Cutaneous intolerance of the pigments used for tattooing has been known for a long time. This may present in different clinicohistologic forms, including eczema, photosensitivity, lichenoid reaction, granulomatous reaction, and pseudolymphoma.1
Cutaneous reactions to a tattoo tend to occur a few weeks or months after the tattoo has been done. Later appearances (after some years) have occasionally been described but are not common. This reaction may be due to retarded hypersensitivity to one of the pigments used and can be reproduced by epicutaneous tests with suitable allergens. On other occasions, the granulomatous reactions are of the foreign-body type or have sarcoid characteristics, and the findings of epicutaneous tests tend to be negative. However, since the delayed reaction to tattoos is also immunological, it is unlikely to be associated with delayed hypersensitivity type IV.