Foreign body reactions Flashcards
What type of tattoos are most commonly associated with delayed reactions?
Red tattoos (mercuric sulfide/cinnabar)
What is the chemical in red tattoos that most commonly leads to delayed-type reactions?
Mercuric sulifde/cinnabar
What are the delayed-type reactions to red tattoos?
Lichenoid or pseudolymphomatous papules/nodules
What ink most often causes photoallergies in tattoos?
Yellow (cadmium sulfide), red ink (cadmium selenide or yellow-red (azo dyes)
What is a way of telling pigment from tattoos from endogenous pigments on histology?
Tattoo pigment granules are smaller and darker than endogenous pigemnts (hemosiderin and melanin)
What is the treatment of choice for tattoo removal?
Q-switched lasers (QS ruby (694), QS-alexandrite (755), QS-Nd:YAG (1064 or 532)
What lasers should be used to remove black, blue, or dark brown tattoo pigment?
QS ruby (694), QS-alexandrite (755), QS-Nd:YAG (1064 or 532)
What lasers should be used to remove green tattoo pigment?
Ruby or alexandrite
What lasers should be used to remove red, yellow, light brown, violet, and white tattoo pigment?
Only frequency-doubled Nd:Yag (532nm)
What treatment should be done if a tattoo is inflamed?
Excision rather than laser to decrease risk of systemic allergic reaction
What type of thing may lead to a foreign body reaction with silica?
Penetrating injury from sand, soil, rocks, glass
What is the incubation period for a foreign body reaction with silica?
Up to 25 years
What is the presentation of silica foreign body reaction?
Nodules, indurated plaques within scar or disseminated papules if from a blast injury
What is the histology of foreign body reaction with silica?
Sarcoidal granulomas containing colorless, birefringent crystals
What are some things that can lead to foreign body reaction with talc (hydrous magnesium silicate)?
Dusting powders, surgical glove lubricants, filler for med tablets (injection of crushed tablets)
Histology of foreign body reaction with talc (hydrous magnesium silicate)?
Sarcoidal or foreign body granulomas with needle-shaped or round crystals that are white and birefringent on polarized light
What is the color on H&E of the talc crystals?
They are needle-shaped or round but are highly variable in color (clear, blue-green or yellow-brown)
What is a cause of foreign body reaction with zirconium?
Antiperspirants
What is the presentation of foreign body reaction with zirconium?
Often soft brown papules in the axilla
Histology of a foreign body reaction with zirconium?
Sarcoidal granulomas, no polarizable particles seen
Why are there no polarizable particles seen in foreign body reaction with zirconium?
The particles are too small to be seen w/ polarized light microscope, need X-ray or electron imaging
What are some risk factors for foreign body reaction with beryllium?
Used in manufacturing fluorescent lights in the past; can result in local or systemic reactions
- Also aerospace industry
What is the appearance of systemic berylliosis?
Granulomatous lung dz with rare skin involvement (<1%) [scattered sarcoidal papules]
What is the clinical appearance of localized cutaneous berylliosis?
From a puncture wound with a fluorescent bulb –> slow healing nodules/ulcers
Histology of foreign body reaction with beryllium?
Caseating granulomas (localized or cutaneous form); no polarizable particles
What is used to make dx of systemic berylliosis?
Bronchoalveolar lavage
Where can a foreign body granuloma reaction due to aluminum be seen?
Sites of vaccine injections (persistent subcutaneous nodules)
How long after an injections does a foreign body granuloma reaction due to aluminum occur?
Several months
What is the histology of a foreign body granuloma reaction due to aluminum?
Granulomas with central granular debris and palisade of surrounding histiocytes; no polarizable particles seen
What effect can topical aluminum chloride cause in histology?
Can cause a stippled appearance to histiocytes in the healing wound
What can cause a foreign body granuloma reaction due to zinc?
Some zinc-containing insulin shots
What is the clinical presentation of a foreign body granuloma reaction due to zinc?
Furuncles at sight of injection, heals with atrophic scars
Where do a foreign body granuloma reaction due to starch often come from?
Contamination of wounds w/ surgical gloves and the starch lubricant
presents w/ papules/nodules
What is the histology of a foreign body granuloma reaction due to starch?
Ovoid basophilic starch granules that stain PAS+
What is the clinical appearance of a foreign body granuloma reaction due to cactus?
Clusters of dome-shaped skin-colored papules with a central black dot
happens in those who work with or handle prickly pear fruit
What is the histology of a foreign body granuloma reaction due to cactus?
Sarcoidal or foreign body granulomas with PAS+ spines
What is the appearance of a foreign body granuloma reaction due to jellyfish, corals, or sea urchin spines?
Pruritic lichenoid papules and plaques
Often have a linear, zig-zag, or whip-like flaggellate pattern of erythema/edema aearly then hyperpigmentationor lichenoid papules later
How long after exposure does a foreign body granuloma reaction due to jellyfish, corals, or sea urchin spines occur?
Usually 2-3 weeks after
What can be seen on histology for a foreign body granuloma reaction due to jellyfish, corals, or sea urchin spines?
Lichenoid reaction
can also see birefringent calcite crystals for sea urchin spines
What can cause a foreign body granuloma reaction due to keratin?
Ruptured epidermoid cyst, pseudofolliculitis/acne keloidalis, pyogenic granuloma-like lesions, ingrown nails, pilonidal sinus
What is the histology of a foreign body granuloma reaction due keratin?
Foreign body granulomas w/ birefringent keratin debris (can see clefts)
What is the appearence of a foreign body granuloma reaction due intralesional corticosteroids?
Occurs weeks to months after injection and you develop skin-colored to yellow-white papules at site of injeciton
What is the histology of a foreign body granuloma reaction due intralesional corticosteroids?
Foreign body granulomas with central pale bluish material (looks like mucin) on H&E
What is the clinical appearance of a foreign body granuloma reaction due to suture?
Inflamed papule in the wound that opens to form a fistula
Histology of a foreign body granuloma reaction due to suture?
Foreign body granulomas with birefringent suture material
