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Correspondence |

Pseudoepitheliomatous Hyperplasia: An Unusual Tattoo Reaction

Thomas S. Breza, MD; Alissa K. O’Brien, MD; Fredrick L. Glavin, MD
JAMA Dermatol. 2013;149(5):630-631. doi:10.1001/jamadermatol.2013.2661.
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Pseudoepitheliomatous hyperplasia (PEH) is a rare tattoo reaction often arising within areas of red or purple ink. The diagnosis and treatment can be challenging. We report herein the first case to our knowledge of PEH tattoo reaction treated with carbon dioxide laser.

Correspondence: Dr O’Brien, Department of Dermatology, University of Florida, 2049 SW 44th Ave, Gainesville, FL 32608 (athena19@ufl.edu).

Conflict of Interest Disclosures: None reported.

Additional Information: We are indebted to each other for collaboration on this joint effort (Drs Breza, O’Brien, and Glavin).

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Figure 1. Clinical images from the present case. A and B, Pseudoepitheliomatous hyperplasia (PEH) tattoo reaction on presentation (A) and after treatment with topical steroid (B). C-E, As the lesion recurred after steroid treatment discontinuation, a test area treated with carbon dioxide laser (C) showed promise for long-term treatment, and surrounding PEH tattoo areas were later treated sequentially (D and E).

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Figure 2. Hematoxylin-eosin–stained skin biopsy specimens showing pseudoepitheliomatous tattoo reaction (original magnifications ×200 [A] and ×650 [B]).

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