1: J Cutan Med Surg. 2008 Jan-Feb;12(1):43-8.

Sarcoidosis appearing in a tattoo.

Ali SM, Gilliam AC, Brodell RT.

Northeastern Ohio Universities College of Medicine, Rootstown, OH, USA.

BACKGROUND: Sarcoidosis is a systemic disease that may present as tattoo granulomas. OBJECTIVE: A patient with systemic sarcoidosis who developed a granulomatous reaction within a tattoo is presented to stimulate interest in this unusual phenomenon. METHODS AND RESULTS: A patient with a 6-year history of pulmonary sarcoidosis developed sarcoidal granulomas restricted to one pigment of a tattoo. Previous reports of sarcoidal granulomas within tattoos are reviewed, and information about the pathogenesis of this process is explored. CONCLUSION: Sarcoid granulomas may develop in tattoos as an isolated local reaction or as the presenting sign of systemic sarcoidosis. The reaction itself may provide insight into further understanding the pathogenesis of sarcoidosis.

2: Ann Dermatol Venereol. 2004 Jan;131(1 Pt 1):49-51.

Sarcoidosis granuloma on a tattoo induced by interferon alpha

Toulemonde A, Quereux G, Dréno B.

Service de Dermatologie, CHU d'Angers.

BACKGROUND: The side effects attributed to interferon alpha are numerous, including autoimmune events such as lupus, arthritis or thyroiditis. Emergence of sarcoidosis in patients with interferon alpha therapy is much more rare. We describe a case occurring in a patient treated for melanoma. CASE REPORT: A 54 Year-old woman who had been treated for fifty Months with low dose interferon alpha (Roféron(R), 3 millions units, three times a week) for a melanoma of the scalp (adjuvant therapy), developed labial nodules on a permanent tattoo. The diagnosis of sarcoid granuloma was confirmed by histopathologic analysis.
Physical examination revealed dyspnea on exertion with a moderate pulmonary interstitial infiltrate on the CT Scan. The diagnosis of cutaneous and pulmonary  sarcoidosis in association with interferon alpha therapy was made. Within 4 weeks, skin nodules began to regress although interferon was pursued at the same dose. Four Months later, at the end of interferon therapy, the nodules had totally disappeared. DISCUSSION: About forty cases of cutaneous or systemic sarcoidosis in patients treated with interferon alpha have been reported, but none of these cases concerned patients treated for melanoma. Interferon alpha might promote the development of sarcoid granuloma by inducing a switch of cytokine secretion from a Th2 to a Th1 cytokine pattern. It is very important to  recognize cutaneous sarcoidosis during interferon alpha treatment because pulmonary sarcoidosis can be confused with common general side effects observed with such treatment.

3: J Eur Acad Dermatol Venereol. 1999 Jan;12(1):51-3.

Systemic sarcoidosis presenting with multiple tattoo granulomas and an extra-tattoo cutaneous granuloma.

Papageorgiou PP, Hongcharu W, Chu AC.

Department of Dermatology, Imperial College School of Medicine, Hammersmith
Hospital, London, UK.

We describe a 29 year old Caucasian man who developed cutaneous sarcoidosis manifesting itself as a tumour at the left outer canthus clinically mimicking a basal cell carcinoma and nine tattoo granulomas. Subsequent investigation revealed that the patient was also suffering from systemic sarcoidosis.

4: Cutis. 1997 Mar;59(3):113-5.

Systemic sarcoidosis presenting in the black dye of a tattoo.

Jones MS, Maloney ME, Helm KF.

Department of Dermatology, Pennsylvania State University, Hershey Medical Center,
Hershey 17033, USA.

Sarcoidosis is an idiopathic granulomatous disease with many cutaneous manifestations and a known predilection for scars and areas of previous trauma. We report the first case of systemic sarcoidosis presenting in only the black dye of a tattoo. The skin manifestations of sarcoidosis and the histologic
differential diagnosis of granulomas are reviewed.

5: Br J Dermatol. 1994 May;130(5):658-62.

Pulmonary sarcoidosis presenting as a granulomatous tattoo reaction.

Collins P, Evans AT, Gray W, Levison DA.

Department of Dermatology, Ninewells Hospital and Medical School, Dundee,
Scotland, U.K.

A 29-year-old man presented with nodular skin lesions localized to areas of navy-blue pigmentation within a tattoo. Light microscopy demonstrated well-defined epithelioid granulomata in close relation to blue and black pigment. Although the patient was asymptomatic, a chest X-ray showed bilateral pulmonary shadowing, and histology of a transbronchial biopsy specimen showed features compatible with a diagnosis of sarcoidosis. X-ray energy dispersive spectroscopy  identified copper and titanium in the tattoo pigment. These elements were not found in tissue from the lung biopsy. The cutaneous eruption resolved with oral steroid therapy. Our observations suggest that the granulomatous reaction in the tattoo was a manifestation of sarcoidosis, rather than a specific reaction to pigment.