Morphea-like tattoo reaction in a patient with systemic sclerosis: Case report and review of the literature

Abstract

Background: Morphea-like tattoo reactions are rare phenomena, with few cases reported in the literature. We present a case of a morphea-like tattoo reaction and a literature review of such reactions for comparison. Case Description: A 38-year-old woman with known history of systemic sclerosis presented with abnormal healing and skin thickening over a red tattoo. Histopathological examination revealed sclerosing dermatitis, consistent with morphea-like tattoo reaction. Treatment included topical clobetasol and oral mycophenolate mofetil. Methods: A literature search of PubMed and EMBASE was performed in August 2023 for known morphea-like tattoo reactions. No time or language filters were applied. Results: A total of six articles were included. Case reports of morphea-like tattoo reactions in patients with no significant past medical history comprise five articles. One review article notes that red tattoo ink with and without cinnabar is associated with adverse skin reactions. Conclusions: Morphea-like tattoo reactions can be triggered by ingredients of tattoo ink, possibly due to local hypersensitivity or the Koebner phenomenon. We encourage high clinical suspicion for morphea-like tattoo reactions when a patient with known history of connective tissue disease presents with skin changes around a tattoo.