A 29-year-old woman from Oregon presented to our dermatology clinic with a 2-week history of itchy, violaceous, flat-topped, 2–3-mm papules on her right forearm that developed ∼2 weeks after tattoo placement (Figure 1). The papules were first limited to the black and gray areas of the tattoo. Before visiting a dermatologist, the patient tried using 1% hydrocortisone cream for 1 week without benefit. After the application of the tattoo, she also applied Aveeno lotion on the area, but this lotion was also applied to other areas of the body unaffected by rash. Physical examination findings and medical history were otherwise unremarkable, with no reports of fever, systemic signs of illness, recent travel, or animal exposure. A trial of betamethasone was initiated, with temporary improvement, but when the patient returned 1 month later, the papules had spread to adjacent, normal skin beyond the tattoo margins. The lesions did not drain or become pustular at any time during the disease course. A punch biopsy of a papule adjacent to the tattoo was performed (Figure 2).

Figure 1.

A Buddha with a papular rash?

Figure 1.

A Buddha with a papular rash?

Figure 2.

Histology demonstrating a subcorneal pustule composed primarily of neutrophils.

Figure 2.

Histology demonstrating a subcorneal pustule composed primarily of neutrophils.

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