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A fit and healthy 28-year-old woman presented with an eight-week history of swelling, erythema, and pruritus arising from a defined area of her back. The affected region corresponded exactly to the red pigmented areas of the tattoo she had acquired 18 months before. The patient had previously consulted her primary-care clinician, who had recommended strong topical steroids for four weeks. This treatment had lessened her pruritus, but the induration had persisted.