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 tattooassociated 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.

Perforating Gout: Expanding the Differential for Transepidermal Elimination

“…Associations with immunobullous diseases have also been noted [ 50 , 51 , 52 ]. Less common associations include pregnancy [ 53 , 54 ], non-red tattoos [ 55 ], MRSA [ 56 ], copper deficiency [ 57 ], Down’s syndrome [ 58 ], and rhabdomyolysis-related hypercalcemia [ 59 ]. One report noted acquired perforating dermatosis in a pair of siblings [ 60 ], suggesting that there may be a genetic component involved in the etiology.…”

Perforating Gout: Expanding the Differential for Transepidermal Elimination

“…Associations with immunobullous diseases have also been noted [50][51][52]. Less common associations include pregnancy [53,54], non-red tat-toos [55], MRSA [56], copper deficiency [57], Down's syndrome [58], and rhabdomyolysisrelated hypercalcemia [59]. One report noted acquired perforating dermatosis in a pair of siblings [60], suggesting that there may be a genetic component involved in the etiology.…”