title: Tattoo ink-related cutaneous pseudolymphoma: a rare but significant complication. Case report and review of the literature.
abstract: BACKGROUND
  The demand for decorative tattoos is steadily growing worldwide, and in the US it is estimated that up to 24% of adults has one or more tattoos. Subsequently, the number of tattoo-related complications is increasing. Among these, lymphoproliferative disorders play a minor but important role. The aim of this article is to arouse the awareness of plastic surgeons and dermatologists about this rare but serious complication and to stimulate stricter clinical control of their tattooed patients.
  
  
  METHODS
  We report a new case of tattoo-related cutaneous pseudolymphoma (CPL) and perform a review of the last 30 years of literature on the topic in PubMed.
  
  
  RESULTS
  Apart from this new case, only 18 cases of CPL have been reported in PubMed so far. In contrast to the classic knowledge, the T cell was the predominant phenotype in 68% of cases. Red is confirmed to be the most involved ink. Topical and intralesional steroids, laser therapy, and surgery were used for treatment of CPL.
  
  
  CONCLUSIONS
  Even if CPL is a very rare and benign complication, we should not forget that in rare cases pseudolymphoma may evolve into a true lymphoma. Diagnosis is still difficult and is based on anamnestic, clinical, and histopathological data. From the review of the literature, the T cell predominance suggests a reclassification of tattoo-induced CPL and there is not a gold standard treatment yet. Finally, once a pseudolymphoma is diagnosed, there must be a long follow-up because of the possibility to transform into a malignancy.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Dipartimento di Chirurgia Plastica Ricostruttiva, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy, ilmarchesiandrea@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Marchesi
authors.forename: Pier Camillo
authors.initials: PC
authors.lastname: Parodi
authors.forename: Marco
authors.initials: M
authors.lastname: Brioschi
authors.forename: Matteo
authors.initials: M
authors.lastname: Marchesi
authors.forename: Barbara
authors.initials: B
authors.lastname: Bruni
authors.forename: Maria Giulia
authors.initials: MG
authors.lastname: Cangi
authors.forename: Luca
authors.initials: L
authors.lastname: Vaienti
mesh_terms: D000328:Adult; D001707:Biopsy, Needle; D004396:Coloring Agents / Q000009:adverse effects*; D062109:Dermatologic Surgical Procedures / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D007281:Ink; D008297:Male; D019310:Pseudolymphoma / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery; D035583:Rare Diseases; D018570:Risk Assessment; D012871:Skin Diseases / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery; D013653:Tattooing / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D004396:Coloring Agents