Diffuse Dermal Angiomatosis at a Tattoo Site

Summary: Cutaneous reactive angiomatoses are rare angioproliferative skin conditions, presenting as erythematous to violaceous purpuric patches and plaques that may ulcerate. We report a case of dermal angiomatosis reaction at a tattoo site. A 37-year-old woman presented with a poorly demarcated erythematous plaque on her right upper extremity, localized within her 20-year-old tattoo. The lesion had been present for eight months without symptoms. A punch biopsy showed epidermal hyperplasia and a diffuse proliferation of thin, compressed vessels within a fibrotic dermis, with no cytologic atypia or mitotic activity. The endothelial cells were diffusely CD-31 positive and α-smooth muscle actin (α-SMA) staining highlighted pericytes around the compressed vascular channels. Diffuse dermal angiomatosis (DDA) has been linked to conditions of local ischemia or vascular inflammation, potentially through the upregulation of vascular endothelial growth factor. However, dermal angiomatosis at a tattoo site has not been previously reported. Although the pathogenesis remains unclear, the trauma associated with tattooing may have triggered an angiogenic response leading to DDA. As the lesion is asymptomatic, the patient is being monitored without active treatment.