Granulomatous tattoo reaction with associated uveitis successfully treated with methotrexate

Maijer, Karen I.; Bent, S A S van der; Vercoutere, Ward; Rustemeyer, Thomas

doi:10.1111/jdv.14854

Cited by 14 publications

(14 citation statements)

References 7 publications

(19 reference statements)

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“…We selected 27 articles, published between 1952 and 2018, for a total of 39 patients . We considered three distinct groups separately: (i) sarcoidosis on permanent tattoos associated with uveitis and systemic involvement or cutaneous sarcoids outside of tattoos; (ii) granulomatous tattoo reactions associated with uveitis without evidence for systemic sarcoidosis; and we also included here (iii) exceptional cases of uveitis after tattooing, without any granulomatous reaction on tattoos nor systemic sarcoidosis . Only three series were dedicated to tattoo‐associated uveitis: seven cases from USA, three cases from Sweden and two cases from Czech Republic .…”

Section: Resultsmentioning

confidence: 99%

“…In 2013, we had reviewed eight cases of uveitis after tattooing, seven cases of which were associated with tattoo granulomas . Since then, we found in the literature 15 additional cases . Overall, 22 cases have been reported since 1969 .…”

Section: Resultsmentioning

confidence: 99%

“…[19][20][21][22][23] Since then, we found in the literature 15 additional cases. 16,[24][25][26][27][28][29][30][31] Overall, 22 cases have been reported since 1969. 19 Fifteen of those cases were reported in ophthalmology journals.…”

Section: Isolated Uveitis With Tattoo Granulomasmentioning

confidence: 99%

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Tattoo‐associated uveitis with or without systemic sarcoidosis: a comparative review of the literature

Kluger

2018

Acad Dermatol Venereol

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Sarcoidosis is a systemic disease of unknown aetiology characterized by the presence of non-caseating epithelioid cell granulomas in multiple organs, mainly the lungs and the lymphatic system. It is also one of the leading cause of inflammatory eye diseases. For the past 70 years, sarcoidal granulomas on tattoos and permanent make-up have been documented. They can be the first and sometimes unique cutaneous manifestation of systemic sarcoidosis. A few cases of sarcoidosis with uveitis and granulomatous reactions within tattoos have been described. However, since the end 60s, a singular entity has been reported associating isolated uveitis with granulomatous cutaneous reaction restricted to tattoos in the notable absence of systemic sarcoidosis. It remains unclear whether this entity must be distinguished from sarcoidosis. This review summarizes the currently available data on this topic and compares cases of sarcoidosis with granulomatous tattoo reaction and uveitis to the cases without notable sarcoidosis. We propose the acronym TAGU (TAttoo Granulomas with Uveitis) as an exclusion diagnosis that emcompasses the patients for whom we fail to find any sarcoidosis or other causes after extensive investigation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Tattoo‐associated uveitis with or without systemic sarcoidosis: a comparative review of the literature

Kluger

2018

Acad Dermatol Venereol

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“…Allergic tattoo reactions were defined as chronic inflammatory reactions, manifesting in one single colour and persisting for at least 3 months [5,19]. As there are currently no routine patch tests, the distinction between an allergic tattoo reaction, sarcoidosis and foreign body reaction is mostly clinical (the allergic tattoo reaction is localised to one specific colour) [20,21]. Furthermore, the histopathology of allergic tattoo reactions is frequently granulomatous as well [22].…”

Section: Methodsmentioning

confidence: 99%

Ablative laser surgery for allergic tattoo reactions: a retrospective study

Bent¹,

Huisman²,

Rustemeyer³

et al. 2020

Lasers Med Sci

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Patients with allergic tattoo reactions are burdened with itch and have a reduced quality of life. Conservative treatment is often insufficient and little is known about treatment options to remove the responsible allergen. We aimed to address the effectiveness and safety of ablative laser therapy including measurement of patient’s satisfaction, in patients with allergic reactions to tattoos. A retrospective study was conducted including patients with allergic tattoo reactions who were treated with a 10,600 nm ablative CO2 laser, either by full-surface ablation or fractional ablation. Clinical information originated from medical files and a 25-item questionnaire. Sixteen tattoo allergy patients were treated with a CO2 laser between January 2010 and January 2018. Fourteen patients completed the questionnaire. Ten patients were satisfied with laser treatment. On a visual analogue scale, pruritus and burning improved with a median of 5.5 and 4 points in the full surface ablation group and 3 points on both parameters in the fractional ablation group. Despite the relatively small group of patients, our results suggest that CO2 laser ablation improves itching, burning and impact on daily life in tattoo allergy.

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“…The pathomechanism of such reactions is suggested to be non‐allergic and due to foreign body reaction where the black pigment particles over time form agglomerates in the skin . Sarcoid reactions locally in the tattoo and systemic sarcoidosis in organs such as the lung and the eye have previously been described in relation to tattoos . Reactions in red‐pigmented tattoos typically occur due to an acquired allergy towards the red pigment with dermal inflammation resulting in distinct clinical reaction patterns namely plaque elevation, excessive hyperkeratosis and ulcero‐necrotic reaction .…”

Section: Introductionmentioning

confidence: 99%

Tattoo pigment agglomerates measured in skin biopsies by computerised light microscopy

Carlsen

Larsen²,

Serup

2019

Skin Research and Technology

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Background Black tattoo reactions are suggested to be foreign body reactions manifested as papulo‐nodular inflammation that is associated with active sarcoidosis. Aim To study the morphology of black and red pigment agglomerates in skin biopsies from tattoo reactions, referenced to clinical diagnoses. Method Agglomerate count, area, width, height, circumference and circularity were measured in 161 patients by light microscopy (Olympus BX51™); 161 unstained skin biopsies from 64 black tattoo reactions and 97 reactions in red tattoos with allergy. Images (Jenoptic Gryphax RGB camera) were taken through a 40× objective using immersion oil. Computerised analysis of agglomerates was performed using ImageJ software. Student t test, chi‐square test, Fisher Exact test, ANOVA and Bonferroni tests were applied. Results Comparison of black and red pigment agglomerates showed no overall differences in count, area, width, height or circumference. However, in black tattoo reactions, the count of agglomerates was higher in patients with sarcoidosis (P = .009) vs no sarcoidosis. Black agglomerates were more circular shaped as compared to red, P = .023. In red tattoo reactions, agglomerates in patients with allergic cross‐reactivity were slightly more circular (P = .036) vs patients with milder allergy. The count of red agglomerates was lower in patients clinically typed excessive hyperkeratosis (P = .041) compared with other clinical types of allergy. Conclusion Patients with reactions in black tattoos associated with sarcoidosis have increased count of pigment agglomerates vs those without associated sarcoidosis indicating that black pigment agglomeration is one among a number of factors triggering sarcoid tattoo complication. Circular shape of agglomerates may code for bioactivity.

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Granulomatous tattoo reaction with associated uveitis successfully treated with methotrexate

Cited by 14 publications

References 7 publications

Tattoo‐associated uveitis with or without systemic sarcoidosis: a comparative review of the literature

Tattoo‐associated uveitis with or without systemic sarcoidosis: a comparative review of the literature

Ablative laser surgery for allergic tattoo reactions: a retrospective study

Tattoo pigment agglomerates measured in skin biopsies by computerised light microscopy

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