Patterns of Reactions to Red Pigment Tattoo and Treatment Methods

Abstract

Tattoos are common and used extensively as either body art or cosmetic make-up; more rarely, they can be traumatic in nature. We have systemically analysed the literature for the patterns of red pigment tattoo reactions and their treatment options. Our search identified 18 articles; there was 1 non-randomised controlled trial, and the rest were small case studies. In total 139 patients were included within the studies. This review systematically analyses the different subsets of red tattoo reactions including lichenoid, dermatitis, granulomatous, pseudolymphomatous and miscellaneous reactions. The current evidence for the treatment for the above is presented. Dermatitis and lichenoid reactions appear to be the most common subtype of red pigment reactions with various treatment methods applied showing laser intervention to have some degree of success.

Systemic contact dermatitis to a surgical implant presenting as red decorative tattoo reaction

“…Tattoo reactions are commonly described clinically and histologically as eczematous, lichenoid, granulomatous, spongiotic, and pseudolymphomatous reactions. Eczematous and lichenoid reactions are the most common type of red pigment reactions 6, 7, 8, 9. Increased T lymphocytes and Langerhans cells are often found at tattoo reaction sites and are consistent with an allergic pathomechanism 6 …”

“…In individuals for whom implant removal is not possible, a tapered dose of oral prednisone over 21 days may be helpful 1, 2, 3. For tattoo-related dermatitis, varying degrees of success with oral allopurinol, topical and intralesional corticosteroids, antibiotics, surgical excision, and laser have been reported 4, 7, 8, 9…”

“…Adverse tattoo reactions are common and predominantly affect red pigmented areas. Although reactions were often caused by an allergy to particular metals within pigments in the past, with the shift toward the use of azo dyes, the mechanism is unclear 6, 7, 8…”

Cutaneous T pseudolymphoma on the red pigmented areas of a tattoo

“…Heterogeneous red tattoo‐related manifestations have been reported in literature, including dermatitis, lichenoid, granulomatous, photoinduced, sarcoid, and pseudolymphomatous reactions, although the first two patterns seem to be the most common subtype. Furthermore, these manifestations can appear immediately or be delayed, particularly as in the case of allergic contact dermatitis, CP, granulomatous, and lichenoid dermatitis …”

“…Furthermore, although cases of spontaneous regression have been described, multiple therapeutic options have been reported in literature such as topical and intralesional corticosteroids, surgery (whenever possible), and Nd‐YAG laser therapy . It is conceivable that PSLs may progress into overt cutaneous lymphoma induced by persistent antigenic stimulation.…”