Histopathology of Red Tattoo Reactions

Sebastiaan A. S. van der Bent · E.M.M. Oyen · Thomas Rustemeyer · Lies H. Jaspars · Rick Hoekzema

26 citations0/0 files storedAmerican Journal of Dermatopathology

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Tattoo and Body Piercing Complications Contact Dermatitis and Allergies Medicine and Dermatology Studies History

Abstract

BACKGROUND: Despite popularity of tattoos, complications may occur. In particular, red tattoo reactions due to allergic reactions are the most frequent chronic tattoo reactions. However, little is known about its histopathology and underlying pathomechanisms. OBJECTIVE: The aim of this article is to analyze the histopathology of red tattoo reactions for diagnostic purposes and to acquire more insight into pathogenesis. METHODS: A retrospective cross-sectional study was conducted by reviewing the histopathology of 74 skin biopsies of patients with allergic red tattoo reactions. Histopathological findings, such as inflammation patterns, inflammatory cells and pigment depth and color, were semi-quantified with an in-house validated scoring system by 2 independent senior investigators. RESULTS: Histiocytes and lymphocytes were both present in >93%. Histiocytes were the predominant inflammatory cells in 74.3%, but well-defined granulomas were mostly absent (78.0%). Eosinophils were uncommon (8.1%) The predominantly histiocytic reaction combined with interface dermatitis was the main inflammation pattern (37.9%). Most biopsies showed more than one reaction pattern. Interface involvement was observed in 64.8%, despite the intended depth of standard tattoo procedures, in which pigment is placed deeper, in the upper- and mid-dermis. Statistical analyses showed a significant association between inflammation severity and pigment depth (P = 0.024). In 6 cases (8.1%) pigments could not be retrieved histologically. CONCLUSIONS: In this cohort we demonstrated that cutaneous reactions to red tattoo ink are frequently characterized by the combination of dermal predominantly histiocytic infiltrates and epidermal interface dermatitis. Allergic reactions to red tattoo pigments probably represent a combination of a subtype IVa and IVc allergic reaction. Clinicians should be aware of the specific histopathology of these reactions and therefore the importance of taking a diagnostic skin biopsy.

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References

2015Epidemiology of Tattoos in Industrialized Countries 2013Adverse Reactions after Tattooing: Review of the Literature and Comparison to Results of a Survey 1991Red tattoo reactions: X-ray microanalysis and patch-test studies 2014Patch test study of 90 patients with tattoo reactions: Negative outcome of allergy patch test to baseline batteries and culprit inks suggests allergen(s) are generated in the skin through haptenization 2015Tattoo Complaints and Complications: Diagnosis and Clinical Spectrum 2016Classification of Tattoo Complications in a Hospital Material of 493 Adverse Events 2019Identification of pigments related to allergic tattoo reactions in 104 human skin biopsies 2012The histopathologic spectrum of decorative tattoo complications

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2022Tattoo Pigment Identification in Inks and Skin Biopsies of Adverse Reactions by Complementary Elemental and Molecular Bioimaging with Mass Spectral Library Matching 2020Ablative laser surgery for allergic tattoo reactions: a retrospective study 2025Tattoo Ink Metal Nanoparticles: Assessment of Toxicity In Vitro and with a Novel Human Ex Vivo Model 2023Investigation of Adverse Reactions in Tattooed Skin through Histological and Chemical Analysis

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