Cutaneous and systemic complications associated with tattooing

Associations of demographic, health, and risk-taking behaviors with tattooing in a population-based cross-sectional study of ~18,000 US adults

Background

Little is known about current characteristics of individuals with tattoos. We quantified the prevalence of tattooing and associations of demographic, health, and risk-behavior factors with tattooing.

Methods

We computed adjusted prevalence ratios (PR) of tattooing in a population-based analysis of > 18,000 Utah adults from the 2020-2021 Behavioral Risk Factor Surveillance System survey.

Results

The prevalence of tattooing was 26% among women and 22% among men, with the highest prevalence among women ages 25-29 (45%). Tattoo prevalence was higher among younger individuals, individuals with a lower education level, and those without religious affiliation. Tattoo prevalence was higher among indviduals with current tobacco (women: PR = 2.89 [95% confidence interval (CI): 2.60, 3.20]; men: 3.39 [2.98, 3.86]), e-cigarette (women: 2.44 [2.21, 2.69]; men: 2.64 [2.37, 2.94]), and heavy alcohol use (women: 2.16 [1.93, 2.43]; men: 1.89 [1.63, 2.19]). Tattoo prevalence was lower among individuals receiving a flu (women: 0.84 [0.76, 0.92]; men: 0.75 [0.67, 0.84]) or COVID-19 vaccine (women: 0.65 [0.54, 0.79]; men: 0.75 [0.61, 0.92]).

Conclusions

Several risk-taking behaviors were associated with tattooing. Tattoo studios/conventions may present opportunities for partnership with tobacco cessation, alcohol reduction, and vaccination public health initiatives.

Esthetic and medical tattooing: Part I: Tattooing techniques, implications, and adverse effects in healthy populations and special groups

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.

Tattoos: risks and complications, clinical and histopathological approach

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.

Knowledge and Attitude Towards Cutaneous Complications of Tattoos and Piercings Among the General Population in Saudi Arabia

Introduction  Tattooing and piercing, which were uncommon in affluent countries, have recently spread throughout societies. Over the past two decades, young people have shown considerable excitement for the practice. This reported growth creates more difficulties because of the numerous operations performed without awareness of health and hygiene requirements. This study aims to assess the knowledge and attitudes of the general population toward the cutaneous complications of tattoos and piercings in Saudi Arabia. Methods This was a web-based descriptive cross-sectional study. An online questionnaire was developed by the study researchers, which included participants' demographic data, their knowledge of tattoos and piercings with associated health effects and possible infections, their attitude towards tattoos and piercings, and their practice and experienced complications regarding tattooing and body piercing. The final validated questionnaire was made publicly available via social media until no more new responses were obtained. Results Eight hundred and forty-eight individuals completed the study questionnaire. The ages of the participants varied from 18 to more than 55 years old, with a mean age of 25.2 ± 13.9 years, and (589 [69.5%]) were female. The most reported health effects and infections were bacterial infections in place of body modification (479 [56.5%]), purpura (380 [44.9%]), cutaneous abscesses (380 [44%]), melanoma (338 [39.9%]), hepatitis B virus (321 [37.9%]), HIV (311 [36.7%]), sepsis (306 [36.2%]), allergic contact dermatitis (296 [35%]), and hepatitis C virus (279 [33.1%]). In total, 336 (39.6%) had an overall good knowledge of tattooing and body piercing hazards, with higher knowledge among females with high education (p< 0.05). Conclusion This study revealed that one in three individuals knew about the health risks and infections associated with tattooing and body piercing. Higher awareness was found among females with high education levels. Of all the associated complications, procedure-related infections were the most common among participants.

Exploratory evaluation of tolerability, performance, and cosmetic acceptance of dexpanthenol-containing dermo-cosmetic wash and sun-care products for tattoo aftercare

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.

A Study of Body Modification Artists’ Knowledge, Attitudes, and Practices Toward Infection Control: A Questionnaire-Based Cross-Sectional Study

Background

Tattoos and piercings, which were once considered taboo, are now widespread like an epidemic, among people of all ages and gender. The rising demand for such body alterations has given rise to a large number of infective complications. This study was, therefore, designed to assess the infection control knowledge, attitudes, and practices of body modification artists in Ethiopia, 2021.

Methods

An anonymous observational cross-sectional study was conducted in Addis Ababa, Ethiopia, from May 25 to June 22, 2021. The data collection instrument was a structured questionnaire that covered the participants’ socio-demographic characteristics, knowledge, attitudes, and practices related to infection control. On the whole, 172 tattoo and body piercing artists participated in the study. SPSS v.20 software was used for data entry and analysis. Pearson’s correlation test, t-test, Tukey’s test, and multiple linear regression analysis were conducted during the data analysis.

Results

Male participants constituted well over three-fourths (96.5%, n = 166) of the sample considered in the study. According to the result, the participants’ knowledge of infection control received the lowest score (7.1 ± 1.22). Participants’ scores of knowledge of infection control increased with an increase in their experience in the multiple linear regression. Experience and training time were also associated with knowledge. Infection control practice was positively associated with the respondents’ attitudes. After controlling other variables, it was found that a one-unit increase in respondents’ attitude scores increased their practice level by 86%.

Conclusion

This is the first study in Ethiopia to examine tattooists’ and body piercers’ infection control knowledge, attitude, and practice. Minimum standards for infection control in inking and piercing establishments are necessary. It is therefore important that local authorities and public health professionals work towards laying down the minimum code of practice for infection control in inking and piercing establishments.

Tattoo-Associated Viral Infections: A Review

Tattoos, a decorative form of body art, are produced by inoculating pigment into the dermis. Tattoo-associated viral infections can be cutaneous and localized to the tattoo ink; however, viral pathogens acquired during inoculation can cause systemic disease. A comprehensive review of the literature only reveals a limited number of published reports regarding patients with tattoo-associated cutaneous viral lesions. Cutaneous viral pathogens causing lesions to occur on a tattoo include herpes simplex virus (HSV), human papillomavirus (HPV), molluscum contagiosum, rubella, and vaccinia. HPV lesions (45 patients) and molluscum contagiosum (14 patients) are the most frequently reported tattoo-associated viral lesions; nearly all the patients were immunocompetent. HPV lesions included verruca vulgaris (29 patients), verruca plana (14 patients) and human immunodeficiency virus (HIV)-associated acquired epidermodysplasia verruciformis (two men). Hypotheses for tattoo-associated HPV lesions and molluscum contagiosum include a black ink-induced cutaneous immunocompromised district since the viral lesions all occurred in black or dark ink and the use of virus-contaminated instruments, pigment, or both during tattoo inoculation. Other sources of HPV include viral spread from a wart that is present but not associated with the tattoo site or virus transmission from the tattooist resulting from contact with a wart on an ungloved hand or HPV-containing saliva used to thin the pigment. Herpes compunctorum (three patients), vaccinia (two patients), and rubella (one patient) were less commonly reported. Blood borne viral pathogens associated with systemic manifestations – such as hepatitis B, hepatitis C and HIV – have also been acquired during tattoo inoculation; however, health care interventions have been adopted to attempt prevention of viral agent transmission during tattoo acquisition.

Systemic infections associated with tattoos or permanent makeup: A systematic review

INTRODUCTION

The aim of this article is to summarize published information on systemic infective complications of tattoos to gain an update of the current picture.

METHODS

A literature search was performed in PubMed database (2009-2019), and compared with a search without year restriction. Eligibility criteria were studies on systemic tattoo-related infections, including case reports, case series, outbreak investigations, reviews, and systematic reviews.

RESULTS

We identified 17 manuscripts with systemic infections between 2009 and 2019, with one reported fatality. In contrast to the historical records, no reports of systemic tuberculosis, syphilis or viral (hepatitis or HIV) infections were reported within the study period. A few sporadic cases or Mycobacterium leprae (India) or regional lymphadenopathy associated with skin lesions in non-tuberculosis mycobacteria were identified. Persistent fever with rigour was common in bacterial bloodstream infections. One episode of staphylococcal toxic shock syndrome and several episodes of septic shock were reported, associated with cellulitis or necrotizing fasciitis within two weeks of the procedure, predominantly caused by pyogenic bacteria (S. aureus or streptococcus). Identification of lung or systemic embolisms in the absence of local symptoms, was indicative of (right or left) infective endocarditis.

CONCLUSIONS

Bacterial bloodstream infections should be considered in subjects developing fever and rigour after tattoos, regardless of local symptoms. A shift in causative organisms has been documented, when comparing with historical reports. NTM are emerging organisms causing lymphadenopathy. Strict hygiene conditions are essential when performing a tattoo.

Metallic glass coating for improved needle tattooing performance in reducing trauma: analysis on porcine and pig skins

The dissemination of tattooing into mainstream culture has raised concerns pertaining to the medical implications of these practices. This paper reports on the coating of tattoo needles with metallic-glass (MG) to reduce trauma to the skin. Extensive experimentation using pork samples and live pigs demonstrated the beneficial effects of non-stick MG coatings. Following 30 insertions into pork skin, significantly less tissue adhered to the MG-coated needles than to uncoated needles. MG-coated needles were also shown to reduce the spread of pigment to the surface of surrounding skin by up to 57%. This resulted in narrower tattoo lines of higher density, indicating that MG-coated needles could be useful in high-resolution tattooing. Histopathological analysis on live pigs revealed severe trauma induced by bare needles, as indicated by the secretion of fluids immediately after tattooing. The wounds formed by coated needles closed within 2 h after tattooing; however, those formed by bare needles remained open for at least 2 h and inflammation was still observed after 3 days. At 5 days after tattooing, skin punctured by the coated needle was entirely healed, whereas skin punctured by the bare needle was still covered with scabs. In addition to the medical benefits, it appears that MG-coated needles could improve the quality of tattoos, based on the fact that the amount of pigment retained in the skin is inversely proportional to the trauma caused by needles.

Systemic diseases and infections, anecdotal complications and oddities associated with tattooing

Complications associated with tattoos are mostly of cutaneous origin. They include chiefly ink allergy, local infection, benign tumors or malignant lesions and elective localization of various dermatoses. Tattoo-related systemic diseases and infections have more rarely been described, the most common being sarcoidosis and hepatitis C. However, unusual associations have also been reported, even though they may be anecdotal or likely unrelated with the procedure.

[Reluctance determinants of dermatologists about tattooing in patients with psoriasis. An international study]

BACKGROUND

Tattoos are an increasingly common phenomenon, with a prevalence of around 10-30 % of the population in Western countries. The "Tatou" project assessed the risks of tattooing for patients with psoriasis. The first part revealed strong opposition to tattoos in these patients on the part of dermatologists, despite fewer than a quarter of them having any personal experience of complications. The second part showed a very low rate (6.6 %) of local complications on tattoos in these patients as well as absence of severe complications. These observations led us to assess the reasons for reluctance about tattoos in the 468 dermatologists involved in the first part of the "Tatou" project.

PATIENTS AND METHODS

We conducted a cross-sectional international study in France, Finland and Italy to evaluate the experience and opinions of dermatologists regarding tattoos in psoriasis patients via an anonymous questionnaire. We then examined the stated reasons for opposition to tattoos in order to establish the profiles of "tattoo-sceptical" dermatologists with regard to 4 different situations: active psoriasis, quiescent psoriasis, treatment with topical steroids and biotherapies.

RESULTS

The opinion of dermatologists regarding tattoos was generally unfavourable (3.5±2.8/10), in particular, via multivariate analysis, among older dermatologists (P=0.01), dermatologists in private practice (P=0.04), and non-tattooed dermatologists (P<0.0001). In multivariate analysis, the main parameter affecting the position of practitioner with regard to tattoos was their personal opinion of tattoos (P<0.0001), regardless of disease activity or type of treatment. Italian, Finnish and female dermatologists exhibited greater reluctance but in a less consistent fashion.

CONCLUSION

This analysis suggests a lack of objectivity among dermatologists opposed to tattoos probably stemming more from a poor opinion of this practice than from any fear of complications in their psoriatic patients.

Tattoo-Associated Basal Cell Carcinoma: Coincident or Coincidence

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.

How to advise a patient who wants a tattoo?

Tattooing and permanent make-up have become mainstream procedures. Many factors play a role in the final outcome of a tattoo and the satisfaction of the customer. The technical and artistic skills of the tattooist will determine the esthetic result and will help to guide the customers in their decision and choice of the tattoo. Although tattooing is by many considered as safe one should be are aware of the risks of complications related to this body modification technique. Some customers have a medical problem and some doubt about the safety of the procedure. People with increased risk of adverse events often seek medical advice prior to decide to get a tattoo or PMU. Physicians should not only be informed about the medical history of their patients but also have some basic knowledge of the practice of tattooing and the effects this procedure can exert on the skin and on the health condition of the patient. Contraindications and special precautions with regard to skin diseases and specific systemic conditions will be addressed in this article.

Tattoos among athletes: a matter of concern?

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.

[Tinea corporis within recent tattoos]

INTRODUCTION

Tattoos are occasionally associated with cutaneous infections. Diagnosis can be challenging as the clinical presentation of such infections may differ from those on plain skin. Herein we report an atypical form of tinea corporis restricted to two recent tattoos during healing, caused by environmental contamination. We reviewed the literature for all cases of fungal infection after tattooing.

PATIENTS AND METHODS

A 27-year-old female patient was seen for ring-shaped, erosive, oozing, pruritic and rapidly extensive skin lesions as well as infiltrated papular lesions occurring on tattoos done 6 and 12 days earlier. Fungal analysis revealed Microsporum canis. History-taking indicated that the patient's cat had ringworm and that the patient's sister also had skin lesions consistent with tinea corporis.

DISCUSSION

Tinea on tattoos is rarely reported. We found ten additional cases in the literature, as well as five cases of less common fungal infections. These could be explained by the skin break created by the needle during tattooing resulting in an impaired skin barrier, or by accidental self-inoculation (e.g. foot-tattoos). The hypothesis of local immune deficiency induced by tattoo inks strikes us as rather improbable. Unlike usual cases of infections (pyogenic bacteria, mycobacteria, viral hepatitis), fungal infections are not related to a lack of hygiene on the part of the tattooist, but rather to contamination during the healing phase. Their clinical presentation may be atypical, resulting in diagnostic difficulties.

Quantitative analysis of metals and metal-based nano- and submicron-particles in tattoo inks

Exposure to metals and metal-based nano- (NPs, 1-100 nm) and submicron-particles (SPs, 0.1-1 μm) contained in tattoo inks and related health safety is currently receiving a great deal of interest. Twenty inks of different brands and colours were sampled in Italy in 2019. The SemiQuant Inductively Coupled Plasma Mass Spectrometry (ICP-MS) analysis allowed quantifying the concentration of 18 metals (Al, As, Ba, Cd, Co, Cr, Cu, Fe, Hg, Mn, Mo, Ni, Pb, Sb, Se, Sn, Ti, Zn) in inks. The Single Particle ICP-MS was used to detect the diameters and concentration of NPs and SPs of 9 metals (Al, Co, Cr, Cu, Hg, Ni, Pb, Ti and Zn). Concentration of metals in tattoo inks were below the recommended concentrations reported in the Resolution ResAP (2008)1 indicating ink production have shifted to purer materials and best manufacturing practices. Regarding particles, Al was found at nano- (62-80 nm) and submicron-sizes (105-140 nm). Sizes of Cr, Cu, Pb and Zn were in the intervals 42-62 nm, 44-96 nm, 26-28 nm and 26-59 nm, respectively. Titanium was at submicron-diameters (166-383 nm). In addition, Cr and Ti particles accounted for the 47% and 80% of their total concentration, respectively. Tattooing practice exposed humans to metal-based NPs and SPs and the presence of a combination of particles of different metals and/or their dynamics (e.g., dissolution) may change their bioavailability and toxicity.

[Melanoma within tattoos: Two cases and a systematic literature review]

BACKGROUND

There have been reports of malignant melanoma arising within tattoos. However, there is no clear relationship between tattoos and the development of cutaneous malignancies. We report two new cases of melanoma and provide a review of cases of melanoma reported in the medical literature.

PATIENTS AND METHODS

Case No. 1: a 61-year-old patient consulted following the appearance one year ago of a nodular lesion measuring 4.5×3cm on a blue and red tattoo on his back. Complete excision of the lesion with histological analysis revealed an ulcerated nodular melanoma with a Breslow depth of 7mm. No secondary sites were found. Case No. 2: a 39-year-old patient with a blue tattoo on his left arm consulted following the appearance of a pigmented lesion a few months earlier. Surgical excision was immediately performed, confirming the diagnosis of SSM, with a Breslow depth of 0.9mm. There was no sign of relapse 9 years later.

DISCUSSION

In our systematic review we noted 34 cases of melanoma occurring in tattoos. There was a high male prevalence (90.3%) and a relatively young mean age (45.9 years). Most tattoos were monochrome (71.0%). The average time between tattooing and onset of melanoma was 13.2 years. The most common sites of melanoma were the upper limbs (53.1%) and trunk (34.4%). Mean tumor size was 11.6mm. Histologic examination revealed 2 cases of melanoma in situ, and in 13 cases, the Breslow depth was 1mm or less. In 5 cases, macroscopic or microscopic lymph node metastasis (sentinel lymph node) was found at diagnosis, and in one case, in transit skin metastases were also observed at the time of diagnosis. We discuss the hypothetical pathogenic role of tattoos in melanoma.

An update on cutaneous complications of permanent tattooing

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.

Characteristics and safety of tattoos in patients with systemic lupus erythematosus

Objective

The objective of this study was to determine the safety of tattoos in patients with systemic lupus erythematosus (SLE).

Methods

Patients ( N = 147; ≤55 years; 92% women) were asked if they had tattoos. The characteristics of the tattoos and the immediate complications were investigated and compared with those of a matched control group. We examined retrospectively after the tattoo was completed whether there had been flare-ups or increased organ damage (Systemic Lupus International Collaborating Clinics/American Collage of Rheumatology Damage Index (SDI)). Finally, we compared the SLE-related characteristics of patients with and without tattoos.

Results

Twenty-eight patients (19%, 26 women, median (interquartile range) age 33 (25–42) years, 65 tattoos in total) had ≥1 tattoo. At the time the tattoo was done the median (interquartile range) SLEDAI and SDI were 2 (0–2) and 0 (0–1), respectively. The characteristics of the tattoos were similar to those of controls. No patients experienced acute complications. After a median follow-up of 17 (12–20) months (3 (2–4) visits/year) four patients had five mild-to-moderate flare-ups. The median time between the tattoo and the flare-up was 9 (6–14) months. No increase in SDI was observed. The SLE-related characteristics of patients with and without tattoos were similar.

Conclusion

Tattoos seem to be safe in SLE patients with inactive or low active disease.

Conjunctival tattoo with inadvertent ocular globe penetration and vitreous involvement: Clinico-pathological correlation and scanning electron microscopy X-ray microanalysis

Purpose:

The aim is to report a case of conjunctival tattooing with inadvertent injection of tattoo ink into the vitreous cavity and its consequences, the scanning electron microscopy X-ray microanalysis of the ink components, and the microscopic findings of the affected conjunctiva and vitreous.

Methods:

Descriptive case report.

Results:

A 32-year-old man complained of ocular pain and blurred vision after undergoing a subconjuctival red ink tattoo in his left eye. Ophthalmologic examination revealed best corrected visual acuity of 20/80 and intraocular pressure of 26 mmHg. Pain was elicited with eye movements. The bulbar conjunctiva was colored intense red. In the anterior chamber, pigment granules and filaments were suspended on the aqueous humor, and lens capsule was also stained red. Ultrasonography showed high-density non-mobile echoes in the conjunctiva; anterior chamber and vitreous cavity revealed high-density mobile echoes corresponding to pigment particles. Conjunctival tattoo with inadvertent globe penetration was the clinical diagnosis. The patient received medical and surgical treatment. Histopathological examination of the conjunctiva showed red pigment globular deposits within the stroma, and neutrophils and sparse histiocytes with similar intracytoplasmic pigment granules were seen. No granulomatous foreign body reaction was noticed. Vitreous material contained pigment granules; no inflammatory cells were observed. Scanning electron microscopy X-ray microanalysis of the tattoo red ink revealed significant signals of iron, barium, and copper.

Conclusion:

Conjunctival tattoo is a new form of body decoration gaining worldwide popularity. This procedure is performed by untrained professionals causing severe ocular complications including blindness. Safety regarding tattoo ink needs further study as the composition varies among colors. Strict regulations on this matter should be considered.

Osteoma Cutis: An Adverse Event Following Tattoo Placement

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.

The girl with the eyeball tattoo—what the ophthalmologist may expect? Case report and a review of literature

Introduction:

We report a case of patient who underwent bilateral eyeball tattoo procedure for cosmetic purpose complicated with intraocular dye injection which led to ocular inflammation, secondary glaucoma, and cataract.

Case description:

A 21-year-old female presented to emergency department with severe right eye pain and photophobia 21 days after conjunctival tattooing procedure. Slit-lamp examination revealed right-sided eyelid edema and black deposits of tattoo ink under the bulbar conjunctiva. Dye deposits were also present in anterior chamber, covering corneal endothelium, iris and anterior lens’ capsule. Ocular inflammation and secondary glaucoma were diagnosed. The patient underwent surgical treatment to control ocular inflammation. Intraocular pressure remained stable after Nd:YAG iridotomy and on topical drugs. Moreover, during the follow-up, in contralateral eye, we observed “conjunctival lumps”—local hypersensitivity reaction to the dye, which were asymptomatic to the patient.

Conclusion:

Eyeball tattooing complications are new challenges that ophthalmologist may have to face nowadays. We also reviewed for the first time possible complications of eyeball tattooing described in available literature.

Tattoos yesterday and today in the Polish population in the decade 2004–2014

Background

The fashion for tattooing the body is becoming increasingly widespread. It seems that both the structure and role of factors motivating individuals to obtain tattoos have changed in recent years. The objective of this study was to evaluate the hypothesis that factors encouraging tattooing and the meaning of tattoos have evolved, leading to some significant recent changes.

Participants and procedure

The participants were individuals of Polish ethnicity aged 16-67 years, having at least one tattoo. The first survey, conducted in 2004, encompassed 100 subjects, while the second one, in 2014, involved 200 subjects. Both groups of respondents answered questions about the functions of tattoos and the factors motivating them to obtain a tattoo, as well as expressing their opinions about individuals with body art.

Results

In the studied decade we found a rise in the number of tattooed women, with tattoos being primarily perceived as an art form and a way to express one’s personality, aid self-enhancement, and improve one’s sexual attractiveness. Currently, tattooing more seldom serves as a provocation, self-identification, a mark of subculture affiliation, or a way to enhance self-esteem.

Conclusions

The functions of tattooing have been rapidly changing. The use among women causes that the perception of tattooing is changing and becoming less aggressive. The mass media insistently promote the fashion for tattoos, which is why this form of body art is becoming more and more popular.

Unusual complication of a tattoo in an immunosuppressed patient

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.

A Practical Guide About Tattooing in Patients with Chronic Skin Disorders and Other Medical Conditions

With tattoos becoming increasingly mainstream, dermatologists are more and more often consulted by patients who are considering getting an ornamental, cosmetic, or even a medical tattoo, and who subsequently ask for advice. This includes not only patients with chronic skin diseases such as psoriasis or atopic dermatitis but also patients with other medical conditions. This review first explores the reasons why patients may want to get a tattoo and aims to offer some key information to dermatologists on what they should know about tattooing and the main risks associated with this procedure. Second, the risks and recommendations of tattooing in patients with specific skin diseases are described more in detail, and the relative and strict contraindications discussed, including the necessity to discontinue certain treatments that could influence the outcome of the procedure and the final result. Our aim was to provide dermatologists with the current knowledge they need to help their patients make adequate and informed choices on skin art, focusing specifically on considerations in patients with chronic skin conditions. Finally, other aspects regarding some general systemic conditions and concomitant diseases that the patient could present are also addressed. In particular, the risks of tattooing in patients with diabetes, coagulation disorders, heart conditions, immunosuppressive treatments, and pregnancy are discussed.

Looking beyond the cosmetic tattoo lesion near the eyebrow: Screening the lungs

Cosmetic tattooing has become a risk factor for several adverse reactions related to inks, procedures, and associated clinical conditions. Development of a sarcoid reaction to the inserted tattoo pigment in the skin is not common. We report a 45 year-old patient with history of dyspnea and mild cough since two years who had subsequently developed reddish, scaly lesions in her 15-year old tattoo done near her right eyebrow. Skin biopsy of the tattoo lesion revealed cutaneous sarcoidosis which led to further investigations and a diagnosis of pulmonary sarcoidosis. The present case highlights the fact that cutaneous sarcoidosis can develop in a long-standing tattoo. Also such a patient should be screened for systemic sarcoidosis disease.