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Year : 1991  |  Volume : 57  |  Issue : 4  |  Page : 188-190

Neovascularisation by tattoo pigment

Correspondence Address:
EM Abdul Razack

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Split skin grafting for the removal of a tattoo resulted in the appearance of pigmented papules in the periphery of the grafted skin as well as distal to it on the normal skin. Histologically they showed large vascular laminae containing red blood corpuscles and pigment deposits, a hitherto not documented complication of tattoo pigment.

Keywords: Neovascularization, Tattoo pigment, split skin grafting

How to cite this article:
Razack EA, Ravichandran G, Somasundaram V, U. Neovascularisation by tattoo pigment. Indian J Dermatol Venereol Leprol 1991;57:188-90

How to cite this URL:
Razack EA, Ravichandran G, Somasundaram V, U. Neovascularisation by tattoo pigment. Indian J Dermatol Venereol Leprol [serial online] 1991 [cited 2020 Jul 4];57:188-90. Available from:

Removal of the tattoo is sought on aes­thetic or cosmetic grounds. Various modalities are in vougue to get rid of the tattoo. Excision of the tattooed area followed by grafting, salabrasion using table-salt, argon or carbon-dioxide lasers, dermabrasion, or chemosurgery have their own advocates depending upon the type of complications and technical imperfec­tions. Among these, excision followed by grafting is the only satisfactory treatment to secure elimination of all particles of pigment[1]

Various metallic pigmentary compounds are employed to produce different tints to the so called ` decorative tattoos ` such as carbon (blue black), cinnabar (mercuric sulphide) vegetables dyes, cadmium sulphide (yellow), cobaltous aluminate (blue), chromic oxide or chromium sesqui oxide (green) and ochre-iron oxides (brown)[2]. Non metallic dyes also are now being increasingly used[3].

Reactions to the tattoo granules can either be an allergic dermatitis or an allergic granulomatous reaction[4]. The tattoo pigment itself or a derived compound formed locally in the tissues provokes the development of hypersensitivity.[1] In some instances, the aller­gic reaction is lichenoid in character showing great resemblance either to lichen planus or to hypertrophic lichen planus[4]. Ordinarily tat­toos show diffusely scattered granules of the dye that seem to be located not only within the macrophages but also extracellularly with­out any inflammatory reaction. In case of al­lergic granulomatous reaction it may be either of tuberculoid type or of sarcoidal type.

Zirconium, beryllium and mercury in tattoos causes a granulomatous inflammation which is manifested by the development of hard dome-shaped papules [5]. We encountered a patient who had developed similar papules around and away from the tattoo which was removed by split skin grafting a month earlier ; but his­tologically, they proved to be different from the various reactions reported so far.

  Case report Top

A 28-year-old male, with a history of split skin grafting, came for the treatment of mul­tiple, painful dark coloured papules over the periphery of the grafted skin, the distal portion of the forearm and the palm. The skin graft­ing was done a month before, on a large tat­tooed area on the flexor aspect of the right forearm. Multiple haphazardly arranged pig­mented papules were seen on the periphery of the grafted site as well as on the thenar eminence and dorsum of the ring finger [Figure - 1]. The papules were painful and there was no regional lymphadenopathy.

Haemogram, urinanalysis, blood sugar, urea, serum calcium were normal and exami­nation of the systems was unremarkable. Histopathology of the one of the papules on the thenar eminence showed hyperkeratosis, irregular moderate acanthosis, multiple vascu­lar spaces subepidermally throughout the dermis containing red blood cells and large deposits of tattoo pigment [Figure - 2].

  Comments Top

The mechanism of dissemination and fi­nally, the disappearance of the tattoo pigments from the site is by the lymphactic system which carry it away internally and by a pro­cess of ` pigment effluvium', where-in the pig­ment is carried away externally along with the flow of serous exudate after dermabrasion[2] Different types of reactions are said to be as­sociated with different tattoo granules at the site of the tattoos. But our case is quite un­usual as he had developed pigmented papules away from the tattooed site after surgery and these lesions histologically proved to be for­mation of vascular laminae showing up as large channels containing ABCs and deposits of the tattoo pigment. The fact that these le­sions occurred distally in the course of one month after split skin grafting goes to show that the spread must have been through lymph channels as suggested by Boo-chai[2] but in a retrograde fashion.

The other intriguing feature is the occurrence of vascularization at the sites where the pigments had lodged. The patient had the black coloured tattoo with the con­ventional carbon and it is said that carbon is completely inert[],[3] By itself it is incapable of producing any reaction, leave alone triggering the neovascularisation; we presume that it might in all probability, be due to some con­taminant in the tattoo which had the propen­sity to stimulate endothelial proliferation re­sulting in the unusual vascularsion at those sites. To our knowledge, this reaction by tattoo pigment and more so by carbon used for black tattoo has not been mentioned in the literature to-date.

  References Top

1.Bleehan SS and Ebling FJG : Disorders of skin colour, in : Text Book of Dermatology, Fourth ed, Editors, Rook A, Wilkinson DS and Ebling FJG : Blackwell Scientific Publications, Oxford and Edinburg. 1987 : p 1602-1604.  Back to cited text no. 1    
2.Hagerman RD, Grammer LG, Bartok WR et al Tropical medications on dermabraded tattoos, Arch Dermatol, 1970 : 102 ; 438-439  Back to cited text no. 2    
3.Wilkinson DS : Cutaneous reactions to mechanical and thermal injury, in : Text Book of Dermatology, Fourth ed, Editors, Rook A, Wilkinson DS and Ebling FJG : Blackwell Scientific Publications, Oxford and Edinburg. 1987 : p 602-603.  Back to cited text no. 3    
4.Lever WF and Lever GS : Inflammatory diseases due to physical agents and foreign substances, in : Histopathology of the skin : Seventh ed, JB Lippincott Company, Philadelphia, 1990 : p 247­248.  Back to cited text no. 4    
5.Shelly WS Hurly HJ : Allergic reaction to a tattoo pigment, Brit J Dermatol, 1958 : 70 : 75-76.  Back to cited text no. 5    


[Figure - 1], [Figure - 2]


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