Tattoos and human papilloma virus: A case report of tattoo-associated flat warts (verrucae planae)

Abstract

The prevalence of tattoos is increasing and as such every physician must be aware of the potential adverse events associated with tattooing. Here we present a 36-year-old man with a recent history of skin-coloured papules appearing suddenly in a 20-year-old tattoo on the right forearm. Biopsy and histologic examination confirmed a diagnosis of verrucae planae or flat warts. Tattoo-associated human papilloma virus infections develop clinical manifestations after long latency periods and are often difficult to treat. The risk of tattoo-related human papilloma virus infection should be discussed when considering acquiring a tattoo.

Keywords: Tattoo; black ink; human papilloma virus; verrucae; warts.

Figure 1.

(a) Clinical photograph of the right ventral forearm showing white to skin-coloured flat-topped papules confined to areas of tattoo pigment. (b) Close-up of flat-topped papules with area of scale that developed after treatment with liquid nitrogen cryotherapy.

Figure 2.

(a) Histopathology of biopsy specimen stained with Hematoxylin and Eosin (H&E) showing verrucae planae (200×). (b) Higher magnification of verruca plana showing koilocytes consistent with HPV infection (400×). (c) Higher magnification of tattoo dye particles within the dermis (400×).