Multiple epidermoid cysts arising within red tattoo ink: A case report

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Conference Proceeding

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J Am Acad Dermatol


Epidermoid cysts are the most common cutaneous cysts, and can occur anywhere on the skin. They may be primary, arise from disrupted follicular structures or be due to traumatically implanted epithelium. We report the case of a 30-year-old Hispanic female who presented for a 5-month history of pruritic bumps and irritation in her tattoo. Physical examination revealed a red, green and black tattoo covering most of her right lower leg with several 2-3 mm firm papulonodules, some with a keratotic core, arising only within the red ink. Her prior tattoos were unaffected. Biopsy of the papulonodules revealed multiple epidermoid cysts. She was started on fluocinonide 0.05% ointment for her pruritus, and tretinoin 0.025% cream for her cysts. We have found only two prior reports of epidermoid-type cysts occurring within new tattoos. A 24-year-old Malay man with multiple epidermoid cysts arising a month after tattooing and a 28-year-old man who developed milia in red and yellow pigments of his tattoo, 6 months after tattooing. Milia in a longstanding tattoo has been reported once, following a lichenoid reaction. The pathophysiology of such a finding is thought to be related to introduction of pigment into the skin which causes disruption of the epithelium, leading to occurrence of these epidermoid cysts. The finding of epidermoid cysts has also been reported following trauma, radiotherapy and after surgical procedures, such as needle biopsy. Reported treatments include excision, laser ablation, electrodessication, and topical retinoid therapy to reduce the size and number of milia cysts.




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