Thirty-one female patients with leprosy lesions starting over tattoo marks observed over a period of 16 years are reported. All the patients belonged to the Chhattisgarh State, which is highly endemic for leprosy. Most of the patients were in the third decade of life. All of them had ornamental tattooing done by roadside tattoo artists, who used unsterile needles for tattooing a large gathering one after another with the same needles. In all of them, the first lesion of leprosy started over a tattoo mark. Twenty-five cases had only single lesion of leprosy exclusively confined to tattoo marks. The duration between tattooing and appearance of first lesion in most of the cases varied from 10 to 20 years. Paucibacillary leprosy was the commonest type observed in 29 cases, while two had multibacillary leprosy. The diagnosis was confirmed by histopathology in all cases. The present report supports the hypothesis of transmission of leprosy in these cases through tattooing. To the best of our knowledge, such a large collection of leprosy cases subsequent to tattooing has not been reported so far.

Congenital linear naevoid psoriasis along Blaschko's lines on the thigh of a 3-year-old girl is reported. The history of asymptomatic, erythematous scaly lesions since birth, the peculiar distribution and the histopathology confirmed the diagnosis.

A 30‐year‐old Indian man presented with multiple asymptomatic skin lesions on the arms, buttocks, trunk, and knees of 4 months’ duration. These lesions had started over the right arm and gradually increased in number and spread to involve the other sites. There was no history of any skin lesions in the past. Family members were normal.  Cutaneous examination showed multiple, skin‐colored, shiny papules abruptly arising over the surrounding normal skin of the arms, buttocks, legs, trunk, and pinnae, varying from 2 to 3 mm in size. Some of the papules over the trunk and arms showed central umbilication resembling molluscum contagiosum, and a few showed superficial erosions and/or crusting (Fig. 1a,b). A few similar, erythematous papules over the left buttock showed a linear distribution, suggestive of pseudo‐isomorphic Koebner phenomenon (Fig. 2a,b). There was hypoesthesia in the distal part of the arms and legs for thermal, touch, and pain sensation, and the bilateral lateral popliteal and ulnar nerves were thick and mildly tender. The clinical features were suggestive of histoid leprosy. Systemic and eye examination were normal. Routine hematology and liver and kidney function tests were normal, and blood venereal disease research laboratory (VDRL) test and enzyme‐linked immunosorbent assay (ELISA) for human immunodeficiency virus (HIV) 1 and 2 were negative. Histopathology from a papular lesion showed a thinned out epidermis, flattened rete ridges, a subepidermal Grenz zone, and granulomas of closely packed, spindle‐shaped histiocytes arranged in whorls, with foamy macrophages. In addition to the above histologic findings, the molluscoid lesion also showed an epidermal erosion with acid‐fast bacilli demonstrated by Ziehl–Neelsen stain (Fig. 3a,b). Slit skin smear examination from both the ear lobes and umbilicated lesions was highly positive, with a bacillary index (BI) of 6+ (> 1000 bacilli per oil immersion field) and a morphologic index (MI) of 80% (Fig. 3c). A diagnosis of histoid leprosy was made. The patient was treated with daily rifampicin and ofloxacin for 2 months, followed by standard multibacillary (MB) multidrug therapy (MDT) with daily dapsone and clofazimine with monthly rifampicin for 2 years. An excellent response to treatment was obtained with regression of all the skin lesions. 1 (a) Umbilicated and shiny papular skin lesions arising abruptly over normal skin. (b) Umbilicated, crusted, and eroded pigmented lesions over the arm 2 (a) Multiple shiny papular lesions over both buttocks, showing linearly arranged skin lesions on the outer aspect of the upper lateral quadrant of the left buttock. (b) Close‐up view of the linearly arranged papular skin lesions on the buttock 3 (a) Histopathology from a ruptured umbilicated papule showing a thinned out epidermis with flattened rete ridges, an epidermal erosion in the center, a subepidermal Grenz zone, and granuloma of closely packed spindle‐shaped histiocytes arranged in whorls, with foamy macrophages (Ziehl–Neelsen stain; original magnificati...

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Lupus vulgaris developing after tattooing and remaining exclusively confined to it, in a 40-year-old-lady is reported. The tattooing was done one year earlier by a roadside tattoo artist. Diagnosis was suggested by the clinical features and confirmed by histopathology.