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Verrucae in a multicolored decorative tattoo

2004; Elsevier BV; Volume: 50; Issue: 3 Linguagem: Inglês

10.1016/s0190-9622(03)02096-6

1097-6787

Uwe Trefzer, K.-P. Schmollack, Eggert Stockfleth, Wolfram Sterry, Gerhard Kolde,

Body Image and Dysmorphia Studies

Decorative tattooing is becoming increasingly popular and is associated with a variety of bacterial and viral infections.1Nishioka S.A. Gyorkos T.W. Joseph L. Collet J.P. Maclean J.D. Tattooing and risk for transfusion-transmitted diseases the role of the type, number and design of the tattoos, and the conditions in which they were performed.Epidemiol Infect. 2002; 128: 63-71Crossref PubMed Google Scholar A healthy 29-year-old man with no pertinent medical history received an extensive tattoo on his left arm, consisting of a skull and a devil's head in the colors light blue, dark blue, green, and red. Eight years later numerous small, skin-colored, acuminate papule–predominantly in the area of the dark blue dye–were noted (Fig 1, Fig 2). The patient denied intravenous drug abuse. Tests for HIV and hepatitis were negative. Routine histology from lesional skin showed the features of old verrucae vulgares with acanthosis, papillomatosis, hyperkeratosis, and perinuclear vacuolization of some keratinocytes (Fig 3). In the papillary and middle dermis there were irregularly shaped granules of dark amorphic material not consistent with an inflammatory tattoo. In situ hybridization using a pan human papillomavirus (HPV) probe and polymerase chain reaction testing failed to show a positive reaction. The patient was treated with topical Imiquimod cream 5%, but the warts remained unchanged and the patient denied further therapies.Fig 2Close examination with most of warts confined to areas of dark blue dye with few warts as satellites in adjacent skin.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig 3Histology with acanthosis and papillomatosis of epidermis, and tattoo deposits in dermis. (Hematoxylin-eosin stain; original magnification ×125).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Complications of tattoos include the development of hypersensitivity to one of the pigments and a variety of infectious diseases such as outbreaks of hepatitis B or hepatitis C in simultaneously tattooed individuals.2Zeuzem S. Teuber G. Lee J.H. Ruster B. Roth W.K. Risk factors for the transmission of hepatitis C.J Hepatol. 1996; 24: 3-10PubMed Google Scholar In our case, the lesional skin presented the clinical and histologic hallmarks of HPV-induced verrucae vulgares, even though HPV could not be detected. There are only a few reports on inoculation of HPV during tattoo placement.3Ragland H.P. Hubbell C. Stewart K.R. Nesbitt Jr, L.T. Verrucae vulgaris inoculated during tattoo placement.Int J Dermatol. 1994; 33: 796-797Crossref PubMed Scopus (42) Google Scholar, 4Miller D.M. Brodell R.T. Verrucae restricted to the areas of black dye within a tattoo.Arch Dermatol. 1994; 130: 1453-1454Crossref PubMed Scopus (42) Google Scholar, 5Baxter S.Y. Deck D.H. Tattoo-acquired verrucae plana.Am Fam Physician. 1993; 47: 732PubMed Google Scholar The source of the virus implanted can be: (1) the tattoo instrument; (2) the saliva of the artist; (3) the patient with a previously unnoticed verrucae in the area of the tattoo with subsequent traumatic spread; or (4) contamination of the color. The last point seems to be the most likely one because the verrucae were almost exclusively confined to the dark blue color. However, attempts to examine the tattoo artist, his instruments, and the different dyes used for this impressive tattoo were unsuccessful because the tattoo parlor had shut down for unknown reasons.