|Year : 1991 | Volume
| Issue : 4 | Page : 188-190
Neovascularisation by tattoo pigment
EM Abdul Razack, G Ravichandran, V Somasundaram, U
EM Abdul Razack
Source of Support: None, Conflict of Interest: None
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 2019 Jun 19];57:188-90. Available from: http://www.ijdvl.com/text.asp?1991/57/4/188/3670
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
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). Non metallic dyes also are now being increasingly used.
Reactions to the tattoo granules can either be an allergic dermatitis or an allergic granulomatous reaction. The tattoo pigment itself or a derived compound formed locally in the tissues provokes the development of hypersensitivity. In some instances, the allergic reaction is lichenoid in character showing great resemblance either to lichen planus or to hypertrophic lichen planus. 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 . 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|| |
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|| |
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 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 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, 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|| |
|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. |
|2.||Hagerman RD, Grammer LG, Bartok WR et al Tropical medications on dermabraded tattoos, Arch Dermatol, 1970 : 102 ; 438-439 |
|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. |
|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. |
|5.||Shelly WS Hurly HJ : Allergic reaction to a tattoo pigment, Brit J Dermatol, 1958 : 70 : 75-76. |
[Figure - 1], [Figure - 2]