Reactive perforating collagenosis on a tattoo

Acquired Reactive Perforating Collagenosis Occurring in Association With Nonred Ink Tattoo

ABSTRACT

Perforating dermatosis is a group of skin conditions in which there is transdermal elimination of collagen, elastic fibers, or other dermal connective tissue. Perforating dermatosis can be genetic or acquired, known as acquired perforating dermatosis (APD). When collagen is the primary extruded material in acquired cases, the disease is designated as acquired reactive perforating collagenosis (RPC). We report a case of acquired RPC occurring in a new tattoo. One week after having a new tattoo placed on the left forearm, a 38-year-old gentleman presented to the emergency room with pruritic, crusted plaques and erosions in the regions of red and green inks of the tattoo. Histopathologic examination of the biopsy revealed an ulceration with transepidermal elimination of collagen bundles accompanied by basophilic debris, scattered dermal tattoo pigment, and a superficial to deep perivascular lymphohistiocytic infiltrate with scattered neutrophils and eosinophils. There have been 2 reported cases of tattoo-associated RPC, both in association with red tattoo ink. This present case is the first reported APD to occur in association with nonred tattoo ink. This case reaffirms the conclusions of others in recognizing APD as a potential tattoo-associated complication.

Suppurative granulomatous tattoo reaction: Complete remission with photodynamic therapy

Tattoo complications are an increasing reason for dermatological consultation in recent years, becoming a therapeutic challenge in some cases. We present a case of a suppurative granulomatous reaction in a tattoo resistant to oral antibiotic and topical corticosteroid treatment that resolved after four sessions of photodynamic therapy (PDT) with methyl aminolevulinate, possibly due to its anti-inflammatory and antimicrobial action, with an excellent aesthetic result. We suggest that the clinical utility of PDT may be expanded to treatment of tattoo complications, as well as in cutaneous infections of unknown microorganisms resistant to antibiotics.

Acquired reactive perforating collagenosis: A case report and review of the literature

INTRODUCTION

Acquired reactive perforating collagenosis (ARPC) is a rare skin disorder, which is associated with various internal diseases and even malignant neoplasms. A comprehensive knowledge of the concomitant diseases in ARPC patients is helpful to decrease the misdiagnosis. Although the treatment of ARPC is challenging, systemic assessment of existing regimens is not available.

PATIENT CONCERNS

A 50-year-old woman was admitted to the hospital due to cutaneous pruritus and papules all over the body.

DIAGNOSIS

Physical examination showed various sized papules on the lower limbs, buttocks, back, chest, and upper arms with keratotic plugs in the center. Histopathology showed typical collagenous fiber perforation. The diagnosis of ARPC was made according to histopathology, onset age and typical skin lesions. Type 2 diabetes mellitus (T2DM), chronic renal failure (CRF), and hypothyroidism simultaneously presented in this patient.

INTERVENTIONS

This patient was initially treated with topical corticosteroids and oral antihistamines for the skin lesion and pruritus. Medications for glucose control and recovery of renal and thyroid functions were also applied. On the second admission, the combined therapy of topical retinoic acid, Chinese medicinal herb-Qingpeng ointment, and Zinc oxide ointment was added.

OUTCOMES

Papules and pruritus were improved significantly after the second hospitalization.

CONCLUSION

We present a case of ARPC associated with T2DM, CRF, and hypothyroidism, which has rarely been described. There is no standardized treatment for ARPC. Co-administration of two or more agents for dermatologic interventions and treatment for associated diseases may help to improve skin symptoms.