Psoriatic lesions at the site of recent tattoo - Koebner phenomenon

A 32-year-old male with a history of scalp psoriasis on coal tar lotion, had undergone recently a tattoo procedure at a parlor. Two months later, the patient noticed scaly lesions at the site of the tattoo. On examination, there was a black tattoo of a bird on the left flexural aspect of the forearm studded with multiple plaques with silvery white scales confined only to the tattoo areas [Figure 1]. There were no similar skin lesions elsewhere on the body, and the patient did not have any scars elsewhere. There were no skin lesions elsewhere. Auspitz sign was positive. Skin biopsy showed bulbous acanthosis with spongiform pustule diagnostic of psoriasis. In tattooing, the needle is usually inserted in the upper dermis, and consequently this has elicited a Koebner phenomenon in our patient precipitating psoriasis. Dermal trauma induced by tattooing may trigger cytokines such as tumor necrosis factor-alpha, interleukin-1, and interleukin-6, which in turn upregulates nerve growth factor, an important chemokine in the pathogenesis of psoriasis, causing an inflammatory cascade leading to the formation of psoriatic lesions.^[1]

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Figure 1:

Scaly plaques of psoriasis confined only to the tattoo area.

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