[Contact dermatitis to permanent make up: manifestation of a pre-existing nickel allergy]

During recent years demands for permanent make up and especially permanent lip liner is increasing not only in the USA but also in Germany. Adverse reactions to these products are almost unknown and not documented in literature. Declaration of contents and side effects are not required for tattoo colors, in contrast to the rules for medical treatments. Our patient developed inflammation and vesiculation within the area of tattooing three days after injection of a permanent lip liner. Treatment with steroids induced complete resolution of the lip liner-associated dermatitis. However, not only the effect of the lip liner was lost but also the natural color of her lip was partly destroyed by inflammation. Diagnostic allergy testing revealed strong delayed hypersensitivity to nickel and a mild patch test reaction to the permanent lip liner. Examination of the permanent make-up by mass spectrometry detected nickel in a concentration of 1.8 ppm. No allergic reaction could be seen when the purified red dye itself was tested. This patient with pre-existing nickel allergy developed an allergic contact dermatitis from the injection of a permanent lip liner contaminated with nickel.