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Anais Brasileiros de Dermatologia 2024Skin modification through tattoos is as old as humanity itself. However, this trend is on the rise, and with the use of different types of pigments and application... (Review)
Review
BACKGROUND
Skin modification through tattoos is as old as humanity itself. However, this trend is on the rise, and with the use of different types of pigments and application practices, both cutaneous and systemic complications can arise. Adverse reactions can be grouped into five classes: inflammatory, infectious, neoplastic, aesthetic, and miscellaneous. On histopathology, inflammatory reactions can exhibit a lichenoid pattern or present as spongiotic dermatitis, granulomatous reactions, pseudolymphoma, pseudoepitheliomatous hyperplasia, or scleroderma/morphea-like changes. This article reviews tattoo complications, including their clinical and histopathological characteristics.
METHODS
An open search was conducted on PubMed using the terms "tattoo", "complications", and "skin". No limits were set for period, language, or publication type of the articles.
RESULTS
Reactions to tattoos are reported in up to 67% of people who get tattooed, with papulonodular and granulomatous reactions being the most common. Some neoplastic complications have been described, but their causality is still debated. Any pigment can cause adverse reactions, although red ink is more frequently associated with them. Patients with pre-existing dermatoses may experience exacerbation or complications of their diseases when getting tattoos; therefore, this procedure is not recommended for this patient group.
CONCLUSIONS
Dermatological consultation is recommended before getting a tattoo, as well as a histopathological examination in case of complications. In patients who develop cutaneous inflammatory reactions following tattooing, additional studies are recommended to investigate systemic diseases such as sarcoidosis, pyoderma gangrenosum, atopic dermatitis, and neoplasms. It is important for physicians to be trained in providing appropriate care in case of complications.
Topics: Tattooing; Humans; Skin Diseases; Coloring Agents; Risk Factors; Skin
PubMed: 38521707
DOI: 10.1016/j.abd.2023.07.004 -
European Journal of Dermatology : EJD Jun 2023
Topics: Humans; Pseudolymphoma; Antibodies, Monoclonal, Humanized
PubMed: 37594345
DOI: 10.1684/ejd.2023.4482 -
Gastroenterology May 2023
Topics: Female; Humans; Herpes Genitalis; Herpes Simplex; HIV Infections; Anus Neoplasms; Herpesvirus 2, Human
PubMed: 31738917
DOI: 10.1053/j.gastro.2019.11.017 -
Dermatology (Basel, Switzerland) 2023Just as the number of tattooed people has increased in recent years, so has the number of adverse reactions in tattooed skin. Tattoo colourants contain numerous, partly...
BACKGROUND
Just as the number of tattooed people has increased in recent years, so has the number of adverse reactions in tattooed skin. Tattoo colourants contain numerous, partly unidentified substances, which have the potential to provoke adverse skin reactions like allergies or granulomatous reactions. Identification of the triggering substances is often difficult or even impossible.
METHODS
Ten patients with typical adverse reactions in tattooed skin were enrolled in the study. Skin punch biopsies were taken and the paraffin-embedded specimens were analysed by standard haematoxylin and eosin and anti-CD3 stainings. Tattoo colourants provided by patients and punch biopsies of patients were analysed with different chromatography and mass spectrometry methods and X-ray fluorescence. Blood samples of 2 patients were screened for angiotensin-converting enzyme (ACE) and soluble interleukin-2 receptor (sIL-2R).
RESULTS
Histology showed variable skin reactions such as eosinophilic infiltrate, granulomatous reactions, or pseudolymphoma. CD3+ T lymphocytes dominated the dermal cellular infiltrate. Most patients had adverse skin reactions in red tattoos (n = 7), followed by white tattoos (n = 2). The red tattooed skin areas predominantly contained Pigment Red (P.R.) 170, but also P.R. 266, Pigment Orange (P.O.) 13, P.O. 16, and Pigment Blue (P.B.) 15. The white colourant of 1 patient contained rutile titanium dioxide but also other metals like nickel and chromium and methyl dehydroabietate - known as the main ingredient of colophonium. None of the 2 patients showed increased levels of ACE and sIL-2R related to sarcoidosis. Seven of the study participants showed partial or complete remission after treatment with topical steroids, intralesional steroids, or topical tacrolimus.
CONCLUSIONS
The combination of the methods presented might be a rational approach to identify the substances that trigger adverse reactions in tattoos. Such an approach might help make tattoo colourants safer in the future if such trigger substances could be omitted.
Topics: Humans; Coloring Agents; Skin; Tattooing; Hypersensitivity; Steroids
PubMed: 37231944
DOI: 10.1159/000530949 -
European Journal of Dermatology : EJD Feb 2024Borreliosis, also known as Lyme disease, is a vector-borne disease caused by different species of the Borrelia burgdorferi complex. It is frequent in Europe and Northern... (Review)
Review
Borreliosis, also known as Lyme disease, is a vector-borne disease caused by different species of the Borrelia burgdorferi complex. It is frequent in Europe and Northern America. The major vectors are ixodoid ticks. Paediatric borreliosis is common and peaks in children between five to nine years. In Europe, the leading symptom of early infection is erythema migrans, in contrast to Northern America where arthritis is the dominating clinical finding. In this review, we focus on Europe, where cutaneous borreliosis is mainly caused by infection with B. afzelii. The cutaneous symptoms include erythema migrans, lymphocytoma, chronic atrophic dermatitis and juxta-articular nodules. In children, lymphocytoma is very common but chronic atrophic dermatitis is rare. Clinical symptoms, diagnosis, peculiarities of childhood disease and treatment are also reviewed. It is important to note that after haematogeneic spread, signs of infection may be non-specific, and this is a challenge for diagnosis.
Topics: Humans; Child; Pseudolymphoma; Lyme Disease; Erythema Chronicum Migrans; Skin Diseases; Dermatitis
PubMed: 38557454
DOI: 10.1684/ejd.2024.4611 -
Rozhledy V Chirurgii : Mesicnik... 2023Borrelial pseudolymphoma, more commonly known as Borrelia lymphocytoma and previously also as lymphadenosis benigna cutis, is a rare manifestation of Lyme borreliosis,...
Borrelial pseudolymphoma, more commonly known as Borrelia lymphocytoma and previously also as lymphadenosis benigna cutis, is a rare manifestation of Lyme borreliosis, which occurs nearly always in children after an infection caused by Borrelia afzelii; this pathogen is transmitted exclusively by the Ixodes ricinus tick in our region. The most common body locations of this lymphocytoma include the earlobe, scrotum, nipples and the areomamillary complex. Therefore, the case of our patient was unexpected and quite rare. The aim of this article is to point out the high incidence of Lyme disease and its atypical manifestations which can be cured without surgical intervention in most cases. The authors describe the case of a 58-year-old healthy female patient with a very rare manifestation of Lyme disease.
Topics: Male; Child; Humans; Adult; Female; Middle Aged; Pseudolymphoma; Borrelia; Eyebrows; Lyme Disease; Borrelia burgdorferi Group
PubMed: 37185032
DOI: 10.33699/PIS.2023.102.2.88-90 -
Clinics in Dermatology 2020Cutaneous manifestations of drug reactions are common yet vary widely in their appearance and degree of internal organ involvement. Serum sickness--like reactions,... (Review)
Review
Cutaneous manifestations of drug reactions are common yet vary widely in their appearance and degree of internal organ involvement. Serum sickness--like reactions, symmetrical drug-related intertriginous and flexural exanthem, granulomatous drug eruption, pseudolymphoma, and drug-induced lupus are medication-induced conditions with dermatologic presentations. Many of the conditions discussed are relatively rare but nonetheless demand our attention and understanding. Some of the conditions presented may be more likely encountered in the hospital setting, as is the case with serum sickness-like reactions and drug-induced lupus, whereas others may present to outpatient clinic for diagnosis. Given the similarities in clinical history of patients presenting with these conditions, an understanding of the clinical presentation, pathophysiology, culprit medications, histologic appearance, and serologic characteristics is warranted to correctly diagnose and manage these uncommon adverse reactions. We also discuss how to differentiate some of these conditions from more serious mimickers, as in the case of pseudolymphoma drug reaction mimicking a true lymphoma and drug-induced lupus mimicking acute systemic lupus erythematosus.
Topics: Diagnosis, Differential; Drug Eruptions; Exanthema; Female; Granuloma; Humans; Lupus Erythematosus, Cutaneous; Male; Pseudolymphoma; Serum Sickness; Skin
PubMed: 33341198
DOI: 10.1016/j.clindermatol.2020.06.013 -
Journal of Cutaneous Pathology Apr 2022Ibrutinib is a Bruton tyrosine kinase inhibitor used to treat many hematologic conditions, most commonly B-cell lymphomas and leukemias. Reportedly, skin rash is an...
Ibrutinib is a Bruton tyrosine kinase inhibitor used to treat many hematologic conditions, most commonly B-cell lymphomas and leukemias. Reportedly, skin rash is an adverse event in up to 27% of treated patients. Histopathologic description of these lesions is limited. We present two cases of ibrutinib-associated skin toxicities showing diverse histopathologic features. Case 1: A 72-year-old man was started on ibrutinib for chronic lymphocytic leukemia. Two months later, he developed multiple erythematous crusted papules on the chest, abdomen, and extremities. Biopsies revealed varied histopathology including poorly formed granulomatous dermatitis, epidermal necrosis, ulceration, and panniculitis. Ibrutinib was discontinued and his skin lesions resolved within 1 month. Case 2: A 48-year-old man received ibrutinib after failing standard therapy for primary central nervous system EBV positive diffuse large B-cell lymphoma. Two months after initiation of ibrutinib, he developed multiple firm, red, non-tender nodules on the forehead, buttock, and thigh. Biopsies revealed "pseudolymphoma"-like reaction with dense pandermal lymphohistiocytic inflammation and granulomas. His skin toxicity resolved without cessation of therapy. Awareness of the spectrum of histopathologic features that may be encountered in skin lesions of patients treated with ibrutinib, as illustrated by these two cases, will be critical for optimal patient management.
Topics: Adenine; Aged; Drug Eruptions; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Lymphoma, Large B-Cell, Diffuse; Male; Middle Aged; Piperidines; Protein Kinase Inhibitors
PubMed: 34726785
DOI: 10.1111/cup.14160 -
Scientific Reports Jul 2020Aluminium hydroxide is a well-known adjuvant used in vaccines. Although it can enhance an adaptive immune response to a co-administered antigen, it causes adverse...
Aluminium hydroxide is a well-known adjuvant used in vaccines. Although it can enhance an adaptive immune response to a co-administered antigen, it causes adverse effects, including macrophagic myofasciitis (MMF), subcutaneous pseudolymphoma, and drug hypersensitivity. The object of this study is to demonstrate pediatric cases of aluminium hydroxide-induced diseases focusing on its rarity, under-recognition, and distinctive pathology. Seven child patients with biopsy-proven MMF were retrieved from the Seoul National University Hospital (SNUH) pathology archives from 2015 to 2019. The medical records and immunisation history were reviewed, and a full pathological muscle examination was carried out. The mean age was 1.7 years (8.9-40 months), who had records of vaccination against hepatitis B, hepatitis A, and tetanus toxoid on the quadriceps muscle. The chief complaints were muscle weakness (n = 6), delayed motor milestones (n = 6), instability, dysarthria, and involuntary movement (n = 1), swallowing difficulty (n = 1), high myopia (n = 1), and palpable subcutaneous nodules with skin papules (n = 1). Muscle biopsy showed MMF (n = 6) and pseudolymphoma (n = 1) with pathognomic basophilic large macrophage infiltration, which had distinctive spiculated inclusions on electron microscopy. The intracytoplasmic aluminium was positive for PAS and Morin stains. Distinctive pathology and ultrastructure suggested an association with aluminium hydroxide-containing vaccines. To avoid misdiagnosis and mistreatment, we must further investigate this uncommon condition, and pharmaceutical companies should attempt to formulate better adjuvants that do not cause such adverse effects.
Topics: Adjuvants, Immunologic; Aluminum Hydroxide; Child, Preschool; Drug Hypersensitivity; Fasciitis; Female; Hepatitis A; Hepatitis B; Humans; Infant; Macrophages; Male; Muscle Weakness; Myositis; Pseudolymphoma; Subcutaneous Tissue; Tetanus; Vaccination; Viral Vaccines
PubMed: 32678281
DOI: 10.1038/s41598-020-68849-8 -
Histopathology Jan 2022This review focuses upon the pragmatic diagnostic approach of suspicious B cell infiltrations in the skin and lists the necessary histopathological and molecular tools... (Review)
Review
This review focuses upon the pragmatic diagnostic approach of suspicious B cell infiltrations in the skin and lists the necessary histopathological and molecular tools for a thorough work-up. We start with the description of different histopathological patterns of cutaneous B cell infiltrations and recommend pattern-dependent immunohistochemical staining algorithms for further differential diagnosis. A summarised description of the current World Health Organisation (WHO) subtypes of primary cutaneous B cell lymphomas highlighting their most relevant clinical, histopathological and molecular features is included. Differential diagnostic clues towards secondary infiltrations by systemic B cell lymphomas, B cell-rich T cell lymphoproliferative disorders and pseudolymphomas are provided. Furthermore, the most important pitfalls also elaborating on rare differential diagnoses are highlighted with helpful hints to solve arising diagnostic difficulties. The clinical work-up and the staging examinations depending on the type of B cell infiltrate are relevant for patient care and a short overview of the main diagnostic standards is given.
Topics: Diagnosis, Differential; Humans; Lymphoma, B-Cell; Skin; Skin Neoplasms
PubMed: 34958501
DOI: 10.1111/his.14556