Indian Journal of Dermatology
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E-IJD® - CASE REPORT
Year : 2017  |  Volume : 62  |  Issue : 6  |  Page : 675
The bumpy face of che guevara: An interesting case


Department of Dermatology, Calcutta School of Tropical Medicine, Kolkata, West Bengal, India

Date of Web Publication24-Nov-2017

Correspondence Address:
Kingshuk Chatterjee
Parnasi, Tikorhat, Ambagan, Lakurdi, Burdwan - 713 102, Kolkata, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_1_17

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   Abstract 


Placement of decorative tattoo on the skin may lead to various immunological, infective, and coincidental complications. Inoculation of human papillomavirus leading to development of verruca is an uncommon complication of tattoos. The present report highlights the development of verruca vulgaris, developing after 2 years of tattooing in a young male.


Keywords: Human papillomavirus, tattoo, verruca


How to cite this article:
Chatterjee K, Roy A, Ghosh R, Barua JK, Halder S, Banerjee G. The bumpy face of che guevara: An interesting case. Indian J Dermatol 2017;62:675

How to cite this URL:
Chatterjee K, Roy A, Ghosh R, Barua JK, Halder S, Banerjee G. The bumpy face of che guevara: An interesting case. Indian J Dermatol [serial online] 2017 [cited 2019 Jun 25];62:675. Available from: http://www.e-ijd.org/text.asp?2017/62/6/675/219236

What was known?

  1. Inoculation of human papillomavirus is an uncommon phenomenon during inking of a decorative tattoo
  2. The tattoo instrument and dye have been considered as potential offenders for inoculation.


The English word “tattoo” owes its origin from the ancient Polynesian words “tatuismus,” “tatahou,” “tatau,” and “tahua” (ta = painting, toua = spirit). The word “tattow” in Tahiti is translated as painting of the skin.[1] While the etymology establishes tattoo as a mark of self-expression, its importance in cosmetic adornment as well as emphasizing cultural identity is well known. A wide range of figures, including different flowers, real and imaginary animals such as dragon, and different scripts and personalities such as revered revolutionist Ernesto “Che” Guevara, have been inscribed on the skin over last 4000 odd years. With the transition of the art of marking the skin evolving through crude plant extracts to permanent dyes and pigments, a wide array of dermatological complications have been observed as a consequence of introducing exogenous chemicals into the skin. Studies documenting serious complications, for example infections, allergic and granulomatous reactions, and malignancies due to tattooing, have depicted very few cases of viral infections.[2],[3] Verruca vulgaris developing on a tattoo was first described by Fox in 1884,[4] and such infections are thought to occur from viral inoculation during tattooing or the presence of the human papillomavirus (HPV) in the tattoo dye itself.

An 18-year-old unmarried male presented with chief complaints of multiple, skin-colored raised lesions over the ventral aspect of left forearm for last 1 year. These lesions were neither itchy nor painful. These lesions developed over a tattoo of Che Guevara, etched on his forearm 2 years ago with black dye by a nonprofessional person [Figure 1]. There was no history of intravenous drug abuse or immunosuppressive drugs. On examination, there were multiple, skin- colored papules, limited to the tattoo area with few papules developing over the adjacent normal skin. The patient tested negative for HIV 1, 2 and hepatitis B and C. Systemic examination was unremarkable. A provisional diagnosis of verruca vulgaris was made with a differential of papular sarcoidosis. A punch biopsy specimen was sent for histopathological examination. The section revealed compact hyperkeratosis with focal parakeratosis, acanthosis, and elongation of rete ridges with lymphohistiocytic infiltration of the papillary dermis [Figure 2] and [Figure 3]. The presence of koilocytes could not be detected, probably due to heavy staining of the section. However, features in favor of verruca vulgaris were hyperkeratosis mainly at the valleys, parakeratosis at the peaks, acanthosis, and incurving of rete ridges. Further confirmation (specific stain or Polymerase chain reaction) was not possible due to logistic limitations. Based on the clinicopathological correlation, a diagnosis of verruca vulgaris was made. The patient has been scheduled for electrocautery.
Figure 1: Multiple skin-colored papules over a tattoo of Che Guevara

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Figure 2: Compact hyperkeratosis with parakeratosis, acanthosis, and upper dermal infiltrate (H and E, ×40)

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Figure 3: Close-up view showing lymphohistiocytic infiltrate in the upper dermis (H and E, ×100)

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Tattoo-induced reactions have mainly been divided into three groups – (A) allergic/granulomatous/lichenoid reaction, (B) infections/inoculations, and (C) coincidental lesions. Inoculation of HPV during inking of tattoo is an uncommon phenomenon. Apart from the dye, the virus can be inoculated through the instrument, saliva of the artist, and pseudo- koebnerization from an unnoticed verruca in the tattoo area.[5],[6],[7] The available literature revealed a latency period ranging from 2 months to 10 years in case of warts developing over the tattoo area.[8] Acute sunburn was indicated as the precipitating factor in one case where lesions developed over a 2.5-years-old tattoo mark. While most of the case reports/studies have been focused on European patients, none of them has deciphered the actual cause of this prolonged latency. In our patient, there was no history of sunburn. In a few reports, where verruca developed over multicolored tattoos, the researchers have demonstrated a preferential involvement of the presence of lesions over black-colored areas. Considering the long latency period, they had ruled out inoculation of HPV during tattoo placement, but considered oxidative damage imparted by the polycyclic aromatic hydrocarbons, present in the black dye, leading to an “immunocompromised district” for preferential growth of HPV after incidental contraction.[9],[10] In our case, the whole tattoo was etched with black dye, explaining the extensive involvement of the tattooed area. Like Western literature, the present report reiterates the importance of sterility of the materials used for tattooing as well as the skin surface to avoid inoculation. To the best of our knowledge, this is the first case of verruca vulgaris developing over black tattoo after a long latency period in the Indian literature.

Acknowledgment

We wish to acknowledge the contribution of Dr. Sherina Laskar in the form of her valuable opinion regarding the histopathology of this case.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Konsulin W. Iskustwo Tatuirowki. TOO Diamant. Sankt-Peterburg: 2000.  Back to cited text no. 1
    
2.
Kasandjieva J. Skin diseases following the process of tattooing. Dermatol Venerol 2004;43:3-8.  Back to cited text no. 2
    
3.
Kazandjieva J, Tsankov N. Tattoos: Dermatological complications. Clin Dermatol 2007;25:375-82.  Back to cited text no. 3
    
4.
Fox TC. Warts occurring on tattooed lines. J Cutan Vener Dis 1884;2:216.  Back to cited text no. 4
    
5.
Karadag AS, Bilgili SG, Onder S, Kosem M. A case of verru plana on tattoo. J Pak Med Assoc 2014;64:840-2.  Back to cited text no. 5
    
6.
Sáez M, Rodríguez-Martín M, Sidro-Sarto M, Cabrera de Paz R, Rodríguez-García F, Fagundo-González E, et al. Multiple verrucae vulgaris in a young woman's tattoo. J Eur Acad Dermatol Venereol 2006;20:356-7.  Back to cited text no. 6
    
7.
Trefzer U, Schmollack KP, Stockfleth E, Sterry W, Kolde G. Verrucae in a multicolored decorative tattoo. J Am Acad Dermatol 2004;50:478-9.  Back to cited text no. 7
    
8.
Wanat KA, Tyring S, Rady P, Kovarik CL. Human papillomavirus type 27 associated with multiple verruca within a tattoo: Report of a case and review of the literature. Int J Dermatol 2014;53:882-4.  Back to cited text no. 8
    
9.
Ramey K, Ibrahim J, Brodell RT. Verruca localization predominately in black tattoo ink: a retrospective case series. J Eur Acad Dermatol Venereol 2016;30:e34-6.  Back to cited text no. 9
    
10.
Huynh TN, Jackson JD, Brodell RT. Tattoo and vaccination sites: Possible nest for opportunistic infections, tumors, and dysimmune reactions. Clin Dermatol 2014;32:678-84.  Back to cited text no. 10
    

What is new?

  1. Prolonged latency period before the onset of verruca over tattoo is an uncommon entity, which may be seen in Indian patients
  2. Carbon particles present in black dye impart an immunocompromised area for the growth of HPV.


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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