Cutaneous reaction to cosmetic lip tattooing

Azo pigments and quinacridones induce delayed hypersensitivity in red tattoos

“…The reaction to quinacridone described by Greve occurred 4 weeks after tattooing . In addition, 5 cases of late reactions (after several years) have been reported with inorganic pigments and inks of unknown composition . One of our patients had an early reaction (2 weeks).…”

“…Reduced quality of life was recently reported in patients with tattoo reactions (29), and treatment is difficult. In our series, as elsewhere, treatment with a potent topical steroid and intralesional triamcinolone was unsuccessful (3,7,8,13,30). Pulsed laser therapy is effective in removing tattoos by selectively blasting the pigment free into the dermis, which is then secondarily removed by macrophages (4,20,31).…”

“…We observed two lichenoid reactions, two pseudolymphomatous reactions and one eczematous reaction with the azo dyes, and one eczematous and one lichenoid reaction with quinacridones. As reported elsewhere, the lichenoid pattern is commonly observed . In contrast, there are few reports of pseudolymphomatous reactions .…”

“…No preservatives were mentioned in the Material Safety Data Sheet enclosed with each ink. In spite of the rarity of positive patch test reactions in other reports, all authors agree in considering colorants to be the causal allergens (3,6,(7)(8)(9)(10)(11)(12)(13)(14). However, the responsibility of other compounds, such as impurities, metal particles, and decomposition products of the inks, cannot be excluded.…”

“…However, 1 of our patients had a reaction at D7 after patch testing, which suggests that delayed test reading can be useful. One other author reported a late reaction, at D8 (8). A negative patch test result does not, however, rule out pigment as a cause.…”