Image 1-Sarcoidal type granulomas situated in the dermis

Image 2-Higher power magnification showing scattered giant cells.

Image 3-Highest power magnification showing black tattoo pigment within the granulomas.


Issues in Dermatopathology

Sarcoidal Granulomas in Tattoos-Tissue Reaction or Harbinger of Systemic Sarcoidosis?

Development of Sarcoidosis in Cosmetic Tattoos.

Antonovich DD and
Callen JP Arch Dermatol. 2005;141:

My residents know I love to point out the danger of assuming that sarcoidal type granulomas associated with tattoos of the skin are simply a tissue reaction pattern. The dermatology and pathology literature is replete with examples that an underlying systemic sarcoidosis may also be present. In fact, there are several publications that suggest that polarizable foreign bodies may be quite common in patients (up to 22%) with granulomatous cutaneous lesions of systemic sarcoidosis. It is hypothesized that these foreign bodies may actually incite the formation of these granulomas.

Thus, it was somewhat surprising to see this recent publication warning against the assumption that foreign material in sarcoidal type granulomas can exclude the diagnosis of an underlying systemic sarcoidosis. The patient described in the publication developed sarcoidal type granulomas in the sites of cosmetic tattoos. A diagnosis of sarcoidosis was made three years later.

Always rule out systemic sarcoidosis when dealing with sarcoidal-type granulomas in the skin, even if a foreign body is present.

When you have reviewed the case and discussion, please comment, I will post them anonymously.

Issues in Dermatopathology

Additional References:

The Doctor's Doctor-Tattoo

The Doctor's Doctor-Sarcoidosis

Arch Dermatol. 2001;137:427-430


Last Updated July 20, 2005

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