A healthy nondiabetic 36-year-old woman attended a dermatologist with a 2-year history of a skin lesion on the right lower leg centered on a tattoo. Two weeks after the initial tattoo application, names were added. Two weeks after this, a rash developed around the tattoo. Of note, another tattoo of the same color was applied simultaneously to the low back without any skin reaction. Physical examination revealed a slightly atrophic yellowish plaque localized to the tattoo site with some extension into the surrounding skin (Fig. 1). A punch biopsy of skin revealed scattered deposits of tattoo pigment in dermal macrophages in addition to a more pronounced diffuse dermal inflammatory process. This was characterized by a perivascular and periadnexal lymphoplas-macytic infiltrate associated with interstitial granulomatous inflammation.
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