27099 Actinomyces infection within red pigment of a tattoo

Document Type

Conference Proceeding

Publication Date


Publication Title

J Am Acad Dermatol


Patient history: A Caucasian woman in her 40s presented with a one-year history of a raised, dry, pruritic papules on the tattoo on the left medial lower leg she received six months prior. Examination revealed multiple open comedones and pustules coalescing into an edematous plaque, limited to the red portions of the tattoo.

Biopsies: Histologic examination revealed pseudoepitheliomatous hyperplasia, tattoo and brisk lymphohistiocytic inflammation, suggestive of an infectious process.

Laboratory data: A wound culture grew Actinomyces neuii. Diagnosis and treatment: Patient was diagnosed with Actinomyces infection of red pigment of her tattoo and was started on amoxicillin 500 mg TID for six months and mupirocin ointment topically. Red pigment within tattoos is the most common cause of cutaneous reactions to tattoos.

We describe a case of PEH secondary to Actinomyces neuii infection limited to the red portions of a tattoo. To our knowledge, this is the first case in which Actinomyces species has been implicated in a tattoo infection. Primary cutaneous actinomycosis is rare; it is typically chronic, recurs after short courses of antibiotic treatment and leads to the formation of granules. While reactions within red tattoos and bacterial infections of tattoos may be relatively common, infection of the red component of a tattoo with Actinomyces has not yet been described. Biopsy and evaluation for bacterial infections such as Actinomyces should be considered within the differential of a red tattoo reaction.







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