An embossed tattoo

Abstract

Conflict of interest: none declared. A 36‐year‐old white woman presented with a 2‐month history of pruritic skin lesions localized to an arm tattoo. The lesions had gradually developed shortly after she underwent the tattooing. Her medical history was unremarkable. Examination revealed a hard, nontender and diffuse ‘embossing’ of the areas of the tattoo that contained red dye. (Fig. 1a). The remainder of her physical examination was normal. ... A punch biopsy of an infiltrated red zone was performed. Histological examination revealed a superficial and deep diffuse lymphocytic dermal infiltrate (Fig. 1b), mainly composed of small lymphocytes and larger cells including macrophages. Neither lymphoid follicles nor germinal centres were observed. In addition, deposits of dark‐brown to black pigment were seen engulfed by the macrophages and also in the intercellular spaces (Fig. 1c). What is your diagnosis? Tattoo‐induced pseudolymphoma. Patch testing was performed with the standard series of the Spanish Group of Contact Dermatitis. A positive patch test reaction to metallic mercury 0.5% in petrolatum was observed. The tattoo was fully removed by surgical excision and no relapses have been observed over the past 3 years.

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