Simultaneous pseudolymphomatous and lichenoid tattoo reactions triggered by re-tattooing

A 46‐year‐old man had multiple tattoos on the forearms, back and legs, some present for as long as 28 years. Two years before presenting to us he became embarrassed about two football‐related tattoos on his back and lower right leg, and had two new complex multicoloured designs tattooed over them. Six months after the new tattooing was done he began to develop asymptomatic nodules in several of his tattoos, both old and new. On examination of the right lower leg he had an indurated plaque involving several different coloured areas of the new tattoo. On comparison with photographs of the previous tattoo of a footballer it was apparent that the reaction corresponded exactly to the underlying red shirt of the football player. Several small thickenings lower down corresponded to the red flashes on the shorts and socks of the footballer (Fig. 1a and b). On his upper back, there was no reaction to the underlying red tattoo, but instead a multifocal nodular reaction was present to some of the new light blue pigment (Fig. 1c). In addition, on his forearms, where he had older blue tattoos which had been present for 28 years, he also had multiple small foci of nodular induration in light blue pigment areas.