Lichen planus or lichenoid tattoo reaction?

A 27-year-old white man with a tattoo of 3 months' duration was referred for possible laser removal because a pruritic eruption had developed in the tattoo 1 month after placement. Physical examination revealed erythematous papules confined to the red areas of the tattoo (Fig. 1). He also had flat-topped papules on the glans penis, which the patient stated had developed a few weeks after tattoo placement. Biopsy of a penile lesion revealed a histologic pattern characteristic of lichen planus. Biopsy of the tattoo eruption revealed a lichenoid lymphocytic infiltrate with hyperkeratosis, hypergranulosis, and jagged epidermal hyperplasia. Deposits of black granular material were also present in the upper part of the dermis (Fig. 2). During a 2-week follow-up visit, the patient developed more lesions on his arms and legs. After 4 weeks of treatment with halobetasol propionate ointment 0.05% to the tattoo, legs, and arms, all lesions had resolved. The red areas of the tattoo became flat, nonpalpable, and asymptomatic (Fig. 3).