Tattoos, a decorative form of body art, are produced by inoculating pigment into the dermis.
Tattoo-associated
viral infections can be cutaneous and localized to the
tattoo ink; however, viral pathogens acquired during inoculation can cause systemic disease. A comprehensive review of the literature only reveals a limited number of published reports regarding patients with
tattoo-associated cutaneous viral lesions. Cutaneous viral pathogens causing lesions to occur on a
tattoo include herpes simplex virus (HSV), human papillomavirus (HPV),
molluscum contagiosum,
rubella, and
vaccinia. HPV lesions (45 patients) and
molluscum contagiosum (14 patients) are the most frequently reported
tattoo-associated viral lesions; nearly all the patients were immunocompetent. HPV lesions included
verruca vulgaris (29 patients),
verruca plana (14 patients) and human immunodeficiency virus (HIV)-associated acquired
epidermodysplasia verruciformis (two men). Hypotheses for
tattoo-associated HPV lesions and
molluscum contagiosum include a black ink-induced cutaneous immunocompromised district since the viral lesions all occurred in black or dark ink and the use of virus-contaminated instruments, pigment, or both during
tattoo inoculation. Other sources of HPV include viral spread from a
wart that is present but not associated with the
tattoo site or virus transmission from the tattooist resulting from contact with a
wart on an ungloved hand or HPV-containing saliva used to thin the pigment. Herpes compunctorum (three patients),
vaccinia (two patients), and
rubella (one patient) were less commonly reported. Blood borne viral pathogens associated with systemic manifestations - such as
hepatitis B,
hepatitis C and HIV - have also been acquired during
tattoo inoculation; however, health care interventions have been adopted to attempt prevention of viral agent transmission during
tattoo acquisition.