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January 2005
By Lawrence A. Schiffman, DO, and Stephen
M. Schleicher, MD
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CASE:
A 26-year-old woman presents to the office complaining of
a rash that has developed in two tattoos, both applied several
months ago. She is distraught over the cosmetic appearance
and is also bothered by occasional pruritus. She denies any
prior history of contact dermatitis. Examination of the affected
areas reveals elevation and induration at the sites where
red pigment had been applied.
WHAT IS YOUR DIAGNOSIS?
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This patient has developed an allergic reaction to cinnabar
pigment, one of the most common dyes implicated in tattoo allergies.
Conservative treatment includes topical steroids and intralesional
triamconolone acetonide. Intralesional steroid injections relieve
the pruritus and reduce the elevation of the affected areas,
although over time both tend to recur. Full excision of the
involved sites results in complete cure. Patients should be
instructed to avoid red pigment in subsequent tattoos. |
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Dr. Schiffman is a fellow at DermDx Centers
for Dermatology of Northeastern Pennsylvania, headquartered
in Hazleton. Dr. Schleicher is director of DermDx Centers
and a clinical instructor of dermatology at the Philadelphia
College of Osteopathic Medicine, at Kings College in Wilkes-Barre,
Pennsylvania, and at Arcadia University in Glenside, Pennsylvania.
He is also a member of the EMERGENCY MEDICINE editorial board.
Emerg Med 37(1):33-34, 2005
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