Am Fam Physician. 2015 Nov 1;92(9):821-822.
A 30-year-old man presented with an erythematous plaque on his left forearm. The plaque began as vesicles and was pruritic. The area was mildly infiltrated and had a particular pattern (Figure 1). He had applied an ornamental tattoo five days prior to the development of the rash, and the rash did not spread beyond the border of the tattoo. His medical history was unremarkable.
Physical examination revealed a raised erythematous lesion with a distinct border. The surrounding skin was normal. The patient was treated with a high-potency topical steroid cream. A hyperpigmented macule persisted for three weeks, but there was no sign of local relapse or neuralgia after six months.
Based on the patient's history and radiologic findings, which one of the following is the most likely diagnosis?
A. Contact dermatitis.
B. Herpes zoster.
C. Koebner phenomenon.
D. Symptomatic dermographism.
REFERENCESshow all references
1. de Groot AC. Side-effects of henna and semi-permanent ‘black henna’ tattoos: a full review. Contact Dermatitis. 2013;69(1):1–25....
2. Kind F, Hofmeier KS, Bircher AJ. Irritant contact dermatitis from a black henna tattoo without sensitization to para-phenylendiamine. Pediatrics. 2013;131(6):e1974–e1976.
3. Kind F, Scherer K, Bircher AJ. Contact dermatitis to para-phenylenediamine in hair dye following sensitization to black henna tattoos - an ongoing problem. J Dtsch Dermatol Ges. 2012;10(8):572–578.
4. Breathnach SM, Allen R, Ward AM, Greaves MW. Symptomatic dermographism: natural history, clinical features laboratory investigations and response to therapy. Clin Exp Dermatol. 1983;8(5):463–476.
5. Kontou-Fili K, Borici-Mazi R, Kapp A, Matjevic LJ, Mitchel FB. Physical urticaria: classification and diagnostic guidelines. An EAACI position paper. Allergy. 1997;52(5):504–513.
This series is coordinated by John E. Delzell, Jr., MD, MSPH, Assistant Medical Editor.
A collection of Photo Quiz published in AFP is available at http://www.aafp.org/afp/photoquiz.
Previously published Photo Quizzes are now featured in a mobile app. Get more information at http://www.aafp.org/afp/apps.
The editors of AFP welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide at http://www.aafp.org/afp/photoquizinfo. To be considered for publication, submissions must meet these guidelines. E-mail submissions to firstname.lastname@example.org.
Copyright © 2015 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact email@example.com for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions