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. 2015 Dec;8(12):48-52.

Pseudoepitheliomatous Hyperplasia in a Red Pigment Tattoo: A Separate Entity or Hypertrophic Lichen Planus-like Reaction?

Viktoryia Kazlouskaya  1 , Jacqueline M Junkins-Hopkins  1
Affiliations

Pseudoepitheliomatous Hyperplasia in a Red Pigment Tattoo: A Separate Entity or Hypertrophic Lichen Planus-like Reaction?

Viktoryia Kazlouskaya et al. J Clin Aesthet Dermatol. 2015 Dec.

Abstract

Red pigment tattoos are known to cause pseudoepitheliomatous hyperplasia in the skin, frequently simulating squamous cell carcinoma or keratoacanthoma. Herein, the authors present two additional cases of red pigment tattoo pseudoepitheliomatous hyperplasia in which they noted a lichenoid tissue reaction. They reviewed the previously published cases and observed a lichenoid reaction in the histopathological images similar to hypertrophic lichen planus. The authors suggest that these reactions might best be referred to as "lichenoid reaction with pseudoepitheliomatous hyperplasia" or "hypertrophic lichen planus-like reaction." Accordingly, recognition of an inflammatory component may allow additional treatment options.

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Figures

Figures 1Aand 1B.
Figures 1Aand 1B.
Case 1. Site of red heart-shaped tattoo. (A) Verrucous plaque in the shape of a heart on the lower leg. (B) Close up view of the lesion, showing an exophytic plaque with a verrucous surface.
Figure 2
Figure 2
Case 2. Butterfly-shaped tattoo with hyperkeratotic pink to violaceous crusted nodules in areas of previously red pigment.
Figure 3
Figure 3
Punch biopsy of the verrucous lesion from Case 1 demonstrating prominent PEH and lichenoid infiltrate. H&E stained sections, x40
Figure 4
Figure 4
Biopsy from Case 1. There is a prominent lichenoid tissue reaction with necrotic keratinocytes, dyskeratosis, early Max Joseph’s spaces (arrow), and tattoo pigment granules in the dermis. H&E stained sections, x400
Figure 5
Figure 5
Second biopsy from the heart-shaped tattoo in Case 1 with PEH and follicular hyperplasia. H&E stained sections, x40
Figure 6
Figure 6
Higher magnification of the second biopsy from Case 1 showing lichenoid tissue reaction and red pigment granules in the dermis. H&E stained sections, x200
Figure 7
Figure 7
Case 2. Biopsy from a nodule within the butterfly tattoo. There is epithelial hyperplasia with dilated hyperplastic infundibula. H&E stained sections, x40
Figure 8
Figure 8
High power of the Case 2 biopsy. There is a dilated infundibulum with hyperplastic changes and lichenoid tissue reaction (arrow). H&E stained sections, x200
Figure 9
Figure 9
Case 2. Sparse red pigment granules in the infiltrate. H&E stained sections, x600.
See this image and copyright information in PMC

References

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