Tattoos are increasingly popular in today's society. As a result, the reactions observed within tattoos are likely to become more abundant. It is well known that tattoos may cause various systemic and/or cutaneous pathologies. The systemic reactions range from infectious diseases such as hepatitis B or C, AIDS, syphilis, tuberculosis or leprosy to diseases with an immunologic or toxic pathogenic mechanism such as erythema multiforme, toxic shock, urticaria, vasculitis or sarcoidosis1
. The skin reactions are mainly infectious: warts, herpes simplex, molluscum contagiosum, cellulitis, erysipelas and erysipeloid. In other less frequent cases, the lesions that are considered coincidental lesions are basal2
cell carcinomas, or even melanomas4
. Apart from these complications, tattooing can also flare a Koebner's response in patients with active susceptible disease. It has been demonstrated that tattooed skin is more sensitive to trauma of all types compared with the surrounding normal skin, possibly because they are sites of compromised resistance.
In our case, the lesional skin presented the clinical and histologic hallmarks of verruca plana. The source of the virus implant is unknown, but several possibilities can be suggested. (1) The tattoo instrument (a staple) may have been used on other tattoo recipients and the virus may have been spread in this manner, (2) the ink or melted plastic used in the tattoo may have been contaminated with the virus, (3) the patient may have a verruca in the area of the tattoo when it was placed and it was spread traumatically through placement of the tattoo and (4) the saliva of the tattoo artist may have contained viral particles that were implanted at the time of placement. Attempts to examine the tattoo artist and his instruments were unsuccessful because he and the tattoo shop were out of business by the time the skin lesions developed.
After experimental papilloma virus inoculation, a verruca usually appears within 2 to 9 months5
. There have been six reports in the medical literature on inoculation of HPV during tattooing6-11
. The time between tattooing and the appearance of verruca varied from 2 months to 8 years, and the mean period was 4.5 years. The latency period of our case was 1 year. In our case, the first verruca lesion developed in the eyebrow semipermanent tattoo placement area. After a few months the lesions spread to the entire face. We think the lesion at the tattoo site was the primary disease focus, and it spread to other sites.
This case report provides support for the belief that HPV can be traumatically inoculated and it can have a long latency period.