An interesting case of oedema and ulceration in red areas of tattoo

Dear Editors, We describe the clinical case of a 25-year-old man who presented to our clinic for a granulomatous reaction in the red areas of a tattoo on his right leg (Figure 1). The patient developed oedema and ulceration 3 weeks after undergoing tattoo. The social meaning of the practice of tattooing has evolved over the centuries. The spread of these fads, especially among adolescents, calls for urgent action to provide for health monitoring of the traders who engage in such practices, and to foster self-protection behaviours among young people. If not monitored, these practices may result in both local and systemic complications. Many dermatoses such as psoriasis, systemic lupus erythematosus (SLE), sarcoidosis and lichen planus can be localised in the area of the tattoo (1), probably because of a minor locus resistentiae or the isomorphism of Koebner. We performed a patch test to exclude an allergic reaction, a cutaneous biopsy for histological examination and microbiological cutaneous tests to exclude an infective nature of the reaction. Patch test series SIDAPA, produced by F.I.R.M.A. S.p.A (Firenze, Italy), involve applying patches containing the following haptens on the back of the patient (by a single operator): potassium dichromate, rosin, epoxy resin, formaldeidica resin, Euxil 400, neomycin sulphate, fragrance mix, nickel sulphate, mercaptobenzotiaziolo, paraphenylendiamine, cobalt chloride, balsam of peru, thiuram mix, benzocaine, lanolin alcohols, parabens, Vaseline, scattered yellow, scattered blue and hydroquinone. The patient was asked not to wash his back, and not to take oral cortisone and antihistamines.