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Sarcoidosis encompasses a heterogeneous spectrum of clinical presentations, including sarcoidosis in association with tattoos. We report the development of cutaneous and pulmonary sarcoidosis in a patient with long-standing eyebrow tattoos whose cutaneous sarcoidosis almost completely resolved when treated with tacrolimus 0.1% ointment. A 70-year-old woman with a 3-year history of an erythematous eruption circumscribing her eyebrow tattoos presented with a chronic, nonproductive cough of 8 months' duration. Skin biopsy results demonstrated naked tubercles consistent with sarcoidosis. Results of radiographs and a computed tomography scan of the chest revealed multiple pulmonary nodules with mediastinal and hilar adenopathy. The results of transbronchial biopsy were consistent with the diagnosis of pulmonary sarcoidosis. Initial treatment with oral prednisone only improved the pulmonary sarcoidosis. The cutaneous sarcoidosis almost completely resolved after the addition of tacrolimus 0.1% ointment.

Seventy (32%) of 222 patients patch tested in our contact dermatitis clinic from 1993 to 1995 had irritant reactions to cobalt. These reactions were "poral" and seemed to reflect a unique and probably toxic effect of cobalt on the acrosyringium. The reactions are neither follicular nor petechial and we believe they are not allergic. The histopathology of the reactions is described in detail.

Twenty-five years of experience in evaluating people with irritant and allergic contact dermatitis has taught me that many of my preconceived notions were false. No patients are more challenging and interesting to investigate or more rewarding to help than those with long-standing histories of undiagnosed contact dermatitis. Furious resolve during investigation coupled with a willingness to be proven wrong and to find the unexpected is most likely to result in a successful outcome for patients with contact dermatitis.