# Clinical Presentations of Granulomatous Skin Reactions Following Tattooing and Cosmetic Micropigmentation: A Systematic Review

## TL;DR

This paper reviews delayed skin reactions from tattoos and cosmetic pigmentation, highlighting their connection to systemic conditions like sarcoidosis.

## Contribution

The study systematically reviews clinical patterns and systemic associations of granulomatous reactions following tattooing and micropigmentation.

## Key findings

- Granulomatous reactions commonly occur with black and red pigments, presenting as papular or nodular lesions.
- Histopathology shows non-caseating granulomas, and many patients have systemic involvement like sarcoidosis.
- Immunosuppressive treatments are commonly used and generally result in favorable outcomes.

## Abstract

Tattooing and cosmetic micropigmentation are widely practiced procedures that are usually considered safe, but they can cause delayed granulomatous reactions and can comprise more than localized foreign-body reactions. This review synthesizes available evidence on granulomatous cutaneous reactions following tattooing and cosmetic micropigmentation, focusing on clinical presentation, histopathology, systemic associations, treatments, and outcomes. Across the included studies, granulomatous reactions occurred commonly with black and red pigments and presented as papular or nodular lesions with variable latency. Histological findings were consistent with non-caseating granulomas, and a substantial proportion of patients demonstrated ocular or systemic involvement, particularly sarcoidosis. Therapeutic approaches varied, most commonly involving immunosuppressive treatments, with generally favorable outcomes reported. Overall, granulomatous reactions associated with tattooing and micropigmentation, although uncommon, carry important clinical implications and should prompt consideration of systemic evaluation rather than being regarded as isolated cutaneous events.