Case and Research Letters
Pseudoepitheliomatous Hyperplasia: An Uncommon Reaction in Tattoos
Hiperplasia seudoepiteliomatosa: una reacción infrecuente de los tatuajes
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Solitary, indurated, crusty plaque on the forehead.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Costin, F. Bonito, J. Alves, H. Barreiros" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Costin" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Bonito" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Alves" ] 3 => array:2 [ "nombre" => "H." 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Conejero, C. Conejero, V. Alcalde, J. García-Latasa de Araníbar" "autores" => array:4 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Conejero" "email" => array:1 [ 0 => "raquel_conejero@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "C." "apellidos" => "Conejero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "V." "apellidos" => "Alcalde" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "García-Latasa de Araníbar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Dermatología, Hospital Royo Villanova, Zaragoza, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Dermatología, Centro Médico Millenium, Zaragoza, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hiperplasia seudoepiteliomatosa: una reacción infrecuente de los tatuajes" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 605 "Ancho" => 805 "Tamanyo" => 119447 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tattoo on the left leg. Well-defined raised, thickened lesions are evident in the red-colored areas of skin, with no surrounding inflammatory reaction.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The growth in popularity of tattooing in recent decades has coincided with an increase in the number of articles describing adverse effects associated with tattooing.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Complications associated with tattoos include cutaneous and systemic infectious processes, inflammatory reactions with varied histological patterns, the appearance of benign or malignant skin tumors in tattooed areas of skin, and various dermatoses in tattooed areas resulting from isomorphic phenomena.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A 39-year-old man consulted for an itchy rash in the red-ink areas of a tattoo completed 1 month earlier. Physical examination revealed well-defined, firm, raised, erythematous hyperkeratotic lesions coinciding with the areas of red ink (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Dermoscopy showed rounded or oval-shaped areas of variable size with an erythematous center and a pinkish periphery, separated from one other by yellowish hyperkeratotic scales (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Histology showed marked acanthosis and epidermal papillomatosis without atypical cells, hyperkeratosis and areas of parakeratosis, and intracellular and extracellular deposits of red pigment in the dermis accompanied by a predominantly lymphohistiocytic infiltrate (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Culture of a biopsy sample for fungi, bacteria, and mycobacteria was negative. The results of patch and prick tests were negative.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The patient was diagnosed with pseudoepitheliomatous hyperplasia in skin areas tattooed with red ink.</p><p id="par0025" class="elsevierStylePara elsevierViewall">He began treatment with high-potency topical corticosteroids under occlusion, without improvement. Two subsequent subcutaneous corticosteroid infiltrations slightly improved the pruritus, but had no effect on the lesions. CO<span class="elsevierStyleInf">2</span> laser treatment was scheduled, but the patient failed to attend the appointment.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Among complications of tattoos, pseudoepitheliomatous hyperplasia is a rare reaction. It consists of irregular hyperplasia of the epidermis with no atypia and little mitotic activity, accompanied by dermal inflammatory infiltrate with a reactive histological pattern in response to the damage caused.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Because only isolated cases have been described and a few short series of patients published,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–9</span></a> there are limited data on this entity and its response to treatment. Among the cases described, more than half occurred in areas tattooed with red ink. Most, including the present case, occurred within 3 months of receiving the tattoo. This temporal association can aid diagnosis.</p><p id="par0040" class="elsevierStylePara elsevierViewall">It is important to differentiate this lesion from true neoplasms such as squamous cell carcinoma, verrucous carcinoma, keratoacanthoma, and viral warts.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9–11</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Treatments described include high-potency topical corticosteroids, which were effective in one case,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and surgical excision (3 patients),<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> which was not considered in the present case owing to the extent of the lesions. Successful treatment with CO<span class="elsevierStyleInf">2</span> laser has been recently reported.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In several cases, patients have been lost to follow-up.</p><p id="par0050" class="elsevierStylePara elsevierViewall">We present a case of pseudoepitheliomatous hyperplasia as a reaction to red tattoo ink. The literature on this characteristic reaction is scarce. This is the first such case described in Spain, and the first for which accompanying dermoscopic images are provided.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Conejero R, Conejero C, Alcalde V, García-Latasa de Araníbar JA. Hiperplasia seudoepiteliomatosa: una reacción infrecuente de los tatuajes. Actas Dermosifiliogr. 2020;111:896–897.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 605 "Ancho" => 805 "Tamanyo" => 119447 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tattoo on the left leg. Well-defined raised, thickened lesions are evident in the red-colored areas of skin, with no surrounding inflammatory reaction.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 605 "Ancho" => 805 "Tamanyo" => 115269 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopy image. Rounded and oval structures of variable size with an erythematous center and pinkish periphery, separated from one other by yellowish scales.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 604 "Ancho" => 805 "Tamanyo" => 238701 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histopathological image. A, Epidermal hyperplasia, hyperkeratosis of the corneal layer, and pigment deposition in the superficial dermis accompanied by inflammatory infiltrate (hematoxylin-eosin, original magnification ×4). B, Detail of pigment deposits inside histiocytes and extracellular cells, accompanied by lymphohistiocytic infiltrate (hematoxylin-eosin, original magnification ×40).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reacciones cutáneas adversas por tatuajes y <span class="elsevierStyleItalic">piercings</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Mataix" 1 => "J.F. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 0 | 7 |
| 2024 October | 113 | 56 | 169 |
| 2024 September | 127 | 41 | 168 |
| 2024 August | 181 | 79 | 260 |
| 2024 July | 158 | 53 | 211 |
| 2024 June | 149 | 45 | 194 |
| 2024 May | 94 | 49 | 143 |
| 2024 April | 99 | 31 | 130 |
| 2024 March | 113 | 33 | 146 |
| 2024 February | 99 | 35 | 134 |
| 2024 January | 85 | 34 | 119 |
| 2023 December | 86 | 24 | 110 |
| 2023 November | 106 | 32 | 138 |
| 2023 October | 95 | 45 | 140 |
| 2023 September | 79 | 36 | 115 |
| 2023 August | 62 | 23 | 85 |
| 2023 July | 119 | 55 | 174 |
| 2023 June | 75 | 34 | 109 |
| 2023 May | 83 | 42 | 125 |
| 2023 April | 65 | 35 | 100 |
| 2023 March | 100 | 37 | 137 |
| 2023 February | 74 | 41 | 115 |
| 2023 January | 84 | 52 | 136 |
| 2022 December | 87 | 43 | 130 |
| 2022 November | 61 | 36 | 97 |
| 2022 October | 49 | 29 | 78 |
| 2022 September | 45 | 41 | 86 |
| 2022 August | 49 | 54 | 103 |
| 2022 July | 64 | 49 | 113 |
| 2022 June | 40 | 33 | 73 |
| 2022 May | 139 | 48 | 187 |
| 2022 April | 123 | 37 | 160 |
| 2022 March | 122 | 57 | 179 |
| 2022 February | 116 | 40 | 156 |
| 2022 January | 143 | 69 | 212 |
| 2021 December | 127 | 51 | 178 |
| 2021 November | 109 | 56 | 165 |
| 2021 October | 116 | 68 | 184 |
| 2021 September | 120 | 52 | 172 |
| 2021 August | 78 | 39 | 117 |
| 2021 July | 125 | 37 | 162 |
| 2021 June | 133 | 41 | 174 |
| 2021 May | 125 | 67 | 192 |
| 2021 April | 199 | 90 | 289 |
| 2021 March | 141 | 50 | 191 |
| 2021 February | 80 | 50 | 130 |
| 2021 January | 69 | 40 | 109 |
| 2020 December | 42 | 21 | 63 |
| 2020 November | 25 | 10 | 35 |
| 2020 October | 7 | 4 | 11 |
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