Lichen planus or lichenoid tattoo reaction?

A 27‐year‐old white man with a tattoo of 3 months’ duration was referred for possible laser removal because a pruritic eruption had developed in the tattoo 1 month after placement. Physical examination revealed erythematous papules confined to the red areas of the tattoo ( Fig. 1 ). He also had flat‐topped papules on the glans penis, which the patient stated had developed a few weeks after tattoo placement. Tattoo before treatment, showing involvement of only the red areas image Biopsy of a penile lesion revealed a histologic pattern characteristic of lichen planus. Biopsy of the tattoo eruption revealed a lichenoid lymphocytic infiltrate with hyperkeratosis, hypergranulosis, and jagged epidermal hyperplasia. Deposits of black granular material were also present in the upper part of the dermis ( Fig. 2 ). Histopathology of the tattoo eruption shows a lichenoid lymphocytic infiltrate with hyperkeratosis, hypergranulosis, and jagged epidermal hyperplasia, with deposits of black granular material in the upper dermis image During a 2‐week follow‐up visit, the patient developed more lesions on his arms and legs. After 4 weeks of treatment with halobetasol propionate ointment 0.05% to the tattoo, legs, and arms, all lesions had resolved. The red areas of the tattoo became flat, nonpalpable, and asymptomatic ( Fig. 3 ). Tattoo after treatment with topical corticosteroids image