In vivo and ex vivo dermoscopy of lesions from implantation of human papillomavirus in tattoos: report of two cases,

The number of individuals with tattoos has been increasing worldwide, alongside with reports of complications varying from reactions to the injected pigments to infections caused by agents inoculated in the pigmentation process. The diagnosis of such unwanted events can be obtained through complementary non-invasive methods, preserving the maximum of the tattoo design. The authors present two cases of patients with warts on tattooing, and correlate their clinical aspects to in vivo and ex vivo dermoscopy, and to the findings in the histopathological examination, aiming to determine patterns that aid the diagnosis of these lesions without performing biopsy.

KEYWORDS
Dermoscopy; Histology; Comparative; Tattooing; Warts

Authorship

John Verrinder Veasey ^** Corresponding author. E-mail:johnveasey@uol.com.br (J.V. Veasey).

Dermatology Clinic, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, BrazilIrmandade da Santa Casa de Misericórdia de São PauloBrazilSão Paulo, SP, BrazilDermatology Clinic, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil

https://orcid.org/0000-0002-4256-5734

Ana Luisa Nasser Erthal

https://orcid.org/0000-0002-0404-9376

Rute Facchini Lellis

Pathology Laboratory, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, BrazilIrmandade da Santa Casa de Misericórdia de São PauloBrazilSão Paulo, SP, BrazilPathology Laboratory, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil

https://orcid.org/0000-0001-7690-0513

* Corresponding author. E-mail:johnveasey@uol.com.br (J.V. Veasey).

Authors’ contribution

John Verrinder Veasey: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analyzing, and interpreting the data; effective participation in research orientation; intellectual participation in propaedeutic and/or therapeutic conduct of the cases studied; critical review of the literature; critical review of the manuscript.

Ana Luisa Nasser Erthal: Conception and planning of the study; elaboration and writing of the manuscript; obtaining, analyzing, and interpreting the data; critical review of the literature; critical review of the manuscript.

Rute Facchini Lellis: Obtaining, analyzing, and interpreting the data; intellectual participation in propaedeutic and/or therapeutic conduct of the cases studied.

Conflicts of interest

None declared.

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Figures

Figures (4)

Thumbnail

Figure 1
(A) Clinical aspect of the tattoo with multiple papules arranged linearly. (B) In vivo dermoscopy (×10 magnification) showing papules with digitiform and red dotted projections corresponding to vascular ectasias. (C) Ex vivo dermoscopy (×20 magnification) showing papillomatous and dotted hemorrhagic projections in the epidermis, with presence of pigment in the superficial dermis.

Thumbnail

Figure 2
Histopathological exam of patient 1, stained with hematoxylin & eosin. (A) ×40 magnification, presenting epidermis with papillomatosis, prominent hyperkeratosis with parakeratosis, hypergranulosis, acanthosis and elongated epidermal ridges, and dermis with presence of extracellular deposits of black pigment, compatible with exogenous pigment. (B) ×200 magnification evidencing detail of papillomatosis. (C) ×200 magnification with detail of black pigment accumulation in dermis.

Thumbnail

Figure 3
(A) Clinical appearance of the tattoo, with multiple discrete and diffuse erythematous papules, both on the tattoo and on healthy skin. (B) In vivo dermoscopy (×10 magnification) showing details of the papules with unspecific desquamation, without digitiform projections and red dots. (C) Ex vivo dermoscopy (×20 magnification) showing a slightly thickened upper portion the epidermis with discrete flat papillomatous projections, associated with the presence of pigment in the superficial and medium dermis.

Thumbnail

Figure 4
Histopathological exam of Patient 2, stained with hematoxylin & eosin. In (A) (×200 magnification) hyperkeratotic epidermis with the presence of balonized keratinocytes on the epidermal surface is observed. In the dermis, there are exogenous black pigment deposits around the vessels. In (B) (×400 magnification), nuclear polymorphism and hyperchromia are evident, in addition to the broad and basophilic cytoplasm of keratinocytes, characterizing the cytopathic effect of HPV. In (C) (×400 magnification), the black pigment of the tattoo deposited around the vessels is observed.

Figure 1 (A) Clinical aspect of the tattoo with multiple papules arranged linearly. (B) In vivo dermoscopy (×10 magnification) showing papules with digitiform and red dotted projections corresponding to vascular ectasias. (C) Ex vivo dermoscopy (×20 magnification) showing papillomatous and dotted hemorrhagic projections in the epidermis, with presence of pigment in the superficial dermis.

Figure 2 Histopathological exam of patient 1, stained with hematoxylin & eosin. (A) ×40 magnification, presenting epidermis with papillomatosis, prominent hyperkeratosis with parakeratosis, hypergranulosis, acanthosis and elongated epidermal ridges, and dermis with presence of extracellular deposits of black pigment, compatible with exogenous pigment. (B) ×200 magnification evidencing detail of papillomatosis. (C) ×200 magnification with detail of black pigment accumulation in dermis.

Figure 3 (A) Clinical appearance of the tattoo, with multiple discrete and diffuse erythematous papules, both on the tattoo and on healthy skin. (B) In vivo dermoscopy (×10 magnification) showing details of the papules with unspecific desquamation, without digitiform projections and red dots. (C) Ex vivo dermoscopy (×20 magnification) showing a slightly thickened upper portion the epidermis with discrete flat papillomatous projections, associated with the presence of pigment in the superficial and medium dermis.

Figure 4 Histopathological exam of Patient 2, stained with hematoxylin & eosin. In (A) (×200 magnification) hyperkeratotic epidermis with the presence of balonized keratinocytes on the epidermal surface is observed. In the dermis, there are exogenous black pigment deposits around the vessels. In (B) (×400 magnification), nuclear polymorphism and hyperchromia are evident, in addition to the broad and basophilic cytoplasm of keratinocytes, characterizing the cytopathic effect of HPV. In (C) (×400 magnification), the black pigment of the tattoo deposited around the vessels is observed.

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In vivo and ex vivo dermoscopy of lesions from implantation of human papillomavirus in tattoos: report of two cases,

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[1] * Corresponding author. E-mail:johnveasey@uol.com.br (J.V. Veasey).