Acquired Reactive Perforating Collagenosis Occurring in Association With Nonred Ink Tattoo

Abstract: Perforating dermatosis is a group of skin conditions in which there is transdermal elimination of collagen, elastic fibers, or other dermal connective tissue. Perforating dermatosis can be genetic or acquired, known as acquired perforating dermatosis (APD). When collagen is the primary extruded material in acquired cases, the disease is designated as acquired reactive perforating collagenosis (RPC). We report a case of acquired RPC occurring in a new tattoo. One week after having a new tattoo placed on the left forearm, a 38-year-old gentleman presented to the emergency room with pruritic, crusted plaques and erosions in the regions of red and green inks of the tattoo. Histopathologic examination of the biopsy revealed an ulceration with transepidermal elimination of collagen bundles accompanied by basophilic debris, scattered dermal tattoo pigment, and a superficial to deep perivascular lymphohistiocytic infiltrate with scattered neutrophils and eosinophils. There have been 2 reported cases of tattoo-associated RPC, both in association with red tattoo ink. This present case is the first reported APD to occur in association with nonred tattoo ink. This case reaffirms the conclusions of others in recognizing APD as a potential tattoo-associated complication.