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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case report</span><p id="par0005" class="elsevierStylePara elsevierViewall">Currently&#44; the practice of tattooing is popular worldwide&#46; This has led to an increase in reactions to tattoo pigments&#46; These reactions are difficult to treat and can sometimes take on curious aspects&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 39-year-old Brazilian male had his right leg tattooed with a 10-letter word representing his greatest passion&#58; &#8220;motorcycle&#8221;&#46; After 15 days&#44; severe pruritus and inflammation appeared in the areas tattooed in red&#46; The patient was assessed by our team approximately 2 months after the tattoo was performed&#59; the dermatological examination showed infiltrated lesions in the areas tattooed in red and sparing the areas tattooed in black &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; After a few weeks&#44; these lesions took on an exuberant hypertrophic appearance&#44; forming a bizarre &#8220;verrucous motorcycle&#8221; &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2&#8211;4</a>&#41;&#46; Other areas tattooed in red located on the trunk and limbs also showed inflammation&#44; but without the verrucous aspect seen on the leg&#46; Other areas of these tattoos that were not red &#40;blue&#44; green&#44; yellow&#44; and black&#41; were normal at the examination &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Several of these other tattoos also reflected the patient&#39;s love for motorcycles&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Histopathological analysis of the biopsy of one of the verrucous areas showed compact hyperparakeratosis&#44; acanthosis&#44; spongiosis&#44; small lymphocyte exocytosis&#44; and vacuolar degeneration of the basal layer&#46; There was a nodular&#44; diffuse and lichenoid infiltrate in the dermis&#44; consisting predominantly of lymphocytes and histiocytes containing variable amounts of pigment&#46; Marked inflammatory infiltrate aggression to the follicular epithelium was observed &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46; Special stains for microorganisms and tissue cultures for fungi and mycobacteria were negative&#46; Immunohistochemistry showed&#58; CD3 positivity in rare epidermal lymphocytes&#59; CD4 and CD8 positivity in rare cells&#59; CD4&#58;CD8 ratio of 2&#58;1&#59; CD56 positivity in numerous mononuclear cells in the dermis&#46; The final diagnosis of a lichenoid reaction to the tattoo red pigment was attained&#46; Despite the lack of clinical response to the performed therapies &#40;local infiltration of corticosteroids&#44; and excision by shaving the verrucous lesions&#41;&#44; the patient stated that he would certainly tattoo his skin again&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">Even though tattoos constitute a disseminated practice&#44; they are not entirely harmless and can result in both infectious and non-infectious complications&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The pigment most often related to hypersensitivity reactions is the red one&#46; The histopathological patterns that can be observed include eczematous&#44; lichenoid&#44; granulomatous&#44; sarcoid&#44; and pseudo-lymphomatous patterns&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The composition of red pigments used in tattoos is varied and non-regulated&#46; Recently&#44; inorganic dyes in red tattoos have been replaced by organic ones&#44; such as azo-compounds and quinacridone&#46; Skin hypersensitivity reactions to organic red pigments can develop after a few weeks or even years&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The patient&#39;s passion for motorcycles resulted in significant damage to his skin&#46; Tattoos can be a creative way of expressing people&#39;s passions<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#59; we&#44; as dermatologists&#44; must warn our patients about possible risks&#44; even though our scientific explanations are often ineffective&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Financial support</span><p id="par0025" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Authors&#8217; contributions</span><p id="par0030" class="elsevierStylePara elsevierViewall">Isadora Rosan&#58; Data collection and writing of the manuscript&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Ninoska Nieto-Salazar&#58; Data collection and writing of the manuscript&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Marcello Menta Simonsen Nico&#58; Data collection and writing of the manuscript&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Images in Dermatology
Motorcycling can be dangerous: verrucous lichenoid reaction to a tattoo
Isadora Rosan
Autor para correspondência
isadorarosan@hotmail.com

Corresponding author.
, Ninoska Nieto-Salazar, Marcello Menta Simonsen Nico
Department of Dermatology, Faculty of Medicine, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case report</span><p id="par0005" class="elsevierStylePara elsevierViewall">Currently&#44; the practice of tattooing is popular worldwide&#46; This has led to an increase in reactions to tattoo pigments&#46; These reactions are difficult to treat and can sometimes take on curious aspects&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 39-year-old Brazilian male had his right leg tattooed with a 10-letter word representing his greatest passion&#58; &#8220;motorcycle&#8221;&#46; After 15 days&#44; severe pruritus and inflammation appeared in the areas tattooed in red&#46; The patient was assessed by our team approximately 2 months after the tattoo was performed&#59; the dermatological examination showed infiltrated lesions in the areas tattooed in red and sparing the areas tattooed in black &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; After a few weeks&#44; these lesions took on an exuberant hypertrophic appearance&#44; forming a bizarre &#8220;verrucous motorcycle&#8221; &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2&#8211;4</a>&#41;&#46; Other areas tattooed in red located on the trunk and limbs also showed inflammation&#44; but without the verrucous aspect seen on the leg&#46; Other areas of these tattoos that were not red &#40;blue&#44; green&#44; yellow&#44; and black&#41; were normal at the examination &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Several of these other tattoos also reflected the patient&#39;s love for motorcycles&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Histopathological analysis of the biopsy of one of the verrucous areas showed compact hyperparakeratosis&#44; acanthosis&#44; spongiosis&#44; small lymphocyte exocytosis&#44; and vacuolar degeneration of the basal layer&#46; There was a nodular&#44; diffuse and lichenoid infiltrate in the dermis&#44; consisting predominantly of lymphocytes and histiocytes containing variable amounts of pigment&#46; Marked inflammatory infiltrate aggression to the follicular epithelium was observed &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46; Special stains for microorganisms and tissue cultures for fungi and mycobacteria were negative&#46; Immunohistochemistry showed&#58; CD3 positivity in rare epidermal lymphocytes&#59; CD4 and CD8 positivity in rare cells&#59; CD4&#58;CD8 ratio of 2&#58;1&#59; CD56 positivity in numerous mononuclear cells in the dermis&#46; The final diagnosis of a lichenoid reaction to the tattoo red pigment was attained&#46; Despite the lack of clinical response to the performed therapies &#40;local infiltration of corticosteroids&#44; and excision by shaving the verrucous lesions&#41;&#44; the patient stated that he would certainly tattoo his skin again&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">Even though tattoos constitute a disseminated practice&#44; they are not entirely harmless and can result in both infectious and non-infectious complications&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The pigment most often related to hypersensitivity reactions is the red one&#46; The histopathological patterns that can be observed include eczematous&#44; lichenoid&#44; granulomatous&#44; sarcoid&#44; and pseudo-lymphomatous patterns&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The composition of red pigments used in tattoos is varied and non-regulated&#46; Recently&#44; inorganic dyes in red tattoos have been replaced by organic ones&#44; such as azo-compounds and quinacridone&#46; Skin hypersensitivity reactions to organic red pigments can develop after a few weeks or even years&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The patient&#39;s passion for motorcycles resulted in significant damage to his skin&#46; Tattoos can be a creative way of expressing people&#39;s passions<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#59; we&#44; as dermatologists&#44; must warn our patients about possible risks&#44; even though our scientific explanations are often ineffective&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Financial support</span><p id="par0025" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Authors&#8217; contributions</span><p id="par0030" class="elsevierStylePara elsevierViewall">Isadora Rosan&#58; Data collection and writing of the manuscript&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Ninoska Nieto-Salazar&#58; Data collection and writing of the manuscript&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Marcello Menta Simonsen Nico&#58; Data collection and writing of the manuscript&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Informação do artigo
ISSN: 03650596
Idioma original: Inglês
DOI:10.1016/j.abd.2020.07.013
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