In a study conducted by Zafar et al9 in 2008 in Karachi, the commonest granuloma was tuberculous granuloma 92.7% followed by foreign body granuloma 3.3%, sarcoidal granuloma 1.6% and suppurative granuloma 1.6%, necrobiotic granuloma 0.8%.
Another study conducted by Gautam et al10 has also given tuberculous granuloma as the commonest type 68.9% followed by foreign body granuloma 18.9%, necrobiotic granuloma in 3.7%, suppurative granuloma 2.8% and sarcoidal granuloma in 1.9%.
Another study conducted by Dhar et al6 in 2002 in India as also reported tuberculous granuloma as the commonest 77.7% followed by sarcoidal granuloma in 13.7 and suppurative granuloma in 9%.
Although there is no pathognomonic finding to differentiate a sarcoidal granuloma
from a granuloma of another cause, some features favor a granuloma being sarcoidal.
(a) Skin biopsy of the scalp showing sarcoidal granulomas
with multinucleated giant cells in the dermis with absence of hair follicles (x20 view).
A biopsy from the right side of his nose demonstrated sarcoidal granulomas. Acid-fast bacilli and periodic acid-Schiff stains were negative.
It is not clear why sarcoidal granulomas occur in tattoos.
tuberculosis, atypically mycobacterial infections, C.tetania, and syphilis.1,4 Allergic reactions, phototoxicity, pseudolymphomatous reaction, immunologic rejection of tattoo can be seen during or after tattooing.4 Rare tattoo following complications include allergic reaction, phototoxicity, pseudolymphomatous reaction, tattoo immunologic rejection, discoid lupus erythematosus, primer inoculation tuberculosis, sarcoidal granulomas
, and psoriasis.1
Cutaneous sarcoidal granulomas
and the development of systemic sarcoidosis.
A tuberculoid granulomatous infiltrate is most helpful, but some patients may instead have a lymphohistiocytic infiltrate, palisading or sarcoidal granulomas
, a mixed inflammatory infiltrate, or other nonspecific findings.
Less frequent reactions at injection sites include vascular thrombosis, mucinosis, dermal and SC sclerosis, necrosis, ulceration and rarely, lupus erythematosus-like lesions, sarcoidal granulomas, erythema nodosum, an acute septal panniculitis with neutrophils, lobular lymphocytic panniculitis and lipoatrophy.
Other described histological reactions at injection sites include allergic contact dermatitis, lipogranulomas, local necrosis, sterile and infectious abscesses, necrotizing, necrobiotic and sarcoidal granulomas, cutaneous lymphoid hyperplasia, lupus profundus-like and morphea-like reactions.