| Introduction Red ink tattoo reactions are an increasingly recognized complication of cosmetic tattooing, often manifesting as granulomatous or lichenoid dermatitis resistant to conventional therapy.Conventional therapies—including topical and intralesional corticosteroids, CO₂ laser ablation, surgical excision, and systemic agents such as allopurinol or hydroxychloroquine—have shown variable success, often limited by recurrence or poor cosmetic outcomes. Management is challenging due to the unpredictable course and patients’ desire to preserve tattoo aesthetics. Methods: We report a case series of ten patients presenting over a 6-month period with red tattoo granulomatous reactions. Clinical features included erythema, induration, pruritus, and in some cases ulceration localized to red-pigmented tattoo areas. All patients underwent histological confirmation to exclude infection or sarcoidosis.Case 1–3: Moderate erythematous granulomas treated with low-dose intralesional corticosteroids, resulting in partial resolution.Case 4–6: Extensive granulomatous reactions refractory to steroids managed with Q-switched Nd:YAG laser (532 nm), achieving flattening and symptomatic relief while preserving tattoo outlinesCase 7–8: singular lesion treated with topical tacrolimus 0.1%. Case 9–10: Mixed lesions required combined Nd:YAG laser sessions with adjunctive topical tacrolimus. Results: Eight patients are currently under follow-up. Two patients were lost to follow-up. No systemic adverse effects were noted, and cosmetic outcomes were acceptable to all who currently undergoing therapy. Conclusion: Red ink tattoo granuloma reactions represent a therapeutic challenge. A multimodal approach integrating Nd:YAG laser, low-dose corticosteroids, and topical tacrolimus offers effective control with preservation of tattoo aesthetics. Larger controlled studies are warranted to standardize management protocols.aeghuiop |
