Tattoo-induced pseudolymphoma is a cutaneous inflammatory response, the pathogenesis of which is still unknown. The objective of the present work was to find a possible causal relationship between pseudolymphomatous reactions on the red areas of tattoos and the metals contained in tattoo pigments and skin biopsies. Three individuals with cutaneous lesions on the red areas of tattoos were observed. Clinical and immunohistochemical examinations of the lesions were performed, and the concentrations of Cd, Co, Cr, Hg, Ni and Pb were measured in pigments and biopsy samples. Pseudolymphomas in the red areas were diagnosed in all three cases; one showed the prevalence of B-lymphocytes, whereas the other two showed a prevalence of T cells with a lichenoid pattern. Patch tests were negative. Corticosteroid therapy was ineffective. Cadmium, Co, Hg and Pb in the pigments were probably present as impurities, whereas Cr and Ni were the main components. Chromium and Ni had the highest concentrations, also in the biopsy samples. Permanent tattoos appear to be unsafe, considering the increasing number of diagnosed pseudolymphomas. It can be excluded that Hg was responsible for the reactions, given that the concentration in the red dyes and biopsies was very low. Significant levels of Cr and Ni should be considered as the causes of possible dermal reactions.
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