Systemic contact dermatitis to a surgical implant presenting as red decorative tattoo reaction

SCD: systemic contact dermatitis INTRODUCTION Up to 5% of orthopedic implant patients suffer metal-related cutaneous complications caused by delayed-type hypersensitivity reactions, most commonly to nickel, cobalt, and chromium. Both generalized and remote site dermatitis to orthopedic implants are uncommon. Traditional and decorative tattoos have been given for thousands of years around the world and remain a popular practice in modern times, with as many as 3 in 10 adults reporting having 1 or more tattoos. As more people get tattoos, the rate of complications, which may be as high as 2%, is likely to increase. Adverse tattoo reactions are common and predominantly affect red pigmented areas. Although reactions were often caused by an allergy to particular metals within pigments in the past, with the shift toward the use of azo dyes, the mechanism is unclear. We report a case of possible systemic contact dermatitis (SCD) manifesting as inflammation and pruritus at multiple red tattoo sites after surgical insertion of a metal implant and resolving with implant removal.