A 56-year-old, otherwise healthy, man was referred to the Academic Tattoo Clinic Amsterdam because of pain and itch in a multicoloured tattoo on his right arm since one month. Two weeks before the start of the complaints the patient had gotten the tattoo in Bali, Indonesia. The patient had no fever or other physical complaints. Physical examination revealed multiple erythematosquamous papules and pustules, especially in the black and white coloured parts of the tattoo (Fig. 1a).