Lichenoid reaction in a red tattoo successfully treated with intralesional triamcinolone

Cutaneous reactions to tattoo pigments, especially red ink, are increasingly prevalent as tattoos become more common. Lichenoid reactions represent the most common subtype of these adverse reactions. This case report describes a case successfully diagnosed and managed with intralesional triamcinolone injections. Our objective is to present a case of lichenoid reaction to red tattoo pigment, outline its clinical presentation, diagnostic considerations, and demonstrate the efficacy of intralesional corticosteroids as a treatment. A 40-year-old woman presented with a four month history of intermittent swelling, itching, and crusting confined to the red areas of a recent tattoo. The patient had failed to respond to a short course of oral prednisone. Clinical examination and biopsy confirmed a lichenoid reaction, and intralesional triamcinolone injections were administered at one month intervals. After one injection, the patient showed significant improvement, and complete resolution of symptoms was achieved after three sessions without recurrence several weeks later. This case highlights the typical presentation and successful treatment of a lichenoid reaction to red tattoo pigment and emphasizes the "can't miss" diagnoses on the differential like sarcoidosis, especially in patients with systemic symptoms such as shortness of breath.