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May 2013

Pseudoepitheliomatous Hyperplasia: An Unusual Tattoo Reaction

Author Affiliations

Author Affiliations: Departments of Dermatology (Drs Breza and O’Brien) and Pathology (Dr Glavin), University of Florida, Gainesville.

JAMA Dermatol. 2013;149(5):630-631. doi:10.1001/jamadermatol.2013.2661

Pseudoepitheliomatous hyperplasia (PEH) is a rare tattoo reaction often arising within areas of red or purple ink. The diagnosis and treatment can be challenging. We report herein the first case to our knowledge of PEH tattoo reaction treated with carbon dioxide laser.

A 31-year-old, healthy Hispanic man presented with a 3-month history of tender and pruritic plaques arising within a tattoo on the right leg. The plaques were confined to the areas of purple ink and arose 2 months after receiving the tattoo (Figure 1A). Two 4-mm punch biopsy specimens were obtained, one for hematoxylin-eosin analysis and one for tissue culturing for bacteria, fungi, and atypical mycobacteria. The culture findings were negative. Histopathologic interpretation as keratoacanthoma did not correlate clinically. A specimen from a repeated incisional biopsy was interpreted as PEH (Figure 2). Empirical minocycline and clarithromycin therapy led to minimal improvement. Repeated culture findings were all negative. Addition of clobetasol propionate, 0.05%, ointment to the treatment regimen resulted in rapid resolution of the plaques (Figure 1B). A diagnosis of PEH tattoo reaction was made.

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