Photodermatitis in patients with tattoos and sensitization to titanium dioxide

Aliakhnovich N.S., Mlyavy A.N., Yanchenko U.V.

Vitebsk State Medical University, Vitebsk
Vitebsk Regional Clinical Pathological Bureau, Vitebsk

Photodermatitis has been described in patients with a tattoo and sensitization to titanium dioxide (TiO2).

Aim. The examination of the patients with photodermatitis after tattoo.

Materials and methods. After anamnesis was taken, an objective examination was performed, as well as an oral provocation test with 2 mg of TiO2 with assessment of oral fluid myeloperoxidase activity and phenotyping of blood lymphocytes. The study of blood leukocytes surface markers after incubation of whole blood with a suspension of TiO2, prik-tests with a suspension TiO2 in saline and autoserum, microscopy of skin biopsy specimens and photoprobe were conducted.

Results. A 32-year-old woman (T1) and a 33-year-old man (T2) complained of itching, flushing of the skin, blisters and exudation with crusts in places of tattooed skin after exposure to the sun, and delayed healing of tattoos after using paints with TiO2. The examination showed that oral provocation test with TiO2 was positive with a significant increase in oral fluid myeloperoxidase activity (+45.6% and +61.8%) and a decrease (more than 30%) of CD14 expression on monocytes (-46%), IL10 bound to receptors on lymphocytes (-36%) in T1, and in both patients – a decrease in CD19+CD154--B-lymphocytes (-66%, -41%) and FcεR1+-eosinophils in blood (-74%, -48%). In vitro, TiO2 caused a similar decrease in CD19+CD154--B-lymphocytes (-85%, -34%) and FcεR1+-eosinophils (-78%, -53%) in blood in both patients, as well as it reduced the density of CD14+-monocytes in T1 (-45%), IL10 bound to receptors on lymphocytes (-29%) in T1 and increase the number of IL10+CD19-lymphocytes (+33%) in T2. Prick-tests were negative after 15 minutes, 12 and 24 hours. Microscopy of skin biopsy samples around the tattoo pigment revealed elastin fibers with a buildup of paint under the epidermis and in the area of the external structures of the sweat ducts in the dermis. After the UV-insolation (6 min in solarium), a pronounced aggravation of the reaction with exudation and crusts throughout the body was observed.

Conclusions. Exposure to sunlight in the place of tattoos can be a trigger for immediate allergic reaction in a sensitized body. In patients, sensitization to TiO2 in OPT was confirmed by increase oral fluid myeloperoxidase activity and decrease the number FcεR1+-eosinophils and CD19+CD154--B-lymphocytes in blood. Focal elastosis was found around the pigment accumulation sites by microscopy of the skin.