Generalized lichenoid tattoo reaction with spontaneous resolution after skin biopsy

Tattooing has been practiced for thousands of years in many parts of the world and it is increasingly popular in today’s society, particularly among the young people. Decorative tattooing involves the introduction of tattoo pigments into the dermis. Cutaneous reactions to tattoos are common and are generally due to the salts or metals in the pigments and may occur from weeks to years after the procedure. Welander first described reactions to tattoos in 1893.1 Different reactions to the different pigments in tattoos have been described, among which a reaction to mercury in red tattoo ink is the most well known. Various types of histopathologic patterns have been reported, including lichenoid, granulomatous, eczematous, and pseudolymphomatous reactions, most of which are confined to the areas of the tattoo. Generalized tissue reactions are infrequent, and only one case of spontaneous resolution of a granulomatous reaction to a cosmetic lip tattoo has been recorded.2 Herein, we present the case of a generalized lichenoid reaction to black tattoos that resolved spontaneously. Based on a review of the literature, we believe that this is the first case of such a finding.