Tattoo pigment agglomerates measured in skin biopsies by computerised light microscopy: Study of 161 patients with adverse reactions in black and red tattoos.
BACKGROUND
Black tattoo reactions are suggested to be foreign body reactions manifested as papulo-nodular inflammation that is associated with active sarcoidosis.


AIM
To study the morphology of black and red pigment agglomerates in skin biopsies from tattoo reactions, referenced to clinical diagnoses.


METHOD
Agglomerate count, area, width, height, circumference and circularity were measured in 161 patients by light microscopy (Olympus BX51™); 161 unstained skin biopsies from 64 black tattoo reactions and 97 reactions in red tattoos with allergy. Images (Jenoptic Gryphax RGB camera) were taken through a 40× objective using immersion oil. Computerised analysis of agglomerates was performed using ImageJ software. Student t test, chi-square test, Fisher Exact test, ANOVA and Bonferroni tests were applied.


RESULTS
Comparison of black and red pigment agglomerates showed no overall differences in count, area, width, height or circumference. However, in black tattoo reactions, the count of agglomerates was higher in patients with sarcoidosis (P = .009) vs no sarcoidosis. Black agglomerates were more circular shaped as compared to red, P = .023. In red tattoo reactions, agglomerates in patients with allergic cross-reactivity were slightly more circular (P = .036) vs patients with milder allergy. The count of red agglomerates was lower in patients clinically typed excessive hyperkeratosis (P = .041) compared with other clinical types of allergy.


CONCLUSION
Patients with reactions in black tattoos associated with sarcoidosis have increased count of pigment agglomerates vs those without associated sarcoidosis indicating that black pigment agglomeration is one among a number of factors triggering sarcoid tattoo complication. Circular shape of agglomerates may code for bioactivity.
['Hutton Carlsen|Katrina|K|https://orcid.org/0000-0003-4183-0580', 'Larsen|Georg|G|', 'Serup|Jørgen|J|']
D001706:Biopsy D004396:Coloring Agents D006801:Humans D008853:Microscopy D012507:Sarcoidosis D012867:Skin D012871:Skin Diseases D013653:Tattooing
tattoo pigment agglomerate reaction sarcoidosis sarcoid