Tattoo and vaccination sites: Possible nest for opportunistic infections, tumors, and dysimmune reactions

Tattoos have gained worldwide popularity in recent years, and vaccinations are universal preventive measures designed to minimize morbidity associated with specific pathogens. Both dermal tattoos and vaccine injections may alter local immune responses, creating an immunocompromised district on or near the site of placement. This can lead to the development of opportunistic infections, benign and malignant tumors, and local dysimmune reactions. With regard to tattoos, a predominance of warts among a variety of opportunistic infections has been reported. These warts appear to result from a local immune dysregulation rather than from direct inoculation or coincidence. A variety of tumors including basal and squamous cell carcinomas, keratoacanthomas, and malignant melanoma also have been reported in association with tattoos. Granulomatous, lichenoid, and pseudolymphomatous reactions represent the most common dysimmune reactions. Vaccination sites similarly provide a setting for both benign and malignant tumors. Frequent reports of dermatofibrosarcoma protuberans would be unlikely to result from coincidence. Granuloma annulare and pseudolymphomatous reactions are relatively common dysimmune reactions.