To the Editor Dr Ayoola and colleagues1 described a patient with systemic sarcoidosis presenting with skin lesions of his tattoos. The authors stated that the differential diagnosis of the skin lesions included drug eruptions, T-cell lymphoma, and tuberculosis. However, other possibilities should have been considered.
Tattoos can be complicated by a variety of infectious, inflammatory, or neoplastic conditions, and the complications have diverse manifestations from macules to plaque.2 Tattoo sarcoidosis should be a diagnosis of exclusion, both clinically and histologically.3 The skin lesions of the patient were red to violaceous macules and papules confined to his tattoos.1 As the authors mentioned, infectious conditions, including atypical mycobacteria, leprosy, and tuberculosis, first need to be excluded.3,4
Fei Han. Etiologies of Tattoo Lesions. JAMA. 2015;314(8):836. doi:10.1001/jama.2015.8986