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March 2009

Pruritic Papules Limited to Tattooed Skin—Diagnosis

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Arch Dermatol. 2009;145(3):321-326. doi:10.1001/archdermatol.2008.624-b

Examination of the hematoxylin-eosin–stained skin biopsy specimens from both papules and plaques within tattooed skin revealed pigment globules in the dermis in close proximity with, but not exclusively bordered by, naked noncaseating granulomas. The granulomas had a minimally dense, patchy, lymphocytic infiltrate. The aggregates of black pigment were present free within the dermis and within epithelioid histiocytes along with occasional multinucleate giant cells, consistent with sarcoidal granulomas. In addition, this patient had bilateral hilar adenopathy visualized on chest radiographs, with normal serum calcium and angiotensin converting enzyme levels. Based on these findings, the patient was given the diagnosis of sarcoidosis and treated with topical steroids. He had no further signs of systemic or cutaneous sarcoidosis after 4 months.

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