Abstract

Microblading is a popular type of semi-permanent tattoo technique that alters eyebrow shapes; fine needles deliver micropigments to the epidermis and dermis that appear as hair-like strokes on the skin. While well-tolerated, microblading uncommonly triggers granulomatous reactions. In the literature, 9 cases of foreign-body granuloma and 11 cases of sarcoidosis exist. We present a case of microblading-induced foreign-body granulomatous reaction in a 25-year-old woman who underwent microblading 5 times before developing raised, itchy, orange plaques over her eyebrows. These plaques appeared 7 months after her final procedure and briefly improved with hydrocortisone. Physical examination revealed well-demarcated, infiltrative pink-brown plaques on the eyebrows. Differential diagnosis included foreign-body granuloma, sarcoidosis, and contact dermatitis. Initially, she declined biopsy and began fluocinonide 0.05% ointment twice daily, 5 days per week empirically. This transiently flattened the plaques. Upon follow up, the patient underwent punch biopsy, which revealed dense granulomatous dermatitis with brisk lymphoid infiltrate and pigment deposition favoring foreign body reaction. The patient began minocycline 100 mg twice daily and continued fluocinonide. After 2 weeks, the patient reported thinning of the plaques, and after 6 weeks, the plaques appeared even thinner with lightening of the color as well. Intralesional triamcinolone 2.5 mg/mL injections were given to treat residual areas of induration. This is the first documented case of microblading-induced foreign-body granulomatous reaction treated with minocycline resulting in rapid improvement. Previously reported treatments include topical, intralesional, or oral corticosteroids, topical tacrolimus; and topical 5-fluorouracil which resulted in resolution after 6 weeks at the earliest. Further research is warranted to determine optimal treatments for this condition.

Financial Disclosure:
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