Journal of Cosmetic Dermatology | 2019
Granulomatous tattoo reactions in permanent makeup of the eyebrows
Abstract
Permanent makeup has become very popular over the last decade(s). Permanent makeup, also named cosmetic tattoos, is used for different indications, such as tattooing eyebrows, eyeliner, or the lining of the lips. It offers a solution to individuals with allergies to cosmetic products or physical incapability’s such as arthrosis or visual impairment. Although permanent makeup is common and regarded safe, it may still cause adverse skin reactions, including infections, allergic reactions, and autoimmune diseases such as sarcoidosis. Regardless of the size of the affected area, tattoo reactions cause a reduced quality of life. Here, we report 5 patients referred to the Academic Tattoo Clinic Amsterdam because of a skin reaction in their tattooed eyebrows. The clinical presentation in these patients includes elevated and frequently yellowish plaques, sharply demarcated around the tattooed skin (Figure 1). Remarkably, all patients got their permanent makeup of their eyebrows several times during the last 4-15 years (Table 1). Time between last placement of the cosmetic tattoo and onset of complaints varied between 1 and 18 months. Dyes used were in the red, brown, and black spectrum. No triggering factors could be identified, and there was no history of systemic complaints. Histopathological evaluation revealed granulomatous inflammation in all patients and additional stains were negative for fungi and acidresistant mycobacteria. In patient 1, an elevated level of angiotensinconverting enzyme (ACE) of 126 (range 20-70 U/L) was found. In the same patient, high-resolution computed tomography (HRCT) revealed mediastinal lymphadenopathy, concluding systemic sarcoidosis. In patient 4, chest X-ray revealed hilar adenopathy and dubious nodules. In the other patients, we did not find any signs of systemic sarcoidosis. Patients were treated with topical or intralesional corticosteroids, resulting in almost complete resolution of the skin manifestation. The differential diagnosis of noninfectious reactions in cosmetic tattoos includes allergic reactions, foreign body reactions, and