EMAILMEXTRASA.COMF the tattoo before sarcoidal manifestations is widely variable and ranges from months to decades [9, 10]. cost of generic viagra 100mg In one report, sarcoidal granulomas developed in a 45-year-old blue tattoo and ultimately led to the discovery of pulmonary sarcoidosis on chest imaging [11]. It is uncommon in the literature to find reports of tattoo granulomas of systemic sarcoidosis that arise with additional cutaneous manifestations of the disease, as is observed in our case report, although parallels do exist [12]. The mutable nature of the tattoo granulomas, as seen in our patient, has been described in other patients in the literature [8]. viagra canada pharmacy Several theories for the development of sarcoidal tattoo reactions exist. The koebner reaction has been implicated, yet so many of the tattoo reactions occur years after tattoo placement [13, 14]. This observation contrasts with the days-to-weeks delay typically noted in the koebner reaction of other conditions, such as lichen planus and psoriasis [15]. order viagra online On the other hand, these tattoo granulomas simply may represent scar sarcoidosis, which is a recognized phenomenon that is a consequence of scar formation around tattoo pigments [4]. An immunologic reaction to one or more tattoo pigments has been implicated and is predicted in sarcoidal granulomas without systemic sarcoidosis [8]. However, this would not explain, at least fully, the manifestation in systemic sarcoidosis [8]. viagra soft Tattoo granulomas remain an uncommon feature of systemic sarcoidosis, yet may prove informative in the pathogenesis of systemic sarcoidosis. safest viagra sites They raise questions for the role of environmental antigens in the pathogenesis of sarcoidosis. Chronic, mild, antigenic stimulation, such as from tattoo pigment, might lead to a systematized, granulomatous hypersensitivity in genetically predisposed individuals [4]. References 1. Judson ma. Sarcoidosis: clinical presentation, diagnosis, and approach to treatment. Am j med sci 2008; 335: 26 [pubmed] 2. English jc iii, et al. Sarcoidosis. J am acad dermatol 2001; 44: 725 [pubmed] 3. Judson ma. generic viagra from india The diagnosis of sarcoidosis. Clin chest med 2008; 29: 415 [pubmed] 4. buy viagra in the united states Lodha s, et al. Sarcoidosis of the skin: a review for the pulmonologist. Chest 2009; 136: 583 [pubmed] 5. viagra online generic cheap Antonovich dd, et al. Development of sarcoidosis in cosmetic tattoos. Arch dermatol 2005; 141: 869 [pubmed] 6. pills like viagra women Madden jf. Reactions in tattoo. Arch dermatol syphilol 1939; 40: 256 7. Lubeck g, et al. generic viagra on line Complications of tattooing. Calif med 1952; 76: 83 [pubmed] 8. buy generic viagra online Ali sm, et al. Sarcoidosis appearing in a tatto. price comparison viagra and viagra viagra viagra viagra price comparison viagra vs viagra vs viagra drinking