Area of Science:

• Dermatology
• Immunology
• Histopathology

Background:

• Tattooing is an 8000-year-old practice with increasing popularity in Western societies over the past three decades.
• Introduction of exogenous pigments into the skin can trigger immune responses, leading to hypersensitivity reactions.
• Cutaneous reactions to tattoo pigments are often localized to specific colors, with red pigment historically linked to mercury (cinnabar) derivatives.

Purpose of the Study:

• To present a series of patients experiencing hypersensitivity reactions to red tattoos.
• To analyze the predominant histopathological patterns observed in these reactions.
• To discuss the implications of granulomatous reactions in tattoo hypersensitivity.

Main Methods:

• Case series of 10 patients with hypersensitivity reactions to red tattoos.
• Histopathological examination of skin biopsies to determine reaction patterns.
• Clinical assessment of treatment response.

Main Results:

• The study identified a predominant granulomatous histopathological pattern in patients with red tattoo hypersensitivity.
• These reactions showed a moderate response to treatment.
• The findings highlight the importance of considering systemic conditions in cases of granulomatous tattoo reactions.

Conclusions:

• Hypersensitivity to red tattoo pigment can manifest with a granulomatous histopathological pattern.
• Moderate treatment response was observed in the studied cohort.
• When encountering a granulomatous reaction pattern, it is crucial to rule out systemic sarcoidosis and mycobacterial infections.