Toxic Tattoo

For years where toxic and tattoo were used in the same sentence it was an urban myth.  Supposedly drug dealers hung around schools to give kids little stick on tattoos that contained LSD.  Not true.  So today I was a surprised to see something about toxic tattoos in my in-box. 

The American Academy of Clinical toxicology sent our this tidbit...

"A 19-year-old female calls the poison center stating she received a tattoo on her upper arm one month ago and now has what sounds like red papules in and around the site of the tattoo. The tattoo consists of a large red rose and most of the ink used was bright red in color. What is the likely source of these red papules?"

Good question.  The tattoo below has a red rose, but it looks clean.  So what is the problem?  I doubt it is LSD.  Maybe hepatitis?  Interesting?

"Based on recent reports and cautions issued by the FDA, these red papules likely represent nontuberculous mycobacterial infection from contaminated tattoo ink. The caller should be referred to a knowledgeable dermatologist or other physician for treatment. The cited reference points out that “Antibiotic choices are limited by the susceptibility profile of the organism and prolonged treatment may be necessary to clear the infection.” They go on to note that many persons treated with macrolides have had “favorable response” to this therapy. A recently reported outbreak found contaminated ink in an unopened contained and “thus, contamination could have occurred at various points in the ink-production process-for instance, from unsanitary manufacturing processes or the use of contaminated ingredients such as water, glycerin or pigments." (LeBlanc PM et al. Tattoo ink-related infections-awareness, diagnose, reporting and prevention. 2012 NEJM 367(11):985-987)" 

Toxic tattoos from contaminated ink!  Thank you AACT for the fun note.