A painful experience: black henna tattoo causing severe, bullous contact dermatitis

Necrotizing Black Tattoo Reaction

“…[5] Previous authors have suggested that carbon is sufficient to stimulate the granulomatous response; [5] however, the lack of a positive patch test and the rapidity of onset of this patient's symptoms together with the resolution of his signs with antibacterials indicates that an infectious etiology was the cause of his symptoms. The rapid resolution of the patient's signs was similar to that reported previously; [5] however, ulceration of the skin at the site of tattooing and subsequent replacement of the pigment with hyperpigmented healthy skin has not been reported previously. We are unable to explain why the red pigment around the black lettering was not involved in the infectious process.…”

“…[1] Reactions to red, green, yellow, and blue tattoos are not infrequent. [2] Although reactions to temporary black tattoos are common, [3][4][5][6] reactions to permanent black tattoos are very rare, with only three cases having been reported. [7][8][9] In patients with allergic reactions to black tattoos, a foreign body or epithelioid granulomatous reaction to the pigment is seen with numerous pigment-filled giant cells and epithelioid cells.…”

“…[7][8][9] In patients with allergic reactions to black tattoos, a foreign body or epithelioid granulomatous reaction to the pigment is seen with numerous pigment-filled giant cells and epithelioid cells. [5] The time interval from tattooing to presentation of an allergic reaction varies from weeks to months. [3][4][5] The reaction seen in our patient was unlikely to have been allergic because the delay between tattooing and the reaction was too short for a delayed-type allergy; moreover, our patient had no previous history of sensitization.…”

“…[5] The time interval from tattooing to presentation of an allergic reaction varies from weeks to months. [3][4][5] The reaction seen in our patient was unlikely to have been allergic because the delay between tattooing and the reaction was too short for a delayed-type allergy; moreover, our patient had no previous history of sensitization. Infectious complications occur within 4-22 days and range from mild cellulitis and small pustules to abscesses; [10,11] however, severe necrotizing infection affecting black tattoos has not been previously reported.…”

Henna tattoo contact dermatitis — a report of four cases and brief review of the selected literature

“…Sensitivity to other additives to henna, mostly to PPD, was more prevalent [6,7,12,[14][15][16][17]. Intensity of skin lesions may vary from eczema, erythema multiformelike reactions, to bullous contact dermatitis reactions [6,12,15,[18][19][20][21]. As a consequence of temporary tattoo contact dermatitis, scarring, keloid formation, and permanent post inflammatory pigment changes have been described [14,22,23].…”