Tattoo reactions in an HIV patient: Autoeczematization and progressive allergic reaction to red ink after antiretroviral therapy initiation

Gamba, Christina S.; Smith, Franki Lambert; Wisell, Josh; Brown, Mariah

doi:10.1016/j.jdcr.2015.09.007

Cited by 9 publications

(8 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It involves the activation of sensitized T lymphocytes when stimulated by contact with an antigen. Historically, most hypersensitivity reactions were related to mercury-derived pigments (i.e., cinnabar); however, reactions to red ink have persisted despite replacement with alternative red pigments such a cadmium red, sienna, and organic substances such as azo, sandalwood, and brazilwood [ 1 , 4 ]. Efforts to identify the specific allergen in modern red tattoo ink have been relatively unfruitful.…”

Section: Discussionmentioning

confidence: 99%

“…Allergy patch testing of patients with red tattoo reactions using common allergens, textile/dyes, tattoo ink stock products, and culprit pigments has generally yielded negative or inconsistent results, calling into question the utility of patch testing in diagnosing delayed hypersensitivity reactions triggered by antigens that are deposited directly into the dermis [ 5 , 6 ]. It has therefore been suggested that metabolism or haptenization with host proteins within the dermis over weeks to years is needed in order to trigger an allergic reaction [ 4 , 5 ]. Further, external factors, such as sunlight exposure, can induce photochemical cleavage of tattoo pigments in the skin and may also play a role in allergen formation [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, a phenomenon termed immune reconstitution inflammatory syndrome has been described in several HIV patients who developed granulomatous tattoo reactions following antiretroviral therapy [ 4 , 11 ]. Gamba et al [ 4 ] noted analogous epidermal hyperplasia and dermal changes on histology in their HIV patient with an allergic tattoo reaction at baseline, which significantly worsened after antiretroviral therapy initiation. The authors also identified epidermal spongiosis; however, this finding was not seen in our case.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Delayed-Type Hypersensitivity Reaction to Red Tattoo Ink Triggered by Ledipasvir/Sofosbuvir for Hepatitis C: A Case Report

McPhie¹,

Ren²,

Hendry³

et al. 2021

Case Rep Dermatol

View full text Add to dashboard Cite

Tattoos have become increasingly popular worldwide making adverse effects from tattoos a growing concern. In our report, we present a 51-year-old man who developed an unusual allergic reaction to the red ink portions of his tattoos that coincided with the initiation of ledipasvir/sofosbuvir treatment for his hepatitis C. Clinical and histological features were consistent with a delayed-type hypersensitivity reaction to red ink.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Delayed-Type Hypersensitivity Reaction to Red Tattoo Ink Triggered by Ledipasvir/Sofosbuvir for Hepatitis C: A Case Report

McPhie¹,

Ren²,

Hendry³

et al. 2021

Case Rep Dermatol

View full text Add to dashboard Cite

show abstract

“…In general, drugs or diseases that affect the immune system may also trigger reactions in tattoos. For example, people infected with HIV may develop a type IV hypersensitivity reaction in tattoos after starting anti‐retroviral therapy [76].…”

Section: Adverse Skin Reactions To Tattoosmentioning

confidence: 99%

Tattoos – more than just colored skin? Searching for tattoo allergens

Weiß

Schreiver

Siewert

et al. 2021

J Deutsche Derma Gesell

View full text Add to dashboard Cite

Summary During tattooing, a high amount of ink is injected into the skin. Tattoo inks contain numerous substances such as the coloring pigments, impurities, solvents, emulsifiers, and preservatives. Black amorphous carbon particles (carbon black), white titanium dioxide, azo or polycyclic pigments create all varieties of color shades in the visible spectrum. Some ingredients of tattoo inks might be hazardous and allergenic chemicals of unknown potential. In Germany, about 20 % of the general population is tattooed and related adverse reactions are increasingly reported. Since tattoo needles inevitably harm the skin, microorganisms can enter the wound and may cause infections. Non‐allergic inflammatory reactions (for example cutaneous granuloma and pseudolymphoma) as well as allergic reactions may emerge during or after wound healing. Especially with allergies occurring after weeks, months or years, it remains difficult to identify the specific ingredient(s) that trigger the reaction. This review summarizes possible adverse effects related to tattooing with a focus on the development of tattoo‐mediated allergies. To date, relevant allergens were only identified in rare cases. Here we present established methods and discuss current experimental approaches to identify culprit allergens in tattoo inks – via testing of the patient and in vitro approaches.

show abstract

“…Cutaneous reactions on permanent tattoos have been reported in the past during immune restauration syndrome under highly active antiretroviral therapy for human immunodeficiency virus [1,2] as well as during interferon therapy for hepatitis C with the induction of sarcoidosis [3,4]. Besides, anecdotal cases of granulomatous tattoo reaction under tumor necrosis factor α inhibitors have been reported [5].…”

Section: Introductionmentioning

confidence: 99%

Tattoo Reactions Associated with Targeted Therapies and Immune Checkpoint Inhibitors for Advanced Cancers: A Brief Review

Kluger

2019

Dermatology

View full text Add to dashboard Cite

To the best of our knowledge, 10 cases (6 men, 4 women; mean age 44.5 years, range 22-59) have been reported since 2012. The main characteristics are summarized in Table 1. Six patients received a combination of BRAF inhibitor (BRAFi) associated with a MEK inhibitor (MEKi), 2 patients a PD-1/PD-L1 inhibitor (PD-1i/ PD-L1i) and 2 patients a CTLA-4 inhibitor (CTLA-4i), including one in combination with a PD-1i. We found that the clinical presentation was different according to culprit drugs. Tattoo eruption associated with BRAFi + MEKi presented mostly as a complete infiltration/induration of dark-colored tattoos with striking inflammatory borders in 5 out of 6 cases [10-13, 16]. Tattoo reactions with CTLA-4i or PD-1i/PD-L1i were reminiscent of what is usually observed with sarcoidosis or granulomatous tattoo reactions in general, e.g. papules and nodules scattered within black tattoos [8, 9, 14, 15]. Tattoos were dark/black in 86% (6/7) of the cases. In case of multicolored tattoos, other colors were spared. Delays of onset after the first cycle were as follows from the earliest to the latest: CTLA-4i + PD-1i (2 months) > BRAFi + MEKi (2-6 months) > PD-1i/PD-L1i (9-15 months). Only 1 patient had additional cutaneous sarcoids on plain skin and erythema nodosum [9]. Biopsies showed noncaseating granulomas in 67% (6/9), including all the cases with CTLA-4i and/or PD-1i/PD-L1i. In the 3 remaining cases, there was only a lymphocytic infiltration without any granulomas [10, 12, 13]. Angiotensin-converting enzyme was elevated in 2 cases of granulomatous reactions [9, 15]. Lung involvement and lymph nodes were reported in 60% (6/10). Management was highly variable according to authors. It included local corticosteroids, combination of local and systemic corticosteroids, abstention with either maintenance or discontinuation of the treatment, and switch to PD-1i or surgery. One patient experienced relapses with BRAFi + MEKi cycles [10]. Overall, outcome was always favorable. Discussion Granulomatous eruptions under ICPIs are an uncommon immune-related adverse event that can become more and more frequently encountered with the increased use of this therapeutic class [7]. All the patients under PD-1i/PD-L1i/CTLA-4i developed sarcoid-like reactions on tattoos. Delays of onset and outcomes were here in line with what is known from the literature [7]. On the other hand, cutaneous granulomatous reactions and sarcoidosis are rather infrequent with BRAFi [17]. Out of the 5 patients under BRAFi + MEKi with available biopsies, 3 displayed a lymphocytic infiltration in the dermis without granulomas. Besides, the clinical presentation was rather different with a marked erythema around the tattoos which is totally unusual compared to the usual tattoo granulomatous reactions we often see in practice [4, 18, 19]. Only 1 patient did not present such an inflammatory reaction around the affected tattoos [16]. To date, there is no case report of tattoo reaction with BRAFi alone. In 1 patient [11], the reaction developed 3 months after MEKi in...

show abstract

Tattoo reactions in an HIV patient: Autoeczematization and progressive allergic reaction to red ink after antiretroviral therapy initiation

Cited by 9 publications

References 13 publications

Delayed-Type Hypersensitivity Reaction to Red Tattoo Ink Triggered by Ledipasvir/Sofosbuvir for Hepatitis C: A Case Report

Delayed-Type Hypersensitivity Reaction to Red Tattoo Ink Triggered by Ledipasvir/Sofosbuvir for Hepatitis C: A Case Report

Tattoos – more than just colored skin? Searching for tattoo allergens

Tattoo Reactions Associated with Targeted Therapies and Immune Checkpoint Inhibitors for Advanced Cancers: A Brief Review

Contact Info

Product

Resources

About