Verruca plana on a tattoo: A case report

Histopathology of Dermatologic Complications of Tattoos

ABSTRACT

Tattoos are characterized by the introduction of exogenous pigments into the dermis. Tattoos usually serve cosmetic purposes, although they may have other causes, such as traumatic pigment implants in accidents or medical-related tattoos in the context of radiotherapy. Dermatologic adverse reactions are relatively uncommon, and they include infections, immune-mediated reactions, cutaneous lesions secondary to the Koebner phenomenon, exacerbation of preexisting dermatosis, benign and malignant neoplasms, and a miscellaneous group of dermatologic conditions that may appear in a preexisting tattoo. The aim of this study is to review the types of histopathologic reactions that may appear in a preexisting permanent tattoo.

Viral Infections Confined to Tattoos—A Narrative Review

Since ancient times, people have tattooed their skin for various reasons. In the past, tattoos were associated with low social status; nowadays, tattoos are very popular and are considered a form of art. However, tattoos are associated with various clinical problems, including immune reactions, inflammatory disorders, infections, and even skin cancer. Epidemiological and clinical data of infections on tattoos are scarce. Tattoo-related infections are mostly bacterial; only a few localized viral infections have been reported so far and are caused by molluscum contagiosum virus (MCV), human papillomavirus (HPV), and herpes simplex virus (HSV). In most cases, the lesions were strictly confined to the area of the tattoo. In this review, we have analysed reported cases of viral infections localized on tattoos and discussed the possible mechanisms involved in the occurrence of these infections.

Verruca Vulgaris Occurring on a Tattoo: Case Report and Review of Tattoo-Associated Human Papillomavirus Infections

Cutaneous infections can occur on tattoos. Tattoo-associated viral infections can be caused by human papillomavirus. A verruca vulgaris developed on the tattoo of a 44-year-old woman; the viral lesion appeared 21 years after she received the tattoo and had been increasing in size during the prior five years. Biopsy of the lesion not only confirmed the diagnosis but also removed most of the wart; the patient declined any additional treatment. In addition to verruca vulgaris (27 individuals), verruca plana (14 individuals) and human immunodeficiency virus-associated acquired epidermodysplasia verruciformis (two men) are human papillomavirus lesions that have been observed to occur on tattoos. The latency period from receiving the tattoo to the appearance of the wart has ranged from one month to 21 years; the median duration was 21 months for verruca vulgaris and 24 months for verruca plana. The warts most frequently appeared in the dark, usually black, inked areas of the tattoo; indeed, it has been postulated that the ink created a cutaneous immunocompromised district that enhanced the opportunity for the viral lesions to occur in the tattoo. The use of contaminated instruments or ink during tattoo inoculation is the most likely etiology for the development of a wart on a tattoo. However, other potential mechanisms for human papillomavirus to occur on a tattoo include transmission of the virus from the tattoo artist's ungloved hand or saliva, a preexisting (albeit unrecognized) human papillomavirus lesion adjacent to or at the site of the tattoo, and postinoculation acquisition of the verruca at the site of the tattoo. Topical retinoid or imiquimod, used as a single agent, was not effective in the treatment of the warts. Some of the patients who were treated with cryotherapy using liquid nitrogen did not achieve any improvement of their viral lesions. However, other patients observed resolution of most or all their warts when cryotherapy with liquid nitrogen, either as monotherapy or followed by topical application of 5% imiquimod cream, was used; yet, following treatment, these individuals experienced mild distortion of their tattoo and/or hypopigmentation. Curettage and squaric acid dibutyl ester contact immunotherapy were both successful approaches to the management of tattoo-associated warts. In addition, warts were efficaciously managed with either photodynamic therapy or treatment with an ablative erbium:yttrium aluminum garnet (YAG) laser followed by topical application of 5% imiquimod cream.