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JAMA Dermatology Clinicopathological Challenge
November 23, 2016

Another Tattoo Reaction PitfallA Pink Lamb in Wolf’s Clothing

Author Affiliations
  • 1Walter Reed National Military Medical Center, Bethesda, Maryland
JAMA Dermatol. Published online November 23, 2016. doi:10.1001/jamadermatol.2016.4048

A black woman in her 50s presented to the clinic with a 3-month history of nontender mildly pruritic verrucous nodules in several areas of a polychromatic tattoo on her right lower leg and foot. She reported that these appeared 1 to 2 months following placement of the tattoo and were restricted to areas where the artist created pink zones by layering white ink over red ink. She denied pain, fevers, and chills and had no history of skin cancer. She reported a distant history of discoid lupus, and was taking 2 antihypertensives but no other oral or topical medications. Physical examination revealed well-demarcated erythematous to violaceous verrucous nodules on the right lateral leg and dorsal foot (Figure 1A). A punch biopsy specimen from a representative nodule was obtained, with an additional biopsy for tissue culture (Figure 1B).

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