Page 110 - Journal of Special Operations Medicine - Summer 2016

An Ongoing Series

Lesions Arising in a Tattoo of an
Active Duty US Marine Corps Woman

Aubrey E. Winn, MD; Shayna C. Rivard, MD; Brian Green, DO

ABSTRACT

Tattoos are ubiquitous in modern society; however, they about half of those Americans with tattoos have two to
do not come without risk of medical complications. five tattoos, and approximately 20% have six or more
When complications arise in the military community, tattoos. Obtaining tattoos does come with medical
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a particularly thorough differential diagnosis should risks, including superficial infection, hepatitis C virus
be considered based on the increased exposures service C infection, hypertrophic scar formation, keloid reac-
members have during deployment and throughout their tion, dermatitis, and allergy to various ink pigments.
2–5
military career. We present a case of a 38-year-old ac- When complications occur in the military community,
tive duty US Marine Corps woman with worsening skin owing to Servicemembers’ environmental exposures and
lesions arising within a tattoo 6 weeks after acquiring deployments, a wide differential should be considered.
the tattoo on her right chest. Given environmental ex- Here, we present the case of a 38-year-old active duty
posures from a recent deployment to the Middle East, woman in the US Marine Corps with skin lesions aris-
a wide differential was considered. Ultimately, a skin ing within a tattoo 6 weeks after acquiring the tattoo on
biopsy revealed early hypertrophic scar formation re- her right chest. She presented with worsening superfi-
sponsive to therapy with intralesional triamcinolone cial pain and pruritus overlying the red-pigmented area
acetonide (Kenalog [ILK]). However, given the Marine of the tattoo. Initial treatment of oral antibiotics and a
®
had recently deployed and is part of the active duty pop- topical steroid yielded minimal relief. After referral to
ulation, consideration of alternative, albeit rare, etiolo- dermatology, a skin biopsy revealed early hypertrophic
gies was imperative. scar formation, which was subsequently responsive to
therapy with ILK. However, both the environmental
Keywords: scar, hypertrophic; keloid collagen; tattoo; al- exposures secondary to multiple deployments and the
lergy, red ink; Mycobacterium, cutaneous atypical; sarcoid- inherent risks in obtaining a tattoo serve to highlight
osis, cutaneous; foreign body granuloma; cellulitis the importance of considering a wide differential in the
active duty population.

Introduction Case Presentation
The practice of obtaining tattoos has existed throughout A 38-year-old otherwise-healthy active duty woman pre-
history. In the 19th century, tattoos were becoming com- sented to her primary care physician with right-sided su-
mon in England as part of honoring a medieval ritual; perficial chest discomfort in close proximity of a recently
however, in the United States, the predominant popula- acquired red-and-black–pigmented tattoo. Pain radiated
tion consisted of US Soldiers and Sailors. Today, tattoos to her right breast, although no drainage or induration
are still commonplace in the military community, but was noted. This tattoo had been obtained 6 weeks ear-
tattoos have gained increasing popularity in general so- lier at a tattoo parlor in North Carolina. Of note, during
ciety. Individuals obtain tattoos to define and visually the same session she also acquired a black-pigmented
cement elements of their identity, to memorialize, or tattoo on her upper back, which had no complications
to show loyalty. Currently, roughly 20% of Americans in healing. Four days after receiving her chest and back
have a tattoo, and approximately 40% of the people in tattoos, she had presented to an emergency department
this group are of the millennial generation. Moreover, with erythema, edema, and pruritus in the vicinity of the
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