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Diagnosis: Allergic reaction to the red component of the tattoo ink. Red (mercury/cinnabar) is the most common allergen in professional tattoo inks.


Discussion:
The composition of tattoo pigment colors is as follows:

Black - Carbon (India ink), iron oxide, logwood
  • Blue - Cobalt aluminate
  • Brown - Ferric oxide
  • Green - Chromic oxide, lead chromate, phthalocyanine dyes
  • Purple - Manganese, aluminum
  • Red - Mercuric sulfide (cinnabar), sienna (ferric hydrate), sandalwood, brazilwood, organic pigments (aromatic azo compounds)
  • White - Titanium oxide, zinc oxide
  • Yellow - Cadmium sulfide

    General discussion on tattoos
    A tattoo may occur accidentally or deliberately for cosmetic and decorative purposes. Accidental tattooing results from unintentional deposition of exogenous pigmented substances such as asphalt, graphite, or carbon within injured skin (Fig. 94.5)13. Automobile, bicycle and skating accidents as well as puncture wounds are the most common causes of traumatic tattoos. In decorative tattooing, the pigment is introduced into the dermis with needles or a tattoo gun to create various pictures, group identity symbols or writings. The motif differs according to the culture of the society and the purpose for which it is created. Cosmetic tattoos are also done to define lip contours, replace eyeliner or hide an abnormality in skin color. Iatrogenic tattoo may remain after the use of ferrous subsulfate (Monsel's solution) for hemostasis. Tattoos often contain a number of pigments that are combined to create different hues. These may be inorganic salts of metals, such as mercury or cinnabar (red), cobalt salts (blue), chromium (green), cadmium (yellow), ferric hydrate (ochre), manganese salts (purple), or organic preparations, e.g. sandalwood and brazilwood and carmine10. The red color is most commonly associated with nodular reactions (Fig. 94.6).


    eMedicine CME article on 'Tattoo Reactions'


    DermNet article on Skin Associcated Skin Reactions



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