We report the case of a 30-year-old man, with no relevant past medical history who presented with a 2-year history of skin lesions on the anterior face of his right forearm tattooed 4 years earlier. The lesions consisted of asymptomatic small whitish papules with a predominant distribution over black ink sparing the non-tattooed skin (red arrowheads in Fig. 1, panels A and C). With the initial suspicion of common wart after tattoo inoculation, a punch biopsy (panel B in Fig. 1) was performed, which confirmed the suspected diagnosis, with epidermal hyperplasia with papillomatosis, acanthosis, and hyperkeratosis. Koilocytes were predominant in the stratum granulosum (yellow arrows in Fig. 1, panel B). Vacuoles loaded with black pigment could be seen on the superficial dermis, corresponding to tattoo ink, predominantly perivascular (blue arrows in Fig. 1, panel B). The patient declined any type of treatment.

Figure 1

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In the past, tattoos used to be associated with low social levels; nowadays, tattoos are widely accepted and considered an art form. Infections are among the complications associated with tattoos. Viral warts (flat or common) are often related to the human papilloma virus and their appearance is more common in areas of black ink on the extremities. The management of viral warts is controversial and topical and physical ablative therapies are often used. Hygiene measures are essential to prevent infections when performing tattoos.