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Patient Story

A teenager presents with itching and swelling along the area of a recent tattoo on the lower leg. She notes that the area has become swollen and is itching and draining (Figure 81-1). On examination there is swelling over the areas of red dye usage. The pediatrician recognized this as an allergy to the red dye and noted that there were signs of excoriations and some crusting. This was secondary to the scratching that broke the skin and allowed for a secondary infection to begin. The physician treated the secondary infection with oral cephalexin and referred the patient to dermatology for consideration of intralesional steroid treatment of the red dye allergy.

A teenager presents with a tender red lump around an embedded neck piercing (Figure 81-2A). The physician notes that there is a granuloma around the piercing site on the left. The patient requests removal of this piercing which is performed in the office. Four months later a new granuloma forms around the piercing on the right neck (Figure 81-2B). The patient requests removal of the second piercing and acknowledges that it is not a good idea for her to get any additional piercings.


Allergic reaction to the red pigment in a tattoo on the lower leg of a teenage girl. (Used with permission from Jonathan Karnes, MD.)


A. Granuloma around the neck piercing on the left. B. Five months later a new granuloma has formed around the second neck piercing and the scar from the removal of the first piercing is visible. (Used with permission from Richard P. Usatine MD.)


Tattoos and piercings in both the adult and adolescent populations have become more commonplace. The complications of both have increased as the popularity of body art grows.


Tattoos and piercings are also called body art.

Dye, pigment, and ink are all interchangeable when referring to the color used in tattoos.


  • Body art including tattooing, piercings and scarification have been practiced worldwide since the beginning of history.

  • Tattoos are increasingly popular in the US with an estimated percentage of adults with one or more tattoos at about 21 to 25 percent in 2012.1

  • More adolescent and adults are choosing both tattoos and piercings as an expression of uniqueness.2

Etiology and Pathophysiology

Complications result from permanent tattooing or piercing dependent on the location of the body, the healing time and the type of body art chosen. Because both tattoos and piercings break the protective skin barrier, there are ...

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