Pseudoepitheliomatous Hyperplasia: An Uncommon Reaction in Tattoos

To the Editor: The growth in popularity of tattooing in recent decades has coincided with an increase in the number of articles describing adverse effects associated with tattooing. Complications associated with tattoos include cutaneous and systemic infectious processes, inflammatory reactions with varied histological patterns, the appearance of benign or malignant skin tumors in tattooed areas of skin, and various dermatoses in tattooed areas resulting from isomorphic phenomena.1 A 39-year-old man consulted for an itchy rash in the red-ink areas of a tattoo completed 1 month earlier. Physical examination revealed well-defined, firm, raised, erythematous hyperkeratotic lesions coinciding with the areas of red ink (Fig. 1). Dermoscopy showed rounded or oval-shaped areas of variable size with an erythematous center and a pinkish periphery, separated from one other by yellowish hyperkeratotic scales (Fig. 2). Histology showed marked acanthosis and epidermal papillomatosis without atypical cells, hyperkeratosis and areas of parakeratosis, and intracellular and extracellular deposits of red pigment in the dermis accompanied by a predominantly lymphohistiocytic infiltrate (Fig. 3). Culture of a biopsy sample for fungi, bacteria, and mycobacteria was negative. The results of patch and prick tests were negative..