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the last being 14 months before&#46; She denied any systemic symptoms&#46; On examination&#44; she had raised plaques on the topography of the eyebrows&#44; especially on the right&#44; in addition to areas of alopecia &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; At dermoscopy&#44; homogeneous orange-brown areas and rarefied hairs were seen &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The remainder of the physical examination was normal&#46; Complementary tests including serum calcium level&#44; electrocardiogram&#44; chest X-ray&#44; serum protein electrophoresis&#44; and tuberculin skin test were normal&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Histopathology showed non-caseating chronic granulomatous dermatitis with a sarcoid pattern &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#59; acid-fast bacillus &#40;AFB&#41; and fungal tests were negative&#46; With the diagnosis of sarcoid reaction secondary to the tattooing of the eyebrows&#44; therapy with doxycycline 100&#8239;mg&#47;day and fludroxycortide occlusive treatment was performed for 15 days&#46; The patient missed the reassessment appointment and returned after three months with complete regression of the lesions &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; She was advised not to repeat the procedure&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Micropigmentation is normally performed with a portable tattoo pen&#44; which is smaller than the traditional tattoo device&#46; Ready-made paints are available on the market&#44; but some professionals make their own mixtures&#46; Pigment washout may occur during the first few days of healing&#44; then the remaining pigment particles are stored in dermal macrophages and fibroblasts&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Sarcoid granulomas can develop in areas of tattooing or permanent makeup as isolated reactions or as part of systemic sarcoidosis&#46; The time between the tattoing and the reaction onset is variable&#44; and there may be a long latency period&#44; justifying the investigation of systemic sarcoidosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Topical and intralesional corticosteroids are the first line of treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Studies suggest that tetracyclines inhibit granuloma formation&#44; and their role in the treatment of sarcoid reactions has been documented&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> There are also reports of systemic treatment with allopurinol and antimalarials&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The patient had an excellent response after a short period of treatment with occlusive corticosteroids associated with doxycycline&#44; with no lesion recurrence to date&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">While numerous cases of sarcoid granulomas have been reported in body tattoos&#44; few have been related to eyebrow micropigmentation&#46; With the greater prevalence of this cosmetic technique&#44; it is important to recognize the possible adverse reactions&#44; as well as the adequate management&#46; Moreover&#44; it is crucial to remember the importance of investigating systemic sarcoidosis in these patients&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#39; contributions</span><p id="par0045" class="elsevierStylePara elsevierViewall">Tamires Ferri Macedo&#58; Approval of the final version of the manuscript&#59; drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; critical review of the literature&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Simone Perazzoli&#58; approval of the final version of the manuscript&#59; drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; critical review of the literature&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Renan Rangel Bonamigo&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the manuscript&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Renata Heck&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; effective participation in research orientation&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; 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Letter - Clinical
Sarcoid reaction in eyebrow tattooing: a complication of a common cosmetic procedure
Tamires Ferri Macedo
Autor para correspondência
tamiresfmacedo@gmail.com

Corresponding author.
, Simone Perazzoli, Renan Rangel Bonamigo, Renata Heck
Service of Dermatology, Sanitary Dermatology Outpatient Clinic, Secretaria de Saúde do Estado do Rio Grande do Sul, Porto Alegre, RS, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In the last decades&#44; facial pigmentation techniques for aesthetic purposes have become common&#46; Among them is eyebrow tattooing or micropigmentation&#46; Unlike traditional tattoos&#44; in which the pigment is deposited in the deeper layers of the dermis&#44; in micropigmentation&#44; the semi-permanent pigment is deposited in the upper layer of the dermis&#46; Adverse reactions to this technique include infection&#44; contact dermatitis&#44; granulomatous reactions&#44; and Koebner phenomenon&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A 30-year-old female patient&#44; with a history of previous bariatric surgery&#44; without other comorbidities&#44; complained of raised eyebrows for three months&#46; She had repeatedly undergone micropigmentation of the region over the past four years&#44; the last being 14 months before&#46; She denied any systemic symptoms&#46; On examination&#44; she had raised plaques on the topography of the eyebrows&#44; especially on the right&#44; in addition to areas of alopecia &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; At dermoscopy&#44; homogeneous orange-brown areas and rarefied hairs were seen &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The remainder of the physical examination was normal&#46; Complementary tests including serum calcium level&#44; electrocardiogram&#44; chest X-ray&#44; serum protein electrophoresis&#44; and tuberculin skin test were normal&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Histopathology showed non-caseating chronic granulomatous dermatitis with a sarcoid pattern &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#59; acid-fast bacillus &#40;AFB&#41; and fungal tests were negative&#46; With the diagnosis of sarcoid reaction secondary to the tattooing of the eyebrows&#44; therapy with doxycycline 100&#8239;mg&#47;day and fludroxycortide occlusive treatment was performed for 15 days&#46; The patient missed the reassessment appointment and returned after three months with complete regression of the lesions &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; She was advised not to repeat the procedure&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Micropigmentation is normally performed with a portable tattoo pen&#44; which is smaller than the traditional tattoo device&#46; Ready-made paints are available on the market&#44; but some professionals make their own mixtures&#46; Pigment washout may occur during the first few days of healing&#44; then the remaining pigment particles are stored in dermal macrophages and fibroblasts&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Sarcoid granulomas can develop in areas of tattooing or permanent makeup as isolated reactions or as part of systemic sarcoidosis&#46; The time between the tattoing and the reaction onset is variable&#44; and there may be a long latency period&#44; justifying the investigation of systemic sarcoidosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Topical and intralesional corticosteroids are the first line of treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Studies suggest that tetracyclines inhibit granuloma formation&#44; and their role in the treatment of sarcoid reactions has been documented&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> There are also reports of systemic treatment with allopurinol and antimalarials&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The patient had an excellent response after a short period of treatment with occlusive corticosteroids associated with doxycycline&#44; with no lesion recurrence to date&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">While numerous cases of sarcoid granulomas have been reported in body tattoos&#44; few have been related to eyebrow micropigmentation&#46; With the greater prevalence of this cosmetic technique&#44; it is important to recognize the possible adverse reactions&#44; as well as the adequate management&#46; Moreover&#44; it is crucial to remember the importance of investigating systemic sarcoidosis in these patients&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#39; contributions</span><p id="par0045" class="elsevierStylePara elsevierViewall">Tamires Ferri Macedo&#58; Approval of the final version of the manuscript&#59; drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; critical review of the literature&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Simone Perazzoli&#58; approval of the final version of the manuscript&#59; drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; critical review of the literature&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Renan Rangel Bonamigo&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the manuscript&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Renata Heck&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; effective participation in research orientation&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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