The rate of cosmetic tattooing in Iran is increasing as in many other countries, with concomitant rises in tattoo-associated complications, including inflammatory (infectious and noninfectious) and neoplastic reactions. We reviewed clinical and pathology features of a series of 13 cases of adverse reactions to tattoo pigments. The participants included 11 women and 2 men aged between 22 and 58. The histopathologic reaction patterns were seven granulomatous (four sarcoid, with heavy tattoo pigments in the superficial dermis, and three tuberculoid, with scanty tattoo pigments in the superficial dermis), three cases of pseudoepitheliomatous hyperplasia, one cutaneous lupus
erythematosus-like reaction, one pseudolymphomatous reaction, and one case of mild superficial perivascular inflammation. More than two-thirds of the reactions were to brown tattoos on the eyebrows. The lag in lesion development after tattooing varied from five days to two years.