State and territorial regulation of tattooing in the United States

Laser-Assisted Tattoo Removal with Topical 5% Imiquimod Cream

BACKGROUND

Laser-assisted tattoo removal is effective but can be costly and time-consuming and can result in disfiguring scars and pigment alterations. Imiquimod, an immune response modifier, may play a role in tattoo removal.

OBJECTIVE

The objective was to evaluate the safety and efficacy of topical 5% imiquimod cream used daily in conjunction with laser therapy to remove unwanted tattoos.

MATERIALS AND METHODS

Twenty subjects with two similar tattoos were enrolled in this randomized, prospective, double-blinded, case-controlled study. Tattoos were treated with either imiquimod or placebo daily and laser therapy every 4 to 6 weeks for a total of six sessions. The primary efficacy parameter was tattoo clearance (5-point scale, poor through complete). Secondary efficacy parameters included textural changes (5-point scale, minimal through severe), pain during and between laser procedures, and undesirable pigment alterations.

RESULTS

Nineteen subjects completed the study. The mean score for tattoo clearance with imiquimod versus placebo was 3.2 versus 2.9 and, for textural changes, was 1.37 versus 1.21 (differences not statistically significant). There was no difference in subjective pain during and between laser sessions and no undesirable pigment alterations were reported. Adverse reactions were more frequent with imiquimod compared to placebo.

CONCLUSION

Topical imiquimod is an ineffective adjunct to laser-assisted tattoo removal.

Tattoos and body piercings in the United States: a national data set

BACKGROUND

Little is known about the prevalence and consequences of body art application.

OBJECTIVE

Our aim was to provide US tattooing and body piercing prevalence, societal distribution, and medical and social consequence data.

METHODS

Random digit dialing technology was used to obtain a national probability sample of 253 women and 247 men who were 18 to 50 years of age.

RESULTS

Of our respondents, 24% had tattoos and 14% had body piercings. Tattooing was equally common in both sexes, but body piercing was more common among women. Other associations were a lack of religious affiliation, extended jail time, previous drinking, and recreational drug use. Local medical complications, including broken teeth, were present in one third of those with body piercings. The prevalence of jewelry allergy increased with the number of piercings. Of those with tattoos, 17% were considering removal but none had had a tattoo removed.

LIMITATIONS

This was a self-reported data set with a 33% response rate.

CONCLUSION

Tattooing and body piercing are associated with risk-taking activities. Body piercing has a high incidence of medical complications.

Response of mouse skin to tattooing: use of SKH-1 mice as a surrogate model for human tattooing

Tattooing is a popular cosmetic practice involving more than 45 million US citizens. Since the toxicology of tattoo inks and pigments used to formulate tattoo inks has not been reported, we studied the immunological impact of tattooing and determined recovery time from this trauma. SKH-1 hairless mice were tattooed using commercial tattoo inks or suspensions of titanium dioxide, cadmium sulfide, or iron oxide, and sacrificed at 0.5, 1, 3, 4, 7, or 14 days post-tattooing. Histological evaluation revealed dermal hemorrhage at 0.5 and 1 day. Acute inflammation and epidermal necrosis were initiated at 0.5 day decreasing in incidence by day 14. Dermal necrosis and epidermal hyperplasia were prominent by day 3, reducing in severity by day 14. Chronic active inflammation persisted in all tattooed mice from day 3 to 14 post-tattooing. Inguinal and axillary lymph nodes were pigmented, the inguinal being most reactive as evidenced by lymphoid hyperplasia and polymorphonuclear infiltration. Cutaneous nuclear protein concentrations of nuclear factor-kappa B were elevated between 0.5 and 4 days. Inflammatory and proliferative biomarkers, cyclooxygenase-1, cyclooxygenase-2, and ornithine decarboxylase protein levels were elevated between 0.5 and 4 days in the skin and decreased to control levels by day 14. Interleukin-1 beta and interleukin-10 were elevated in the lymph nodes but suppressed in the tattooed skin, with maximal suppression occurring between days 0.5 and 4. These data demonstrate that mice substantially recover from the tattooing insult by 14 days, leaving behind pigment in the dermis and the regional lymph nodes. The response seen in mice is similar to acute injury seen in humans, suggesting that the murine model might be a suitable surrogate for investigating the toxicological and phototoxicological properties of ingredients used in tattooing.

Acute allergic contact dermatitis due to para-phenylenediamine after temporary henna painting

The use of temporary natural henna painting for body adornment and hair dyeing is very common in several countries of the Indian subcontinent, Middle East, and North Africa, and the fad is spreading in other parts of the world. Several cases of para-phenylenediamine (PPD) contaminated, temporary traditional/natural henna induced sensitization and acute allergic reaction have been reported, along with occasional serious long term and rare fatal consequences. We report here a 17-year-old girl with blisters over her hands of five-days duration that appeared within 72 hours of applying a temporary henna paint to her hands during a social occasion. Similar lesions were noted on her face. She had previously applied black henna only once, a year earlier without developing any lesions. Clinical diagnosis of acute allergic contact dermatitis (ACD) was made. After a short course of oral corticosteroids, topical mometasone furaote 1.0% cream, and oral antihistamines, the lesions healed completely over the next four weeks leaving post-inflammatory hypopigmentation. Patch testing done with standard European battery, PPD 1% in petrolatum, and commercially available natural henna powder revealed a 3+ reaction to PPD at 48 hours. No reaction was seen at the natural henna site. Awareness of the condition among physicians and the public and regulation regarding warnings of the risks of using such products is urgently warranted.

The adolescent traveler

Oh, to travel again with the carefree attitude of the adolescent! Yet most readers will think that this enormous list of precautions would merit never letting the adolescent out of the house. The traveler and his or her provider can be reassured that with appropriate (and confidential) forethought, the journeys that lie ahead can be joyful and healthy. The bottom line? The more information obtained before travel both for the traveler and his or her family, the less morbidity will be incurred. The primary care provider is in the perfect position to provide all of these services to the adolescent traveler.

Sensitization to para-phenylenediamine from a streetside temporary tattoo

"Temporary" henna tattoos (skin painting or pseudotattooing) are in vogue among American and European youngsters, particularly when vacationing. A 17-year-old girl presented with a severe contact dermatitis of her scalp and face after having dyed her hair with a permanent oxidative hair dye. She denied previous use of oxidative hair dye. Eight months earlier she had a "temporary" henna tattoo applied on her shoulder by a transient artist in downtown Montreal and developed an acute, erythematous, edematous eruption that resolved with residual, prolonged hyperpigmentation. As henna tattooing is a lengthy and tedious procedure, para-phenylenediamine (PPD) may be added to the mixture to accelerate the process, to darken, and to give more precision to the design. This short-lived fad can have longer-term sequelae then expected, ranging from postinflammatory hyperpigmentation of the tattoo site to permanent sensitization to PPD and related compounds.

Tattooing, body piercing, and branding are on the rise: perspectives for school nurses

This journal presented the first nursing information on adolescents and tattooing 6 years ago, and 5 years ago, information was provided about body piercing. These were published to help school nurses assist adolescents become informed decision makers. Another purpose was to prevent risks and, if possible, help dissuade adolescents from tattooing and body piercing. Continuing this theme, the latest information and trends are reported and discussed, and new information on scarification and branding is presented. If an adolescent wants some form of body art (tattooing, body piercing, or branding), they will often obtain it regardless of regulations, risks, or money. School nurses can take a powerful, proactive role by sharing applicable information, realistic concerns, and care instructions about tattooing, body piercing, and branding. Specific information, risks, and care about each form of procedure is presented. A convenient reference table is available for nurses and students. Additionally, nursing actions are suggested including making changes in health policies regarding body art on a local and state level.

Tattoos: counseling the adolescent

In Western society, approximately 3% to 5% of the population has at least one decorative tattoo, and the number of new tattoos has increased dramatically over the last decade. Tattooing is becoming increasingly popular among adolescents. Pediatric nurse practitioners (PNPs) are in key positions to counsel preadolescents and adolescents about tattoos. PNPs should be knowledgeable about the care, potential adverse reactions, risks of blood-borne diseases, and removal of tattoos. PNPs should also have an understanding of who gets tattoos, why they get tattoos, and what type of regulations exist related to tattooing in the United States.

Lip cosmetics

Throughout the centuries, the beauty of lips has been extolled by poets, and painters; and people in many different cultures decorate their lips. Modern cosmetics are designed not only to beautify the lips but also to moisturize and protect them from environmental hazards. Familiarity with the ingredients used in lip cosmetics is essential to recognizing and diagnosing the adverse reactions that are associated with these products.

Appearance, cosmetics, and body art in adolescents

Appearance in adolescents is a means of communication, a language expressing self identity. Teenagers explore fashions to make personal statements. Teenagers are significant consumers of various toiletry and skin care products that fill their cleansing, hydrating, and photoprotective needs. They also are enthusiastic consumers of products aimed at adolescent fads, such as decorative hair and nail cosmetics. For some teenagers, the expression of individualism is achieved through body art, such as tattooing and body piercing. Areas of concern are the lack of motivation for sun protection and the risky behavior associated with body piercing and tattooing.

Tattooing and body piercing. Body art practices among college students

Tattooing and body piercing are increasing, especially among college students. A study of 766 tattooed and/or body-pierced college students in 18 universities across the United States and one in Australia was conducted to discover the demographic characteristics, motivational factors, and health concerns. The traditional college time of 18 to 22 years of age (69%) was when they obtained their tattoo (73%) and/or body piercing (63%). More frequent health problems and impulsive decision making were noted for those with body piercing when compared to those tattooed. Three cases of hepatitis were reported. Health professionals should openly discuss body art with students, convey a nonjudgmental attitude, and assist with informed decision-making information to either reduce risks or dissuade. Open communication and applicable health education will be very important.

Cosmetics, skin care, and appearance in teenagers

Adolescence is a period of tremendous transformation in the appearance of the body and the evolution of the mind that will eventually lead to adulthood. "Yesterday's child" will need to assume and exert control over these changes. Therefore his/her appearance becomes a means of communication, a language to express his/her pursuit of self-identity. The cosmetic industry has identified teenagers as "powerful" consumers, and offers them various toiletry and skin care products that should fulfill their needs, such as cleansing, hydrating, and photoprotective agents. Certain decorative cosmetics, especially for hair and nails, are attractive to them also. For some teenagers, the expression of individualism is through body art such as tattooing and body piercing. Areas of concern are the lack of motivation for sun protection and the risky behavior associated with body piercing and tattooing.

Reasons for requesting laser removal of unwanted tattoos

Laser removal of tattoos is not generally or readily available on the National Health Service and removal in privately run clinics is expensive. For those seeking removal of their tattoo this can create significant financial hardship. We investigated the psychological, social and financial impact of tattoos on the lives of those patients requesting laser removal. Sixty-eight patients with a mean age of 36 years participated. Twenty-seven (40%) had one tattoo, whereas eight (12%) possessed 10 or more; 54% had an amateur tattoo. Only 18% had received an explanation of the procedure or side-effects. The mean age at application of the first tattoo was 16 years; 48 (71%) were tattooed below the legal age limit of 18 years. Most tattoos were applied for the sake of fashion. The median duration of regret was 14 years before seeking removal. The main reasons for removal were enhancement of self-esteem and social, domestic and family reasons. In those patients attending for removal, most tattoos are applied impulsively and inexpensively in youth. They are often regretted for decades and create significant psychological, social and financial burdens.

Tattooing: another adolescent risk behavior warranting health education

A cross-sectional, convenient sample of adolescents (N = 2101) from 8 states were queried regarding interest in tattooing. Permanent markings and blood-borne diseases were reasons respondents refrain from tattooing, yet 55% (n = 1159) expressed an interest in tattooing. Tattooed adolescents in the sample (10%, n = 213) responded with their experiences. Tattooing was frequently done around the 9th grade and as early as 8 years of age; over half (56%, n = 120) report academic grades of As and Bs. Potential health risks and definite psychosocial findings of purchase and possession risks were evident, building on data from a similar 1994 study by Armstrong and McConnell. Health providers and educators should initiate applicable health education and become community adolescent advocates regarding this risk-taking behavior. Findings indicate that adolescents who want a tattoo will obtain one, regardless of money, regulations, or risks. Adolescents view the tattoos as objects of self-identity and body art, whereas adults perceive the markings as deviant behavior. Informed decision-making could be promoted in health education by incorporating information about the possibility of blood-borne diseases, permanent markings, and themselves as growing and changing people.