Allergic reactions to pigments, metals, and more? Body art from the allergist’s point of view

Abstract

In this chapter allergic reactions related to body art procedures will be discussed. Nickel allergy is a common side effect of body piercing. Other metals like cobalt, palladium or gold are of minor significance, although they bear the risk of co-exposure due to tattoos and implants in sensitized individuals. An allergic or hypersensitivity tattoo reaction is everything but uniform: Different clinical phenotypes can overlap and be observed in the same patient; the same is applicable for different histological patterns which can be observed in one and the same biopsy. In the differential diagnosis foreign body granulomas and sarcoidosis should be considered. In case of difficult diagnoses, we suggest the umbrella term “Tattoo-Induced Immunologic Reaction.” The major problem for the investigator is the fact that the ink may contain any material, toxic or allergenic, in a hidden or even non-declared form, thus leaving the investigator in the dark, not knowing what he/she should look or test for. At this stage, predictive patch testing seems to be of no avail, expensive, time consuming, and unreliable and appears to be obsolete, especially with regard to the treatment of the patient. Nevertheless, from the allergologist’s point of view, identification of culprit substances is a challenge because it is indispensable for complete diagnosis, comprehensive advice, and even initiation of reasonable legislative actions. Epidemiological studies of larger scale should be conducted, in order to collect more information with an ultimate goal to reduce the allergy risk substantially. Better knowledge of the ink composition and reliable test methods are required. The paraphenylenediamine contained in black henna preparations still constitutes the major problem of contact dermatitis in temporary tattoos.