Tattoos and sarcoidosis

We are pleased that our article1 was read with keen interest. In response to Madan’s letter,2 our patient’s tattoos were amateur tattoos acquired over many years via a variety of methods, and presumably pigmentary substances were used, although all tattoos were black in colour. While sarcoidal reactions to a particular dye is well known, simultaneous reactions occurring in all the tattoos as well as in the eyes and lungs is more unusual. When a reaction occurs in a tattoo, pigment in the tissue is expected. Determining whether pigment is present in eyes or lungs is more difficult. If the sarcoidal reaction is immune-based, one would expect that a single pigment is responsible. Perhaps more likely is that, as is the case in sarcoidosis occurring in scars, tattoos act to localize the granulomatous reaction as a Koebner phenomenon.