Hypersensitivity reactions can occur in both temporary and permanent tattoos. Traditional temporary tattoos consist of red henna or black henna; paraphenylenediamine is the most common allergen and usually is present in black henna. Contact allergy to genipin in jagua temporary tattoos also has been reported. Permanent tattoo inks traditionally contain black pigment of amorphous carbon or black iron oxides or metals. Modern permanent tattoo ink is a blend of pigments, including metals, as well as carbon, azo, diketopyrrolopyrrole, quinacridone, anthraquinone, dioxazine (purple), or quinophthalone (yellow) dyes. Patch testing for temporary and permanent tattoos is complex and challenging.