Description:
<jats:title>Summary</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Allergic reactions to tattoos are not uncommon. However, identification of the culprit allergen(s) remains challenging.</jats:p></jats:sec><jats:sec><jats:title>Objectives</jats:title><jats:p>We present a patient with papulo‐nodular infiltration of 20‐year‐old tattoos associated with systemic symptoms that disappeared within a week after surgical removal of metal osteosynthesis implants from his spine. We aimed to explore the causal relationship between the metal implants and the patient's clinical presentation.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Metal implants and a skin biopsy of a reactive tattoo were analysed for elemental contents by inductively coupled plasma mass spectrometry and synchrotron‐based <jats:styled-content style="fixed-case">X</jats:styled-content>‐ray fluorescence (<jats:styled-content style="fixed-case">XRF</jats:styled-content>) spectroscopy.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Nickel (<jats:styled-content style="fixed-case">N</jats:styled-content>i) and chromium (<jats:styled-content style="fixed-case">C</jats:styled-content>r) as well as high levels of titanium (<jats:styled-content style="fixed-case">T</jats:styled-content>i) and aluminium were detected in both the skin biopsy and the implants. <jats:styled-content style="fixed-case">XRF</jats:styled-content> analyses identified <jats:styled-content style="fixed-case">C</jats:styled-content>r(<jats:styled-content style="fixed-case">III</jats:styled-content>), with <jats:styled-content style="fixed-case">C</jats:styled-content>r(<jats:styled-content style="fixed-case">VI</jats:styled-content>) being absent. Patch testing gave negative results for <jats:styled-content style="fixed-case">N</jats:styled-content>i and <jats:styled-content style="fixed-case">C</jats:styled-content>r. However, patch tests with an extract of the implants and metallic <jats:styled-content style="fixed-case">T</jats:styled-content>i on the tattooed skin evoked flare‐up of the symptoms.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>The patient's hypersensitivity reaction and its spontaneous remission after removal of the implants indicate that <jats:styled-content style="fixed-case">T</jats:styled-content>i, possibly along with some of the other metals detected, could have played a major role in this particular case of tattoo‐related allergy.</jats:p></jats:sec>