Lichen planus pemphigoides after body tattooing

Abstract

Decorative tattooing is very popular worldwide and is associated with cutaneous complications, ranging from infections to localized or generalized skin reactions. We report a case of a patient presenting with generalized violaceous pruritic papular lesions 1 month after obtaining a black ink tattoo. Histological examination of a papular lesion distal to the tattoo site showed focal band‐like lymphocytic infiltrate. He subsequently developed bullae over the papular lesions, with elevated serum BP180 antibody levels. A diagnosis of generalized lichen planus and lichen planus pemphigoides was made. He responded to treatment with potent topical corticosteroids and ciclosporin. We also reviewed the presentation and treatment of published cases of lichenoid reactions in the literature. With the increasing popularity of tattoos, awareness of this potential complication and possible treatments is important.

A 9‐year‐old boy with lichenoid skin lesions

“…1 It is therefore assumed that the inflammatory process of LP leads to basal cell layer damage and antigen exposure, evoking autoantibody production (epitope spreading). 5,9 LPP is usually idiopathic, but there are case reports describing drug-induced LPP (angiotensin-converting-enzyme inhibitors, 10 simvastatin, 11 pembrolizumab 12 ), after hepatitis B infection, 13 after tattooing, 14 and in association with paraneoplastic diseases. 15,16 Considering the theory of epitope spreading and the different triggers, it could be hypothesized that LPP is a variant of bullous pemphigoid triggered by LP rather than a distinct entity.…”

Ein neunjähriger Junge mit lichenoiden Hautveränderungen

“…Diese, 5,9 wiederum können die Produktion von Autoantikörpern hervorrufen (Epitop-Spreading). 5,9 Die LPP ist in der Regel idiopathisch, es gibt jedoch Fallberichte, in denen eine medikamentös induzierte LPP beschrieben wird (Angiotensin-Converting-Enzyme-Hemmer, 10 Simvastatin, 11 Pembrolizumab 12 ), nach einer Hepatitis-B-Infektion, 13 nach Tätowierungen, 14 und in Verbindung mit paraneoplastischen Erkrankungen. 15,16 In Anbetracht der Theorie des Epitop-Spreading und der verschiedenen Auslöser könnte die Hypothese aufgestellt werden, dass das LPP eher eine Variante des bullösen Pemphigoids ist, die durch die LP ausgelöst wird, als eine eigenständige Entität.…”

“…2,17 Die Entwicklung von LP an der Tätowierung wird als Köbner-Phänomen betrachtet und wurde insbesondere bei Patienten mit vorbestehenden Dermatosen berichtet. 14…”

Histopathology of Dermatologic Complications of Tattoos

“…Systematic search of skin and mucosal lichen planus lesions should be performed. 63 Pseudolymphomas on tattoos are characterized by a diffuse lymphocytic infiltrate that extends over the whole dermis with perivascular reinforcement (Fig. 25).…”

“…68 Isomorphic reactions in tattoos were initially described by Koebner himself, and several dermatoses are at risk, such as psoriasis, 69,70 (Fig. 26) lichen planus, 63,71 vitiligo, 72 pyoderma gangrenosum, 73 discoid lupus erythematosus, 74,75 or systemic sarcoidosis. 61,76 Papulonodular reactions in black tattoos are highly associated with sarcoidosis.…”