Systemic Allergic Reaction to Red Tattoo Ink Requiring Excision

Duan, Linna; Kim, Samuel; Watsky, Kalman L.; Narayan, Deepak

doi:10.1097/gox.0000000000001111

Cited by 3 publications

(3 citation statements)

References 5 publications

(5 reference statements)

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“…These include infections, allergic reactions, or the manifestation of autoimmune diseases. Of all tattoo complications, allergic reactions are the most frequent chronic tattoo reactions observed in the dermatologic practice. − Here, red tattoo pigments are involved in the vast majority of the cases. These reactions are characterized by chronic itch, pain, or swelling and may occur weeks or even years later. , Treatment is difficult as the tattoo pigments are permanently dermally located .…”

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confidence: 99%

Tattoo Pigment Identification in Inks and Skin Biopsies of Adverse Reactions by Complementary Elemental and Molecular Bioimaging with Mass Spectral Library Matching

et al. 2022

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Tattooing has become increasingly popular throughout society. Despite the recognized issue of adverse reactions in tattoos, regulations remain challenging with limited data available and a missing positive list. The diverse chemical properties of mostly insoluble inorganic and organic pigments pose an outstanding analytical challenge, which typically requires extensive sample preparation. Here, we present a multimodal bioimaging approach combining micro X-ray fluorescence (μXRF) and laser desorption ionization-mass spectrometry (LDI-MS) to detect the elemental and molecular composition in the same sample. The pigment structures directly absorb the laser energy, eliminating the need for matrix application. A computational data processing workflow clusters spatially resolved LDI-MS scans to merge redundant information into consensus spectra, which are then matched against new open mass spectral libraries of tattoo pigments. When applied to 13 tattoo inks and 68 skin samples from skin biopsies in adverse tattoo reactions, characteristic signal patterns of isotopes, ion adducts, and in-source fragments in LDI-MS 1 scans yielded confident compound annotations across various pigment classes. Combined with μXRF, pigment annotations were achieved for all skin samples with 14 unique structures and 2 inorganic pigments, emphasizing the applicability to larger studies. The tattoo-specific spectral libraries and further information are available on the tattoo-analysis.github.io website.

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confidence: 99%

Tattoo Pigment Identification in Inks and Skin Biopsies of Adverse Reactions by Complementary Elemental and Molecular Bioimaging with Mass Spectral Library Matching

et al. 2022

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“…They typically present as, localized to the red tattoo area, swelling, granulomas, ulceration, pruritis or hyperkeratosis [ 4 , 5 , 13 ]. Very rarely, systemic response, as in the case of our patient, occurs [ 13 , 19 ]. It may manifest as widespread dermatitic eruption, rosacea, scaling, erythema and papules on extensive parts of the body.…”

Section: Discussionmentioning

confidence: 90%

When Body Art Goes Awry—Severe Systemic Allergic Reaction to Red Ink Tattoo Requiring Surgical Treatment

Szulia

Antoszewski

Zawadzki

et al. 2022

IJERPH

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The aim of this report is to present a case of a patient who developed unusual systemic hypersensitivity reaction to a red-pigmented tattoo and to discuss diagnostic difficulties in case of systemic reactions to tattoo ink. The patient reported erythroderma on his arms and chest accompanied by plaque elevation of red parts of his most recently performed forearm tattoo as his primary symptoms. His health condition entailed a prolonged topical and intravenous immunosuppressive therapy, which proved ineffective. Over a year after emergence of initial symptoms, he presented to the Plastic Surgery Clinic with generalized erythroderma, systemic lymphadenopathy, elevation and granuloma formation in red tattoos on his forearm and complaints of fatigue and inability to participate fully in work-related and social activities. The patient underwent six staged excisions with direct closures, flap plasties and full-thickness skin grafts. Following completion of each surgical resection, the patient’s symptoms gradually subsided. We find this case illustrative of a clinical challenge that delayed hypersensitivity reactions to red tattoos may pose. Furthermore, we provide insights on management of hypersensitivity reactions. This report underlines the importance of social awareness of and public health approach to tattoo complications as key to successful prevention, identification and treatment of adverse reactions to tattoos.

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“…In recent years, studies and case reports have been published on black and red tattoos since these colours are predominantly used and more often cause problems . Black tattoo reactions primarily present a papulo‐nodular pattern.…”

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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Systemic Allergic Reaction to Red Tattoo Ink Requiring Excision

Cited by 3 publications

References 5 publications

Tattoo Pigment Identification in Inks and Skin Biopsies of Adverse Reactions by Complementary Elemental and Molecular Bioimaging with Mass Spectral Library Matching

Tattoo Pigment Identification in Inks and Skin Biopsies of Adverse Reactions by Complementary Elemental and Molecular Bioimaging with Mass Spectral Library Matching

When Body Art Goes Awry—Severe Systemic Allergic Reaction to Red Ink Tattoo Requiring Surgical Treatment

Tattoo pigment agglomerates measured in skin biopsies by computerised light microscopy

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