Dermatophytic infection over the tattoo: A case report

Introduction

Tattooing has been practiced in India since ancient times. Tattooing is a very old practice which involves insertion of ink pigment of the desired color into the dermis. It is more commonly seen in young individuals of India due to an increased enthusiasm toward newer fashion trends. Allergic reactions to tattoo pigments are uncommon following tattooing because ink pigment gets encapsulated in fibrous tissue and become less reactive histologically.¹ Occasionally, individual may become sensitive to ink pigment or its constituents which may manifest in several ways including allergic contact dermatitis and photoallergic dermatitis. Tattoo ink reactions can be classified as acute inflammatory reactions, allergic hypersensitivities, and granulomatous, lichenoid, and pseudo lymphomatous types of reactions.² Cutaneous reactions to tattoos are uncommonly reported in the literature. Here we report a case of Dermatophytic infection over and surrounding the tattoo.

Case report

A 24-year male patient presented to the outpatient department of Dermatology at our institute with a chief complaint of a dry reddish lesion over the tattoo on his right side of the chest since a month.

The lesion progressively increased to the present size of 5cm X 5cm and was accompanied with Itching (Fig. 1). Patient gave history of tattooing over the same area 3 months ago and it was done under unhygienic conditions by an unprofessional person. On examination, the lesion was circumscribed scaly, erythematous annular plaque and had an inflammatory advancing margin. Central clearing was present. No similar history in the past. No other parts of the body showed similar lesions. Skin scrapings were taken from the active margin of the lesion for examination. A Direct KOH mount was positive. Fungal culture was performed on Sabouraud’s dextrose agar (SDA) and the organism isolated was Trichophyton mentagrophyte (Fig. 2). Treatment was initiated after lab confirmation with antifungal drugs.

Discussion          

Both in India and Western world Tattooing has become a common procedure, and is no longer restricted to outlaws, prisoners, sailors or gang members. It is part of a culture using body modifying techniques. Although tattoos are more frequent among youngsters and young adults, there seems to be no age-limit. Both tattooing and removal of tattoos has become a business, with the latter less successful but more expensive than the former.³

With the growing interest in tattoos, there is also a need for awareness about unwanted adverse effects. Concerns are growing by official bodies and Dermatologists.^4,5

Although the risk of infection is known for a long time, new germs possess new risks. Ink and other tattoo equipment are related possible infections.⁶

Tinea on tattoo presents as a scaly erythematous plaque with vesiculopustular borders and central clearing that is usually pruritic. Literature reports suggest the occurrence of this fungal infection within a month of tattoo placement. Tinea is known to spread by direct contact, and a likely source of infection can usually be identified.^7,8

Fungal infections at tattoo sites have been described, [9-11] including a case of fungal eye infection thought to be related to a tattoo.¹²

Dermatophytes are a group of fungi that have a capacity to invade keratinized tissues (skin, hair and nails) of humans and other animals to cause acute and chronic dermatophytosis. It is prevalent throughout the World, and it depends on habits and living conditions of people.¹³

The severity of dermatophyte infection may range from mild-to-severe as a consequence of the host’s responses to the metabolic products of the fungus. The dermatophytes have distinct clinical manifestations in different parts of the body. Tinea corporis is a disease of non-hairy skin and disease is characterized by erythematous scaly lesion, and sharply marginated plaques.¹³ Clinically Tinea corporisia being reported particularly in HIV-positive patients or immunocompromised patients.¹³

Tinea corporis, mainly caused by T. rubrum,¹³ but in this case study T. mentagrophytes were isolated from the tattoo site. With clinical findings and mycological examination, KOH test was positive and isolates of Trichophyton mentagrophytes was observed on SDA Culture. Treatment with antifungal was initiated.

Conclusion

Tattooing and removal of tattoos are more frequent among youngster and young adults and it is associated with unwanted adverse effects. In this case study T. mentagrophytes were isolated from the tattoo over the chest. On the basis of clinical and   mycological   examination Dermatophytic infection over tattoo was confirmed.