![]() For the detection of psoriasis lesions, RGB clinical images (shown in Figure 1(a)) were converted into the L a b color space. The spatial concordance of tattoo and psoriasis lesions was analyzed on clinical pictures of tattoo sites taken during the flare-up. (b)–(d) Voronoi patches intersecting (red) or not intersecting (green) tattooed skin areas (yellow contoured). Tattoo #2 (panels (a) and (b)) and tattoo #3 (panels (c) and (d)). The patient reported no KP on previous tattooing with either local or generalized exacerbations of his psoriasis. The tattoos (two of them monochrome black and the third black contours on whitish background Figures 2 and 3) were performed on different occasions over the last 3 years (the last one about 9 months before the flare-up) in the same tattoo studio. Remarkably, the rash spared almost completely the sites of his three tattoos (lower leg, forearm, and shoulder larger diameters 15–25 cm, shown in Figures 2 and 3). Except for psychosocial stress, no other triggering events of the dermatosis could be elucidated. Based on patient’s history, the macromorphology of the rash, and a lesional skin biopsy, guttate psoriasis was diagnosed. The laboratory evaluation including chest X-ray, ASO, syphilis, and hepatitis A, B, and C serology returned no pathologic findings. The patient was diagnosed with plaque psoriasis at the age of 15 years, which was treated successfully with topical regimens. The rash was accompanied by moderate itching and an apparent tendency to coalesce in typical for plaque psoriasis skin localizations, i.e., the knees. Case PresentationĪn afebrile, 27-year-old male patient, in otherwise good general condition, presented with a rash of scattered, up to 1.0 cm large psoriasiform lesions that progressively affected his torso (shown in Figure 1) and the extremities during the past two weeks. Herein, on the occasion of a patient who presented with a distinct sparing of three tattoo sites during a guttate psoriasis episode that was unrelated to tattooing, we would like to comment on the putative role of macrophages as the key cellular link in the complex pathophysiologic relationship between tattooing/tattoo and psoriasis. Moreover, Grodner and colleagues observed that much more patients with psoriasis did not recall lesions that had affected their tattoo sites during episodes of disease flare-ups (47.6%) than recalling them (19.8%). Despite the intuitive concern that tattoo trauma might induce the disease (Koebner phenomenon, KP), a KP was reported in only 3.2% of psoriasis patients undergoing tattooing, an overall rather moderate rate. The nosologic relationship of psoriasis and tattoo remains a matter of debate. Further clinical studies of the relationship of psoriasis lesions to the tattooed skin are needed and may provide important insights into the role of macrophages in the pathogenesis of psoriasis. Taking into account the relationship of autophagy and psoriasis lesions, we propose the hypothesis that tattoos represent a “psoriasis-hostile” tissue environment pertained by a population of LAP active M2-polarized macrophages. Based on our findings, we would like to discuss the possible role of macrophages as the key cellular link in the complex pathophysiologic relationship between tattooing/tattoo and psoriasis. Compared to skin areas without tattoos, a tattoo introduced a higher variation in the sizes of the Voronoi patches centered around psoriasis lesions. ![]() For the quantification of the spatial distribution of the psoriasis lesions, Voronoi diagrams were generated, and coefficients of variation and the two-sample t-test were employed to compare the distributions of Voronoi patch sizes in different settings. The spatial concordance of tattoo and psoriasis lesions was analyzed on clinical pictures of tattoo sites taken during the psoriasis episode. In this case report, we discuss a patient who presented with a remarkable sparing of his three tattoo sites during a guttate psoriasis flare-up that was unrelated to tattooing. Induction of new psoriasis sites was reported in only a small amount of psoriasis patients undergoing tattooing, despite the intuitive belief that tattoo trauma might awaken the disease due to the isomorphic phenomenon of Koebner.
0 Comments
Leave a Reply. |