10.5826/dpc.1401a11
text/xml
2160-9381
3322
en
Ane  Jaka 
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
“A Strange Flower in the Garden”: The Importance of the Dermatoscope in the Assessment of Tattoos
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2024-01-31
2023-03-08
2024-01-31
2024-02-21
e2024011
Dermatol Pract Concept
Ane  Jaka 
2024/01/31
10.5826/dpc.1401a11
e2024011
Dermatology and Venereology Department. Germans Trias i Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain
2160-9381
en
e2024011
Rogowska P, Sobjanek M, Sławińska M, Nowicki RJ, Szczerkowska-Dobosz A. Tattoos Dermatological Complications: Analysis of 53 Cases from Northern Poland. Dermatology. 2022;238(4):799-806. DOI: 10.1159/000520752. PMID: 34969030.
“A Strange Flower in the Garden”: The Importance of the Dermatoscope in the Assessment of Tattoos
https://dpcj.org/index.php/dpc/article/download/3322/2543
 “A Strange Flower in the Garden”: The Importance
 of the Dermatoscope in the Assessment of Tattoos
 Júlia Verdaguer-Faja1, Verónica Mora-Fernandez1, Maria Fabregat-Pratdepadua1, Ane Jaka1


1 Dermatology and Venereology Department. Germans Trias i Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain



Citation: Verdaguer-Faja J, Mora-Fernandez V, Fabregat-Pratdepadua M, Jaka A. “A Strange Flower in the Garden”: The Importance of the
Dermatoscope in the Assessment of Tattoos. Dermatol Pract Concept. 2024;14(1):e2024011. DOI: https://doi.org/10.5826/dpc.1401a11
Accepted: September 5, 2023; Published: January 2024
Copyright: ©2024 Verdaguer-Faja et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Júlia Verdaguer-Faja, Dermatology Department. Hospital Universitari Germans Trias I Pujol. Carretera de Canyet
s/n. 08916, Badalona (Barcelona), Spain. Phone: 0034934978813 E-mail: verdaguer.ju@gmail.com




Case Presentation                                                        Teaching Point
A 49-year-old healthy female presented with a 12-months                  Decorative tattooing involves the introduction of exogenous
history of an asymptomatic red and crusty lesion on her                  pigments into the dermis. Complications include primarily
left arm, next to a tattoo inoculated 6 years before. Cuta-              infections, allergy to tattoo pigments, the localization of
neous examination showed a red plaque with yellow crust                  ­various dermatoses to tattoos, but also benign and some-
and erosions, next to the black and red tattoo (Figure 1A).              times malignant tumors arising on them [1,2], such as mela-
Under the diagnostic suspicion of infectious impetigo vs.                noma or basal cell carcinoma. The occurrence of cutaneous
reactive dermatosis to tattoo ink, treatment with topical                malignancies in tattoos may be related to the “scarring pro-
corticosteroids and antibiotics was prescribed, showing                  cess” and local chronic inflammation, and the presence of
only partial improvement and persistence of the plaque at                carcinogenic substances in tattoo ink. However, a directly
the two-month follow-up (Figure 1B). This time, the use of               causative relationship cannot yet be confirmed [1,2].
dermoscopy revealed small erosions, arborizing telangiecta-                   Although pigment allergy is the most common tattoo
sias (white arrows) and concentric structures (green arrows)             complication, especially when red ink is used [1], we claim
(Figure 1C), suggesting the diagnosis of superficial basal cell          the importance of using dermoscopy in the assessment of
carcinoma associated to tattoo, what was later confirmed by              any lesion in a tattoo, as malignant tumors may also arise
a skin biopsy.                                                           on them. In addition, it can also facilitate the diagnosis of




Image Letter | Dermatol Pract Concept. 2024;14(1):e2024011                                                                               1
              Figure 1. (A) Cutaneous examination showed a red plaque with yellow crust and erosions, next to one of
              the tattoo red flower and black branch (tattoo of a tree in bloom with black and red colors). (B) Persistence
              of a red plaque, although with less crust and erosions. (C) Examination of the red plaque with dermos-
              copy revealed the presence of small erosions (black arrows), arborizing telangiectasias (white arrows) and
              concentric structures (green arrows).


tattoo infectious complications like viral warts, molluscum            2. Leijs M, Schaefer H, Rübben A, Cacchi C, Rustemeyer T,
contagiousum or demodicosis, and, consequently, reduce the                van der Bent S. Cutaneous malignancies in tattoos, a case series of
                                                                          six patients. Curr Oncol. 2021;28(6):4721–3477. DOI: 10.3390
number of unnecessary biopsies [3].
                                                                          /curroncol28060398. PMID: 34898571. PMCID: PMC8628776.
                                                                       3. Rogowska P, Sobjanek M, Sławińska M, Nowicki RJ,
References                                                                Szczerkowska-Dobosz A. Tattoos Dermatological Complica-
                                                                          tions: Analysis of 53 Cases from Northern Poland. Dermatol-
1. Kluger N. An update on cutaneous complications of permanent
                                                                          ogy. 2022;238(4):799-806. DOI: 10.1159/000520752. PMID:
   tattooing. Expert Rev Clin Immunol. 2019;15(11):1135-1143.
                                                                          34969030.
   DOI: 10.1080/1744666X.2020.1676732. PMID: 31594417.




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