and an acute arthritis of the knees and elbows. She had a complex medical background and had been on immunosuppressants for three years after a liver transplant. Tissue samples from her skin lesions and synovial fluid showed acid-fast bacilli. Mycobacterium haemophilum, an atypical mycobacteria, was later grown on culture. During her treatment with combination antibiotic therapy, she developed a pronounced generalised lymphadenopathy. Histology showed features of a diffuse B-cell lymphoma, a posttransplant lymphoproliferative disorder (PTLD).

Systematic review of tattoo-associated skin infection with rapidly growing mycobacteria and public health investigation of a cluster in Scotland, 2010

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.

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

BACKGROUND

The incidence of tattoos has been increased markedly during the last 20 years.

AIMS

To analyze the patient files for severe adverse medical reactions related to tattooing.

SETTINGS

Academic Teaching Hospital in South-East Germany.

MATERIALS AND METHODS

Retrospective investigation from March 2001 to May 2012.

RESULTS

The incidence of severe adverse medical reactions has been estimated as 0.02%. Infectious and non-infectious severe reactions have been observed. The consequences were medical drug therapies and surgery.

CONCLUSIONS

Tattooing may be associated with severe adverse medical reactions with significant morbidity. Regulations, education and at least hygienic controls are tools to increase consumer safety.