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Kassirer S, Marini L, Zachary CB, Sarnoff DS, Landau M. Esthetic and medical tattooing: Part I: Tattooing techniques, implications, and adverse effects in healthy populations and special groups. J Am Acad Dermatol 2024:S0190-9622(24)00964-2. [PMID: 38980248 DOI: 10.1016/j.jaad.2024.05.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 07/10/2024]
Abstract
Tattooing, the introduction of exogenous pigments into the skin, has a rich history spanning thousands of years, with cultural, cosmetic, and medical significance. With the increasing prevalence of tattoos, understanding their potential complications and contraindications is of growing importance. The most common complications are hypersensitivity reactions, which may vary in morphology and timing. Infectious complications are often due to inadequate aseptic and hygienic practices during the tattooing process or healing period. Tattoo pigment can present diagnostic challenges, affecting cancer diagnosis and imaging. This CME article explores the history, cultural significance, epidemiology, chemistry, technique, contraindications, and complications of tattoos. Appreciating these factors can help individuals considering tattoos understand the safety and potential risks of their body art, and provide physicians with a thorough understanding of tattooing if consulted.
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Affiliation(s)
- Samuel Kassirer
- American Medical Program, Tel Aviv University Faculty of Medicine, Tel Aviv, Israel
| | - Leonardo Marini
- Diplomate General Surgery and Dermatology, Medical and Scientific Director, SDC The Skin Doctors Center, Trieste, Italy
| | | | - Deborah S Sarnoff
- Clinical Professor, Ronald O. Perelman Department of Dermatology at NYU Grossman School of Medicine, New York, New York
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2
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Chalarca-Cañas D, Caviedes-Cleves MA, Correa-Londoño LA, Ospina-Gómez JP, Velásquez-Lopera MM. Tattoos: risks and complications, clinical and histopathological approach. An Bras Dermatol 2024; 99:491-502. [PMID: 38521707 PMCID: PMC11221160 DOI: 10.1016/j.abd.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/16/2023] [Accepted: 07/23/2023] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Skin modification through tattoos is as old as humanity itself. However, this trend is on the rise, and with the use of different types of pigments and application practices, both cutaneous and systemic complications can arise. Adverse reactions can be grouped into five classes: inflammatory, infectious, neoplastic, aesthetic, and miscellaneous. On histopathology, inflammatory reactions can exhibit a lichenoid pattern or present as spongiotic dermatitis, granulomatous reactions, pseudolymphoma, pseudoepitheliomatous hyperplasia, or scleroderma/morphea-like changes. This article reviews tattoo complications, including their clinical and histopathological characteristics. METHODS An open search was conducted on PubMed using the terms "tattoo", "complications", and "skin". No limits were set for period, language, or publication type of the articles. RESULTS Reactions to tattoos are reported in up to 67% of people who get tattooed, with papulonodular and granulomatous reactions being the most common. Some neoplastic complications have been described, but their causality is still debated. Any pigment can cause adverse reactions, although red ink is more frequently associated with them. Patients with pre-existing dermatoses may experience exacerbation or complications of their diseases when getting tattoos; therefore, this procedure is not recommended for this patient group. CONCLUSIONS Dermatological consultation is recommended before getting a tattoo, as well as a histopathological examination in case of complications. In patients who develop cutaneous inflammatory reactions following tattooing, additional studies are recommended to investigate systemic diseases such as sarcoidosis, pyoderma gangrenosum, atopic dermatitis, and neoplasms. It is important for physicians to be trained in providing appropriate care in case of complications.
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Affiliation(s)
- David Chalarca-Cañas
- Department of Dermatology, School of Medicine, University of Antioquia, Medellín, Colombia.
| | | | - Luis A Correa-Londoño
- Department of Dermatology, School of Medicine, University of Antioquia, Medellín, Colombia
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3
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Vogel M, De Bodt J, Jacques JM. Necrotizing Fasciitis Occurring After a Conventional Tattoo. Cureus 2024; 16:e55368. [PMID: 38562342 PMCID: PMC10982681 DOI: 10.7759/cureus.55368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
A 34-year-old patient presented to the emergency department after getting a tattoo from a licensed tattoo artist at home. The patient was in septic shock with renal failure, and the clinical examination revealed a skin infection at the tattoo site. Suspecting necrotizing fasciitis, the patient underwent fasciotomy with deep tissue sampling and vacuum-assisted closure therapy. Broad-spectrum antibiotic therapy was initiated and later adjusted based on bacterial culture results. The patient quickly recovered and was discharged from the intensive care unit. We report the first case of post-conventional tattoo necrotizing fasciitis in Belgium. The tattoo was performed by a professional licensed tattoo artist, equipped as required by Western legislation. Previously reported cases highlighted necrotizing fasciitis occurring after Samoan or Samoan-style tattoos, an ancestral practice with handmade tools. In our case, the tattoo was done in a conventional way with modern tools and techniques. It is the lack of hygiene precautions that we can attribute to the development of this serious pathology.
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Bălăceanu-Gurău B, Apostol E, Caraivan M, Ion A, Tatar R, Mihai MM, Popa LG, Gurău CD, Orzan OA. Cutaneous Adverse Reactions Associated with Tattoos and Permanent Makeup Pigments. J Clin Med 2024; 13:503. [PMID: 38256637 PMCID: PMC10816451 DOI: 10.3390/jcm13020503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Tattooing is the procedure of implanting permanent pigment granules and additives into the dermal layer of the skin, serving various purposes such as decoration, medical identification, or accidental markings. There has been a significant rise in the popularity of decorative tattooing as a form of body art among both teenagers and young adults. Thus, the incidence of tattoos is increasing, with expanding applications such as permanent makeup, scar camouflage, nipple-areola, lips, and eyebrows tattooing, and utilization in oncological radiotherapy such as colon marking. However, there have been reported a broad range of adverse reactions linked to tattooing, encompassing allergic reactions, superficial and deep cutaneous infections, autoimmune disorders induced by the Koebner phenomenon, cutaneous tumors, and others. These reactions exhibit different onset times for symptoms, ranging from immediate manifestations after tattoo application to symptoms emerging several years later. Given the limited information on a tattoo's side effects, this review aims to elucidate the clinical spectrum of cutaneous complications of tattoos in different patients. The analysis will investigate both allergic and nonallergic clinical presentations of tattoo-related side effects, microscopic findings from skin biopsies, and therapeutic outcomes. This exploration is essential to improve our understanding of tattoo-related cutaneous complications and associated differential diagnoses and highlight the significance of patient awareness regarding potential risks before getting a tattoo.
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Affiliation(s)
- Beatrice Bălăceanu-Gurău
- Department of Oncologic Dermatology, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.B.-G.); (E.A.); (A.I.); (M.M.M.); (L.G.P.); (O.A.O.)
- Clinic of Dermatology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
| | - Eliza Apostol
- Department of Oncologic Dermatology, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.B.-G.); (E.A.); (A.I.); (M.M.M.); (L.G.P.); (O.A.O.)
- Clinic of Dermatology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
| | | | - Ana Ion
- Department of Oncologic Dermatology, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.B.-G.); (E.A.); (A.I.); (M.M.M.); (L.G.P.); (O.A.O.)
- Clinic of Dermatology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
| | - Raluca Tatar
- Department of Plastic Reconstructive Surgery and Burns, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Plastic Reconstructive Surgery and Burns, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 010621 Bucharest, Romania
| | - Mara Mădălina Mihai
- Department of Oncologic Dermatology, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.B.-G.); (E.A.); (A.I.); (M.M.M.); (L.G.P.); (O.A.O.)
- Clinic of Dermatology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
| | - Liliana Gabriela Popa
- Department of Oncologic Dermatology, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.B.-G.); (E.A.); (A.I.); (M.M.M.); (L.G.P.); (O.A.O.)
- Clinic of Dermatology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
| | - Cristian-Dorin Gurău
- Orthopedics and Traumatology Clinic, Clinical Emergency Hospital, 014451 Bucharest, Romania;
| | - Olguța Anca Orzan
- Department of Oncologic Dermatology, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.B.-G.); (E.A.); (A.I.); (M.M.M.); (L.G.P.); (O.A.O.)
- Clinic of Dermatology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
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5
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Schmid DA, Domingues MP, Nanu A, Kluger N, de Salvo R, Trapp S. Exploratory evaluation of tolerability, performance, and cosmetic acceptance of dexpanthenol‐containing dermo‐cosmetic wash and sun‐care products for tattoo aftercare. Health Sci Rep 2022; 5:e635. [PMID: 35782304 PMCID: PMC9235347 DOI: 10.1002/hsr2.635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/04/2022] [Accepted: 04/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Aims Tattoo prevalence has significantly increased over the last decades. Proper tattoo aftercare, such as cleansing, moisturizing, and protection against sunlight, is essential to prevent complications and to keep the beauty of the tattoo. The tolerability, performance, and cosmetic acceptability of two dexpanthenol‐containing dermo‐cosmetic products, a wash and a sun‐care, were investigated on tattooed skin in two separate trials. Methods Two single‐center, exploratory, open‐label cosmetic studies were conducted between August and November 2020 to evaluate the dexpanthenol‐containing dermo‐cosmetic products. In the first study, healthy adults applied the 2.5% dexpanthenol‐containing wash right after their tattoo session daily for 14 consecutive days. In the second study, healthy adults applied the 2.5% dexpanthenol‐containing sun‐care sun protection factor 50+ cream on existing tattoos that were daily exposed to sunlight for 28 consecutive days. Clinical examination by a dermatologist and self‐assessment through subject questionnaires were used to assess the tolerability, acceptance, ease of use, and cosmetic outcomes of both products. Additionally, transepidermal water loss and moisturization assessments were performed to evaluate skin hydration after use of the sun‐care product. Results Both study products were well tolerated, and no product related adverse events were reported during the studies. At least 90% of the study participants appreciated the performance of the dexpanthenol‐containing wash and sun‐care product, including moisturizing properties, relief of unpleasant sensations, and preservation of the cosmetic appearance of the tattoo. For the sun‐care, it was shown that its application supported maintaining the skin barrier of tattooed skin, while keeping it hydrated. Conclusion The 2.5% dexpanthenol‐containing wash and sun‐care products are well tolerated and appreciated by tattooed subjects. Hence, they represent valid options for tattoo aftercare in line with current recommendations and practice.
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Affiliation(s)
| | | | - Alina Nanu
- Eurofins Evic Product Testing Romania SRL Bucharest Romania
| | - Nicolas Kluger
- “Tattoo consultation”, Department of Dermatology, Bichat‐Claude Bernard Hospital Assistance Publique‐Hôpitaux de Paris Paris France
- Department of Dermatology University of Helsinki and Helsinki University Hospital Helsinki Finland
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6
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Fauger A, Sonck S, Kluger N, Chavagnac-Bonneville M, Sayag M. Tattoo aftercare management with a dermo-cosmetic product: Improvement in discomfort sensation and skin repair quality. J Cosmet Dermatol 2021; 21:1051-1056. [PMID: 33884740 PMCID: PMC9290601 DOI: 10.1111/jocd.14157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/31/2021] [Accepted: 04/07/2021] [Indexed: 12/19/2022]
Abstract
Background A moisturizer application during the healing process after a tattoo session is a common practice to help wound healing and to reduce discomfort sensations. This practice was recently recommended by the standard European guidelines on tattoos, with the use of an adapted ointment to keep the site moist. Aims To assess the efficacy and the tolerability of a specific dermo‐cosmetic product (Cicabio Pommade, Laboratoire Bioderma, NAOS, France) in tattoo aftercare. Patients/Methods Thirty subjects included in this survey applied the product immediately after the tattoo session for 14 days. The objective symptoms (redness, edema, skin repair quality) were assessed by the tattooist and the subjects. The subjective symptoms, discomfort sensations (pain, itching, burning sensations, tingling), soothing, moisturizing, and undesirable effects were assessed by the tattooed individuals. Results After 14 days of application, redness was absent for 100% and 96% of subjects according to the tattoo artist and the subjects, respectively, and edema had completely disappeared for both assessors. Most of the subjects rated the skin quality repair and the aesthetic outcomes as very good to excellent. Soothing and moisturizing effects were observed as early as the first day. The effects were maintained over 14 days. Discomfort sensations were judged absent to slight in 96%–100% of cases after 7 days. They were assessed as absent to slight in all cases for pain, itching, and tingling, and in 96% for burning sensations after 14 days. The product was very well tolerated by 87% of the subjects. Conclusions Our survey demonstrates that this dermo‐cosmetic product is suitable for tattooed skin aftercare as it reduced skin discomfort as soon as the first day and led to a good skin quality repair while being well tolerated.
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Affiliation(s)
| | | | - Nicolas Kluger
- Helsinki University Hospital; Department of Dermatology, Helsinki, Finland.,Department of Dermatology, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Michèle Sayag
- NAOS; Research and Development Department, Lyon, France
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7
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Cutaneous non-allergic complications in tattoos: An overview of the literature. Presse Med 2020; 49:104049. [DOI: 10.1016/j.lpm.2020.104049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 07/28/2020] [Indexed: 01/09/2023] Open
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8
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Cohen PR, Erickson CP, Uebelhoer NS, Calame A. Tattoo-Associated Basal Cell Carcinoma: Coincident or Coincidence. Biomed Hub 2020; 5:2055-2062. [PMID: 32884932 DOI: 10.1159/000508208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/25/2020] [Indexed: 12/13/2022] Open
Abstract
Tattoos may be associated with medical complications including, albeit rarely, skin cancer. The features of a 46-year-old man who developed a basal cell carcinoma within a tattoo on his left scapula are described and the characteristics of the other 13 patients (7 men and 6 women) with tattoo-associated basal cell carcinoma are reviewed. The tumor usually occurs on the sun-exposed skin of individuals aged 60 years and older whose tattoo has often been present for 20 years or more. The pathogenesis of a basal cell carcinoma developing within a tattoo may merely be a coincidence. However, there is supporting evidence that the tattoo and the subsequent basal cell carcinoma may be coincident events whereby either tattoo injection-associated trauma or the tattoo pigments and dyes (in their native state or after ultraviolet radiation alteration) or both have a carcinogenic impact on the development of the basal cell carcinoma at that location.
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Affiliation(s)
- Philip R Cohen
- San Diego Family Dermatology, National City, California, USA.,Department of Dermatology, Touro University California College of Osteopathic Medicine, Vallejo, California, USA
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9
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Abstract
Ten to 30% of the population is currently tattooed. This trend does not spare athletes and sports medicine specialists may have to manage tattooed athletes. The purpose of this study was to review the possible issues associated with tattoos among athletes. Overall, tattooed athletes are exposed to the same complications as anyone, mainly healing issues, skin infections and allergic reactions to a tattoo color. Besides, the main pitfall in sports medicine remains invasive gestures such as puncture or infiltration, as they must be avoided at all cost if the tattoo is recent and under healing. Issues associated with imaging are rather limited (artifacts, visible calcification). Burns during magnetic resonance imagining may occur but they are rather rare. Local neuromuscular complications attributable to tattooing are exceptional. Whether tattoos may have a "systemic" impact on the prevalence of unexplained symptoms in athletes (fatigue, distant tendon or musculoskeletal wounds) remain unknown.
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Affiliation(s)
- Nicolas Kluger
- Department of Dermatology, Allergology and Venereology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland - .,Tattoo Consultation, Department of Dermatology, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France -
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10
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Gorski J, Proksch E, Baron JM, Schmid D, Zhang L. Dexpanthenol in Wound Healing after Medical and Cosmetic Interventions (Postprocedure Wound Healing). Pharmaceuticals (Basel) 2020; 13:ph13070138. [PMID: 32610604 PMCID: PMC7407203 DOI: 10.3390/ph13070138] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/26/2020] [Accepted: 06/26/2020] [Indexed: 12/27/2022] Open
Abstract
With the availability of new technologies, the number of subjects undergoing medical and cosmetic interventions is increasing. Many procedures (e.g., ablative fractional laser treatment) resulting in superficial/minor wounds require appropriate aftercare to prevent complications in wound healing and poor cosmetic outcome. We review the published evidence of the usefulness of topical dexpanthenol in postprocedure wound healing and the associated mechanisms of action at the molecular level. A search in the PubMed and Embase databases was performed to query the terms dexpanthenol, panthenol, superficial wound, minor wound, wound healing, skin repair, and postprocedure. Search results were categorized as clinical trials and in vitro studies. In vitro and clinical studies provided evidence that topically applied dexpanthenol promotes superficial and postprocedure wound healing. Latest findings confirmed that dexpanthenol upregulates genes that are critical for the healing process. The gene expression data are of clinical relevance as evidenced by prospective clinical studies indicating that topical dexpanthenol accelerates wound healing with rapid re-epithelialization and restoration of skin barrier function following skin injury. It can therefore be inferred that topical dexpanthenol represents an appropriate and state-of-the-art treatment option for superficial postprocedure wounds, especially when applied early after the superficial skin damage.
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Affiliation(s)
- Julian Gorski
- Bayer Vital GmbH, Building K 56, D-51368 Leverkusen, Germany;
| | - Ehrhardt Proksch
- Department of Dermatology, University of Kiel, Schittenhelmstrasse 7, D-24105 Kiel, Germany;
| | - Jens Malte Baron
- Department of Dermatology and Allergology, RWTH Aachen University, Pauwelsstrasse 30, D-52074 Aachen, Germany;
| | - Daphne Schmid
- Bayer Consumer Care AG, Peter Merian-Strasse 84, CH-4002 Basel, Switzerland;
| | - Lei Zhang
- Bayer Consumer Care AG, Peter Merian-Strasse 84, CH-4002 Basel, Switzerland;
- Correspondence: ; Tel.: +41-58-272-7497; Fax: +41-58-272-7902
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11
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Abudu B, Erickson CP, Calame A, Cohen PR. Basal Cell Carcinoma Originating in a Tattoo: Case Report and Review of an Uncommon Complication in Tattoo Recipients. Dermatol Pract Concept 2019; 9:265-270. [PMID: 31723458 DOI: 10.5826/dpc.0904a03] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2019] [Indexed: 10/31/2022] Open
Abstract
Background The placement of a tattoo is a common event. Basal cell carcinoma arising from a tattoo is rare despite this neoplasm being the most common form of skin cancer. Objective We describe a 41-year-old man who developed a basal cell carcinoma in his tattoo and review the literature of basal cell carcinomas originating in a tattoo. Methods A literature search using PubMed was performed. The following terms were searched: "basal," "carcinoma," "cell," and "tattoo." The characteristics of individuals with a basal cell carcinoma originating in a tattoo were analyzed and summarized. Results A total of 13 patients (6 women and 7 men) with a basal cell carcinoma arising in a tattoo have been reported. The majority of the tumors were located on the head (6 cases, 46.2%) followed by either an upper extremity (4 cases, 30.7%) or the trunk (3 cases, 23.1%). Most of the carcinomas were asymptomatic; however, 2 patients reported pruritus associated with their tumor. Nodular basal cell carcinoma was the most common subtype diagnosed (5 tumors), followed by superficial basal cell carcinoma (2 tumors). One patient had either a pagetoid or a mixed (nodular and sclerosing) histology. The pathological variant was not described for 4 patients. Conclusions Basal cell carcinoma arising in a tattoo is a rare occurrence. Although this occurrence may be coincidental, emerging evidence of carcinogenesis associated with tattoo pigment may suggest a causal link. Elucidating this important relationship warrants further investigation.
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Affiliation(s)
- Boya Abudu
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | | | | | - Philip R Cohen
- San Diego Family Dermatology, National City, CA, USA.,Touro University California College of Osteopathic Medicine, Vallejo, CA, USA
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12
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Abstract
Introduction: Decorative tattooing involves the introduction of exogenous pigments and/or dyes into the dermis to produce a permanent design.Areas covered: This review provides an overview of the current aspects of cutaneous complications associated with permanent tattooing and permanent make-up based on the previous reviews of interest, case series, and case reports of interest. References for this review were found through a search of PubMed by use of the terms 'tattoo', 'tattoos', or 'tattooing'.Expert opinion: Complications include primarily infections, allergy to tattoo pigments, benign, and sometimes malignant tumors arising on tattoos and the localization of various dermatoses to tattoos. Immunocompromised patients and individuals with chronic conditions should be able to discuss with their physician and ask advice before getting tattooed. Tattoo color allergy still remains an unsolved issue. The identification of current culprit failed. It is most likely a byproduct that appears in situ in the skin during the life of the tattooed bearer. Studies involving expert centers are warranted to establish the best treatments for tattoo allergy. The risk of tattoo associated cancers appears to this author as largely overstated. However, case controls studies on large on cohorts of individuals with or without tattoos could help to evaluate whether tattoos have a possible in role in cancers.
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Affiliation(s)
- Nicolas Kluger
- Department of dermatology, allergology and venereology, Helsinki University Central Hospital, Helsinki, Finland.,"Tattoo" Consultation, Department of Dermatology, Bichat-Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
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13
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Basu P, Erickson CP, Calame A, Cohen PR. Osteoma Cutis: An Adverse Event Following Tattoo Placement. Cureus 2019; 11:e4323. [PMID: 31183302 PMCID: PMC6538411 DOI: 10.7759/cureus.4323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 03/26/2019] [Indexed: 01/22/2023] Open
Abstract
Osteoma cutis can occur as a primary or secondary cutaneous lesion. Isolated lesions of perforating osteoma cutis are uncommon and can present with varying clinical features. Adverse events that can occur following placement of a tattoo include benign and malignant neoplasms, dermatoses, infections, and miscellaneous complications. We present a case of a man who developed perforating osteoma cutis within a tattoo and propose that osteoma cutis be included among the list of adverse events that can occur in individuals who obtain a tattoo.
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Affiliation(s)
- Pallavi Basu
- Dermatology, University of California, San Diego, USA
| | | | | | - Philip R Cohen
- Dermatology, San Diego Family Dermatology, National City, USA
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14
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Wilson WT, O'Boyle M, Leach WJ. Unusual complication of a tattoo in an immunosuppressed patient. BMJ Case Rep 2018; 2018:bcr-2018-224968. [PMID: 29914878 DOI: 10.1136/bcr-2018-224968] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Tattooing for decorative body art is becoming more popular and, as a result, so are tattoo-related complications. Patients are unlikely to discuss tattoos with medical professionals, even though these might be relevant. Long-term immunosuppressed patients are often young adults who may wish to consider tattooing. It is well recognised that immunosuppressed patients are at increased risk of infection including cutaneous mycobacterial infections. They therefore represent a group that is at a potentially higher risk of tattoo-related complications and warrant special consideration.We present the first documented case of inflammatory myopathy as a complication following tattooing in an immunosuppressed individual. This unusual case presented as distal thigh and medial knee pain and it was only after some time that a link to the tattoo was made. This serves as a reminder to consider tattoo-related complications in the differential diagnosis of unusual atraumatic musculoskeletal pain, especially in immunosuppressed individuals.
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Affiliation(s)
| | - Mannix O'Boyle
- Trauma and Orthopaedics, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - William J Leach
- Trauma and Orthopaedics, NHS Greater Glasgow and Clyde, Glasgow, UK
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15
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Florid Granuloma Annulare-Like Reaction in Regional Lymph Nodes After "Regression" of Red Pigment in Tattoos. Am J Dermatopathol 2017; 40:383-385. [PMID: 29140806 DOI: 10.1097/dad.0000000000001043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A healthy 50-year-old woman had a tattoo performed on the posterior aspect of her neck and another on the dorsum of her left foot. Several weeks later, she noted redness, tenderness, and intense pruritis at both tattoo sites. Treatment with cephalexin and hydrocortisone cream was instituted, without success. Within a few months, the red, but not black, pigment had disappeared from both tattoos and was replaced by pale areas of scarring. Persistently enlarged left supraclavicular and suboccipital lymph nodes were excised 7 and 10 months after receipt of the tattoos, respectively. The nodes were pigmented on gross examination, and on microscopy, a granuloma annulare-like reaction was observed. Normal lymphoid tissue was seen to be replaced by large palisading granulomas with central degenerative change, abundant stromal mucin, and scattered deposits of tattoo pigment. Histochemical stains, tissue culture, and serological studies revealed no evidence of infection. There are rare reports of granuloma annulare-like reactions in tattoos, and these are believed to represent delayed-type hypersensitivity reactions. Our case is unique in the observation of this reaction pattern in regional lymph nodes, and it expands the spectrum of complications known to be associated with tattoos.
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Breuner CC, Levine DA, Breuner CC, Alderman EM, Garofalo R, Grubb LK, Powers ME, Upadhya KK, Wallace SB. Adolescent and Young Adult Tattooing, Piercing, and Scarification. Pediatrics 2017; 140:peds.2017-1962. [PMID: 28924063 DOI: 10.1542/peds.2017-1962] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Tattoos, piercing, and scarification are now commonplace among adolescents and young adults. This first clinical report from the American Academy of Pediatrics on voluntary body modification will review the methods used to perform the modifications. Complications resulting from body modification methods, although not common, are discussed to provide the pediatrician with management information. Body modification will be contrasted with nonsuicidal self-injury. When available, information also is presented on societal perceptions of body modification.
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Affiliation(s)
- Cora C. Breuner
- Adolescent Medicine Division, Department of Pediatrics, Orthopedics and Sports Medicine, Seattle Children’s Hospital, University of Washington, Seattle, Washington; and
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17
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Kluger N. Cutaneous and systemic complications associated with tattooing. Presse Med 2016; 45:567-76. [PMID: 27160631 DOI: 10.1016/j.lpm.2016.02.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 01/28/2016] [Accepted: 02/08/2016] [Indexed: 12/31/2022] Open
Abstract
Tattooing can result in a wide variety of complications, whose prevalence and incidence remain still unclear. Hypersensitivity reactions (or allergies) to tattoo pigments are currently the most common complication on a tattoo, however they are not predictable. Infections are nowadays directly related to the lack of asepsis and hygiene during the tattooing procedure or during the healing phase. Patients with a known cutaneous disease should be warned of a potential risk of localization of their disease to the tattoo. A skin eruption restricted to a tattoo may reveal sarcoidosis. Patients with chronic conditions and/or impaired immunity should discuss with their physician about the possibility and when to have a tattoo.
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Affiliation(s)
- Nicolas Kluger
- University of Helsinki, Helsinki University Central Hospital, dermatology, allergology and venereology, Meilahdentie 2, P.O. Box 160, FI-00029 HUS, Finland.
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Islam PS, Chang C, Selmi C, Generali E, Huntley A, Teuber SS, Gershwin ME. Medical Complications of Tattoos: A Comprehensive Review. Clin Rev Allergy Immunol 2016; 50:273-86. [DOI: 10.1007/s12016-016-8532-0] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Godinho MM, Aguinaga F, Grynszpan R, Lima VM, Azulay DR, Cuzzi T, Ramos-E-Silva M, Manela-Azulay M. Granulomatous reaction to red tattoo pigment treated with allopurinol. J Cosmet Dermatol 2015. [PMID: 26211454 DOI: 10.1111/jocd.12149] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Granulomatous reactions to tattoo ink are most commonly associated with mercury sulfide, a component of red pigments. Treatment options show limited results. Allopurinol, an inhibitor of xanthine oxidase, has been reported as a successful alternative treatment to granulomatous disorders, such as sarcoidosis and granulomatous reactions to fillers and tattoos. We report a case of granulomatous reaction to red tattoo pigment treated with allopurinol for 6 months. Good clinical improvement could be noticed during this time. Two months after we stopped the treatment, the lesion recurred. Allopurinol emerges as an important drug for the management of granulomatous reactions caused by tattoo pigments. Based on the significant clinical improvement noticed during its use, we recommend new studies to elucidate all the potential benefits of the use of allopurinol for the treatment of granulomatous reactions to tattoo ink.
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Affiliation(s)
- Mariana Marteleto Godinho
- Sector of Dermatology and Post-Graduation Course in Dermatology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Felipe Aguinaga
- Sector of Dermatology and Post-Graduation Course in Dermatology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rachel Grynszpan
- Sector of Dermatology and Post-Graduation Course in Dermatology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Victor Maselli Lima
- Sector of Plastic Surgery, Ivo Pitanguy Institute/Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - David Rubem Azulay
- Sector of Dermatology and Post-Graduation Course in Dermatology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tullia Cuzzi
- Sector of Pathology and Post-Graduation Course, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcia Ramos-E-Silva
- Sector of Dermatology and Post-Graduation Course in Dermatology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mônica Manela-Azulay
- Sector of Dermatology and Post-Graduation Course in Dermatology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Abstract
Decorative tattoo is a popular practice that is generally safe when performed in the professional setting but can be associated with a variety of inflammatory, infectious, and neoplastic complications, risks that may be increased with current trends in home tattooing. Modern tattoo inks contain azo dyes and are often of unknown composition and not currently regulated for content or purity. Biopsy of most (if not all) tattoo reactions presenting to the dermatologist is recommended, given recent clusters of nontuberculous mycobacterial infections occurring within tattoo, as well as associations between tattoo reactions and systemic diseases such as sarcoidosis.
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Affiliation(s)
- Michi M Shinohara
- Divisions of Dermatology and Dermatopathology, University of Washington School of Medicine, Seattle, Washington.
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Kotzen M, Sell J, Mathes RW, Dentinger C, Lee L, Schiff C, Weiss D. Using Syndromic Surveillance to Investigate Tattoo-Related Skin Infections in New York City. PLoS One 2015; 10:e0130468. [PMID: 26076006 PMCID: PMC4468107 DOI: 10.1371/journal.pone.0130468] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/20/2015] [Indexed: 12/03/2022] Open
Abstract
In response to two isolated cases of Mycobacterium chelonae infections in tattoo recipients where tap water was used to dilute ink, the New York City (NYC) Department of Health and Mental Hygiene conducted an investigation using Emergency Department (ED) syndromic surveillance to assess whether an outbreak was occuring. ED visits with chief complaints containing the key word "tattoo" from November 1, 2012 to March 18, 2013 were selected for study. NYC laboratories were also contacted and asked to report skin or soft tissue cultures in tattoo recipients that were positive for non-tuberculosis mycobacterial infection (NTM). Thirty-one TREDV were identified and 14 (45%) were interviewed to determine if a NTM was the cause for the visit. One ED visit met the case definition and was referred to a dermatologist. This individual was negative for NTM. No tattoo-associated NTM cases were reported by NYC laboratories. ED syndromic surveillance was utilized to investigate a non-reportable condition for which no other data source existed. The results were reassuring that an outbreak of NTM in tattoo recipients was not occurring. In response to concerns about potential NTM infections, the department sent a letter to all licensed tattoo artists advising them not to dilute tattoo ink with tap water.
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Affiliation(s)
- Mollie Kotzen
- New York City Department of Health and Mental Hygiene, Queens, New York, United States of America
- New York University, New York, New York, United States of America
| | - Jessica Sell
- New York City Department of Health and Mental Hygiene, Queens, New York, United States of America
| | - Robert W. Mathes
- New York City Department of Health and Mental Hygiene, Queens, New York, United States of America
| | - Catherine Dentinger
- New York City Department of Health and Mental Hygiene, Queens, New York, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lillian Lee
- New York City Department of Health and Mental Hygiene, Queens, New York, United States of America
| | - Corinne Schiff
- New York City Department of Health and Mental Hygiene, Queens, New York, United States of America
| | - Don Weiss
- New York City Department of Health and Mental Hygiene, Queens, New York, United States of America
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23
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Simunovic C, Shinohara MM. Complications of decorative tattoos: recognition and management. Am J Clin Dermatol 2014; 15:525-36. [PMID: 25385257 DOI: 10.1007/s40257-014-0100-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Tattooing is an ancient practice that enjoys continued popularity. Although a modern, professionally performed tattoo is generally safe, complications can occur. A skin biopsy of all tattoo reactions is recommended as some tattoo reactions have systemic implications. Tattoo-related infections are seen days to decades after tattooing, and range from acute pyogenic infections to cutaneous tuberculosis. In particular, non-tuberculous mycobacterial infections happen in tattoos with increasing frequency and are introduced at the time of tattooing through contaminated ink or water used to dilute inks. Despite a transition in tattoo pigments from metal salts to industrial azo dyes, hypersensitivity reactions also persist, and include eczematous, granulomatous, lichenoid, and pseudoepitheliomatous patterns (among others). Granulomatous tattoo reactions can be a clue to cutaneous or systemic sarcoidosis, particularly in the setting of interferon use. Pseudoepitheliomatous tattoo reactions have substantial overlap with squamous cell carcinoma and keratoacanthoma, making diagnosis and management difficult. Other malignancies and their benign mimics can occur in tattoos, raising questions about the safety of tattoo ink and its role in carcinogenesis.
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[Rose necrosis: Necrotizing granulomatous reaction with infected node at red pigment of a tattoo]. ANN CHIR PLAST ESTH 2013; 59:144-9. [PMID: 23992853 DOI: 10.1016/j.anplas.2013.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 07/22/2013] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Nowadays, necrotizing cutaneous reaction after a tattoo is rare especially with the sterile tattoo equipment and antisepsis rules. We report the rare case of a necrotizing reaction secondary to a granulomatous reaction after a red tattoo, with a satellite node. CASE REPORT A 40-year-old patient suffering from a granulomatous reaction to red dye of a large pectoral tattoo, with cutaneous and sub-cutaneous necrosis, and an infected axillary node. This pectoral tattoo also triggered a necrotizing granulomatous reaction on red-pigmented areas of other older tattoos. Local treatments (dressings, antibiotics, repeated excisions of necrotizing tissues) did not stop the allergic reaction, and an infectious origin was eliminated. The patient asked for a complete excision of the pectoral tattoo. Black intramacrophagic pigment was found in the black lymph node analysed. We did not experience any complications and the patient is satisfied with the results. DISCUSSION Very few examples of cutaneous necrotizing secondary to a tattoo have been found in the literature. The hypothesis of a primitive infection that had secondarily led to necrosis is refuted by the lack of infective structures found in the analysed node, and most of all by the same reaction on other older tattoos on red-pigmented areas. This rare complication must be known by plastic surgeons, who will probably be called upon to take care of more and more tattooed patients. CONCLUSION Even if it's rare, necrosis with a granulomatous reaction to red pigment after a tattoo must be known. This case illustrates a very violent immune reaction where infection was not proved.
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Kluger N. Tattooing, piercing and inherited coagulation disorders. Haemophilia 2013; 19:e358-9. [DOI: 10.1111/hae.12217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2013] [Indexed: 01/26/2023]
Affiliation(s)
- N. Kluger
- Departments of Dermatology, Allergology and Venereology; Institute of Clinical Medicine; University of Helsinki, Skin and Allergy Hospital; Helsinki University Central Hospital; Helsinki Finland
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Kluger N. Tattooing and piercing: an underestimated issue for immunocompromised patients? Presse Med 2013; 42:791-4. [PMID: 23453496 DOI: 10.1016/j.lpm.2013.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 12/04/2012] [Accepted: 01/13/2013] [Indexed: 10/27/2022] Open
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