A well-built man covered with tattoos comes in to ask for your advice, complaining his tattoos have started to itch. He says he's never had any problems with his skin, and has had the tattoos for several years, but all areas inked red have swollen, and the itchiness seems centred on these patches. QUESTIONS 1. This man has an allergic reaction to the red ink used to produce his tattoo. True or false?
2. When this occurs it always develops a few days after ink has been injected. True or false?
3. The treatment of choice is a course of oral antibiotics, and a two-week course may be required. True or false?
4. Topical steroids may help when applied to the affected area. True or false?
5. If other treatments fail, excision of the affected areas may be required. True or false? DISCUSSION 1. True. Allergies can develop to any tattoo inks, but red is the most common colour to cause a reaction.
2. False. There may be no reaction for a number of years, as in this case.
3. False. Infection can occur after tattooing but localised inflammation occurring months to years later won't respond to antibiotics.
4. True. Topical steroids and oral antihistamines can be tried after the onset of inflammation and itching.
5. True. In this case the severe and relentless itching meant that the man was pleased to have the affected areas removed.