Photo Rounds
Foreign-body reactions, syphilis are part of the differential Dx
Nonsarcoidal tattoo granulomas are a foreignbody reaction to the pigment used in tattooing and are characterized by lesions occurring only at the site of tattoos. This type of granulomatous reaction is most commonly seen in redpigmented tattoos, but can be seen in other tattoo colors as well. Macrophages containing pigment and “naked” granulomas are seen on histology.
Atypical mycobacterial skin infection can occur in tattoos that were created with contaminated ink or ink diluted with nonsterile water.5 Mycobacterial species such as Mycobacterium chelonae have been isolated from skin biopsies taken from the margins of new tattoos that developed a persistent erythematous eruption.5
Granuloma annulare is characterized by red or skin-colored plaques in annular and rope-like patterns with central clearing and nonscaly borders. A localized variant is frequently found on the extremities.6 There are associations between granuloma annulare, diabetes mellitus, and internal malignancy.7
Secondary syphilis classically presents with symmetric macules or papules distributed on the trunk and extremities. However, cutaneous manifestations vary widely. Lesions involving the palms and soles are important clues to a syphilis diagnosis, and patients often have malaise and fever.
Treatment includes topical, intralesional corticosteroids
The evidence for the treatment of cutaneous sarcoidosis is largely drawn from uncontrolled case series; there have been few double-blind, placebo-controlled studies.8 The first-line treatment for limited papules is a high-potency topical corticosteroid (eg, clobetasol 0.05% ointment applied twice weekly) and an intralesional corticosteroid (eg, triamcinolone, one 5-10 mg/mL injection every 4 weeks).8