Sarcoidosis
Sarcoidosis in tattoos
Persistent bumps or swelling in a tattoo can sometimes be caused by sarcoidosis.
If you notice these changes, it is important to have them evaluated by a dermatologist, preferably one with experience in tattoo related skin conditions. Sarcoidosis can be a serious inflammatory disease and should always be properly assessed.
What is sarcoidosis?
Sarcoidosis is an inflammatory disease in which small clusters of immune cells, called granulomas, form in different parts of the body.
The lungs and lymph nodes are most commonly affected, but the skin is also frequently involved. In some people, skin changes are the first or only visible sign of the disease.
The course of sarcoidosis varies. In some cases it resolves on its own, while in others it can become chronic and require long term medical follow up.
What does sarcoidosis look like in a tattoo?
Sarcoidosis in tattoos usually appears as firm bumps or swelling within the tattooed skin. It most often affects black or dark colored areas of the tattoo. The affected skin may itch, feel painful or sensitive, but sometimes causes little or no discomfort at all.
These changes can develop months or even years after getting the tattoo. In the Tattoo Clinic in Alrijne Hospital there have been patients who developed these skin manifestations after up to 20 years! They may remain limited to the tattoo or occur together with skin changes elsewhere on the body.
Cause
The exact cause of sarcoidosis is still unknown. It is thought to result from a combination of genetic predisposition and environmental triggers, such as small foreign particles that activate the immune system.
When sarcoidosis appears in tattoos, it is unclear whether the tattoo itself is the cause. Current medical understanding suggests that the tattoo acts as a local trigger in people who already have an underlying susceptibility to sarcoidosis, rather than being the primary cause of the disease.
Tattoo associated uveitis
There is also a specific condition in which swelling of black tattoos (granuloma formation) can be accompanied by inflammation inside the eyes, known as uveitis. This may cause symptoms such as redness, eye pain, sensitivity to light, blurred vision or floaters. In some cases, eye inflammation can occur at the same time as swelling in the tattoo, but it may also develop separately. Because untreated uveitis can lead to permanent vision problems, any new eye symptoms in combination with changes in a tattoo should be assessed urgently by an ophthalmologist.
Treatment depends on the severity and the organs involved. When the eyes are affected, anti inflammatory eye drops or ointments are often prescribed. In some cases, treatment may also include oral medication. These can include drugs such as hydroxychloroquine, methotrexate, or, temporarily, oral corticosteroids such as prednisone. The exact treatment plan is tailored to the individual and usually coordinated between a dermatologist and an ophthalmologist.
If you have swelling in a tattoo and experience eye symptoms, inform your dermatologist about both. A multidisciplinary evaluation may be necessary.
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