Foreign body granulomas after lip tattooing: a case series and literature review

doi:10.3969/j.issn.1674-8115.2026.10.016

Abstract

Abstract:

Foreign body granuloma after lip tattooing is a chronic inflammatory response caused by the introduction of tattooing materials into the tissues, and its histopathological manifestation is granulomatous inflammation. This article reports three cases of foreign body granulomas accompanied by chronic cheilitis following lip tattooing, and discusses their treatment and prognosis in light of the existing literature, aiming to improve diagnosis and treatment and enhance patients' quality of life.

Key words: foreign body granuloma, lip tattooing, corticosteroids, cheilitis

CLC Number:

R781.5

Wang Zhenyuan, Shao Ruru, Tang Guoyao, Du Guanhuan. Foreign body granulomas after lip tattooing: a case series and literature review[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026,(10): 1449-1454.

Figures/Tables 4

TrendMD

References 22

[1]	Uzuncakmak T K, Durdu M, Karadag A S. Granulomatous annular diseases[J]. Clin Dermatol, 2023, 41(3): 355-367.
[2]	Chatterjee D, Bhattacharjee R, Saikia U N. Non-infectious granulomatous dermatoses: a pathologist's perspective[J]. Indian Dermatol Online J, 2021, 12(4): 515-528.
[3]	Nakamizo S, Kabashima K. Cutaneous granulomas: mechanisms, cellular interactions and therapeutic insights[J]. Br J Dermatol, 2025, 192(6): 974-982.
[4]	Klontz K C, Lambert L A, Jewell R E, et al. Adverse effects of cosmetic tattooing: an illustrative case of granulomatous dermatitis following the application of permanent makeup[J]. Arch Dermatol, 2005, 141(7): 918-919.
[5]	Martín J M, Revert Á, Monteagudo C, et al. Granulomatous reactions to permanent cosmetic tattoos successfully treated with topical steroids and allopurinol[J]. J Cosmet Dermatol, 2007, 6(4): 229-231.
[6]	Jones B, Oh C, Egan C A. Spontaneous resolution of a delayed granulomatous reaction to cosmetic tattoo[J]. Int J Dermatol, 2008, 47(1): 59-60.
[7]	Kamouna B, Litov I, Bardarov E, et al. Granuloma formation after oil-soluble vitamin D injection for lip augmentation-case report[J]. J Eur Acad Dermatol Venereol, 2016, 30(8): 1435-1436.
[8]	Jin Y T, Yu-Fong Chang J, Lang M J, et al. Cosmetic materials-induced foreign body granuloma at the lower lip[J]. J Dent Sci, 2022, 17(1): 586-588.
[9]	Gao X Y, Xiang W Z. Reflectance confocal microscopy as a tool for the diagnosis of labial foreign body granuloma caused by red tattoo pigment: a case report[J]. Skin Res Technol, 2023, 29(1): e13261.
[10]	Wu Y H, Lee Y P, Sun A, et al. Polymethylmethacrylate-induced foreign body granuloma in the left lower lip[J]. J Dent Sci, 2025, 20(2): 1303-1305.
[11]	do Carmo Silva R, Mühleisen B, Vasconcelos-Berg R, et al. Methotrexate and triamcinolone as a nonsurgical management for polymethyl methacrylate-induced granulomatous reaction: a case report[J]. JAAD Case Rep, 2026, 70: 7-10.
[12]	Serup J. Technical and clinical complications of cosmetic tattooing[J]. Curr Probl Dermatol, 2022, 56: 225-244.
[13]	Alawi F, Shields B E, Omolehinwa T, et al. Oral granulomatous disease[J]. Dermatol Clin, 2020, 38(4): 429-439.
[14]	Scofield-Kaplan S M, Patel S Y, Mueller A, et al. Foreign-body granulomata caused by injected permanent filler masquerading as cutaneous sarcoidosis[J]. Ophthalmic Plast Reconstr Surg, 2019, 35(3): e82-e84.
[15]	Ebrahimiadib N, Adelpour F, Ghahari M, et al. Intermediate uveitis associated with tattooing of eyebrows as a manifestation of systemic sarcoidosis: report of two cases[J]. Ocul Immunol Inflamm, 2021, 29(5): 902-905.
[16]	Yamamoto U, Ikuma D, Oba Y, et al. A case of tattoo-related sarcoidosis with generalised lymph node enlargement[J]. Mod Rheumatol Case Rep, 2025, 9(2): rxaf036.
[17]	Jäger C, Hartschuh W, Jappe U. Sunlight-induced granulomatous reaction to permanent lip liner[J]. Hautarzt, 2005, 56(1): 63-65.
[18]	Baumann L S, Halem M L. Lip silicone granulomatous foreign body reaction treated with aldara (imiquimod 5%)[J]. Dermatol Surg, 2003, 29(4): 429-432.
[19]	de Winter R W, van der Bent S A S, van Esch M, et al. Allergic reaction to red cosmetic lip tattoo treated with hydroxychloroquine[J]. Dermatitis, 2019, 30(1): 82-83.
[20]	Meyer zu Altenschildesche C, Triebswetter S, Simon J C, et al. Topische Anwendung von Allopurinol Bei Tattoo-Granulomen: a case of tattoo granuloma treated with topical allopurinol[J]. Dermatologie, 2025, 76(12): 817-820.
[21]	Fu J Q, Luo W, Wang P, et al. Successful treatment of cutaneous foreign body granuloma with JAK inhibitor abrocitinib and prednisone: a case report[J]. Clin Cosmet Investig Dermatol, 2025, 18: 1199-1206.
[22]	Luo Y, Luan X L, Sun Y J, et al. Effect of recombinant bovine basic fibroblast growth factor gel on repair of rosacea skin lesions: a randomized, single-blind and vehicle-controlled study[J]. Exp Ther Med, 2019, 17(4): 2725-2733.

Author	Sex/Age	Medical history	Clinical feature	Histological feature	Treatment
Klontz et al.^[4]	F/32	Lip tattooing 5 months earlier; lip lesion developed shortly after the procedure	Indurated, erythematous papules	Epidermal hyperplasia, papillary dermal edema, and granuloma formation	Topical corticosteroids + imiquimod cream + laser therapy
Martín et al.^[5]	F/59	Lip tattooing 6 years earlier, with lip lesions developed 2 years ago	An erythematous nodule measuring 1×0.8 cm on the left side of the upper vermilion	Non-caseating granulomas composed of epithelioid cells and Langhans cells, with brownish-black pigment	Topical corticosteroids + oral allopurinol
Jones et al.^[6]	F/27	Lip tattooing 4 years earlier; papules developed 4 months ago	Discrete, elongated, yellowish papules, some of which coalesced linearly along the upper and lower vermilion borders	Dense dermal histiocytic granulomatous inflammation with abundant granular pigmentation	Resolved spontaneously without treatment
Kamouna et al.^[7]	F/30	A lip lesion developed 2 years after Vitamin D injection for lip augmentation	2 firm dermal nodules located on the left side of the upper lip and the lower lip	Fibrotic collagen and foreign body granulomas containing multinucleated giant cells	Surgery
Jin et al.^[8]	F/61	A lesion on the left lower lip for more than 2 months	A tender, elastic, palpable subcutaneous nodule on the left lower lip	Granulomatous fibrous micronodules with epithelioid macrophages, multinucleated giant cells, and lymphocytes	Surgery
Gao et al.^[9]	F/43	Hyperplasia of the upper and lower lip mucosa for 4 months; history of lip tattooing	Irregular hyperplasia of the upper and lower lip mucosa confined to the vermilion, with mild localized edema	Numerous macrophages in the papillary dermis containing red tattoo pigment granules in the cytoplasm	Topical tacrolimus ointment
Wu et al.^[10]	F/43	A lip lesion developed 2 years after the injection of dermal filler	A nontender, firm mass on the left lower labial mucosa	Numerous round vacuoles surrounded by epithelioid cells, a few multinucleated giant cells, and mild lymphocytic infiltration	Surgery
do Carmo Silva et al.^[11]	F/40	Lip swelling for 3 days, with a history of lip filler injection 1 year earlier	Nodules, erythema, and edema in the perioral region	A deep foreign body granulomatous reaction with characteristic PMMA microspheres	Oral methotrexate + triamcinolone injection

Author	Sex/Age	Medical history	Clinical feature	Histological feature	Treatment
Klontz et al.^[4]	F/32	Lip tattooing 5 months earlier; lip lesion developed shortly after the procedure	Indurated, erythematous papules	Epidermal hyperplasia, papillary dermal edema, and granuloma formation	Topical corticosteroids + imiquimod cream + laser therapy
Martín et al.^[5]	F/59	Lip tattooing 6 years earlier, with lip lesions developed 2 years ago	An erythematous nodule measuring 1×0.8 cm on the left side of the upper vermilion	Non-caseating granulomas composed of epithelioid cells and Langhans cells, with brownish-black pigment	Topical corticosteroids + oral allopurinol
Jones et al.^[6]	F/27	Lip tattooing 4 years earlier; papules developed 4 months ago	Discrete, elongated, yellowish papules, some of which coalesced linearly along the upper and lower vermilion borders	Dense dermal histiocytic granulomatous inflammation with abundant granular pigmentation	Resolved spontaneously without treatment
Kamouna et al.^[7]	F/30	A lip lesion developed 2 years after Vitamin D injection for lip augmentation	2 firm dermal nodules located on the left side of the upper lip and the lower lip	Fibrotic collagen and foreign body granulomas containing multinucleated giant cells	Surgery
Jin et al.^[8]	F/61	A lesion on the left lower lip for more than 2 months	A tender, elastic, palpable subcutaneous nodule on the left lower lip	Granulomatous fibrous micronodules with epithelioid macrophages, multinucleated giant cells, and lymphocytes	Surgery
Gao et al.^[9]	F/43	Hyperplasia of the upper and lower lip mucosa for 4 months; history of lip tattooing	Irregular hyperplasia of the upper and lower lip mucosa confined to the vermilion, with mild localized edema	Numerous macrophages in the papillary dermis containing red tattoo pigment granules in the cytoplasm	Topical tacrolimus ointment
Wu et al.^[10]	F/43	A lip lesion developed 2 years after the injection of dermal filler	A nontender, firm mass on the left lower labial mucosa	Numerous round vacuoles surrounded by epithelioid cells, a few multinucleated giant cells, and mild lymphocytic infiltration	Surgery
do Carmo Silva et al.^[11]	F/40	Lip swelling for 3 days, with a history of lip filler injection 1 year earlier	Nodules, erythema, and edema in the perioral region	A deep foreign body granulomatous reaction with characteristic PMMA microspheres	Oral methotrexate + triamcinolone injection