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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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Kühn LM, Beiteke U, Nashan D. [Useful knowledge regarding tattoos]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00105-023-05184-9. [PMID: 37314452 DOI: 10.1007/s00105-023-05184-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 06/15/2023]
Abstract
The number of people with tattoos has continued to increase in recent years. In the USA about 23% and in Europe 9-12% of the population have tattoos. In the German media (2019) and by the infoportal Statista (2017), it is assumed that 21-25% of citizens have tattoos and that the trend is increasing (Statista 2018: 36%). Men and women wear tattoos equally. The age group 20-29 years dominates with almost 50% having tattoos. The following article describes the new regulations especially the REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals) regulation, legal basis, and governmental controls on the subject of "tattoos". The composition of tattooing agents and testing options relevant for the user before and for the performance of tattooing are presented. Dermatologically associated diseases and testing procedures are listed. Since 70% of the population denies knowledge of this information even when they have tattoos themselves, this update is written as an overview for treating physicians and users.
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Affiliation(s)
- L M Kühn
- Hautklinik, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Deutschland.
| | - U Beiteke
- Hautklinik, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Deutschland
| | - D Nashan
- Hautklinik, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Deutschland
- Hautarztpraxis, Müllheim, Deutschland
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3
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Schubert S, Kluger N, Schreiver I. Hypersensitivity to permanent tattoos: Literature summary and comprehensive review of patch tested tattoo patients 1997-2022. Contact Dermatitis 2023; 88:331-350. [PMID: 36772861 DOI: 10.1111/cod.14291] [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: 09/05/2022] [Revised: 02/01/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023]
Abstract
We outline constituents of tattoo and permanent make-up ink with regard to inflammatory tattoo reactions and population-based confounders. The comprehensive review of patch-tested tattoo patients between 1997 and 2022 shows that tattoo allergy cannot be reliably diagnosed via patch testing with today's knowledge. Weak penetration and slow haptenization of pigments, unavailability of pigments as test allergens and a lack of knowledge concerning relevant epitopes hamper the diagnosis of tattoo allergy. Patch testing p-phenylenediamine and disperse (textile) dyes is not able to close this gap. Sensitization to metals was associated with all types of tattoo complications, although often not clinically relevant for the tattoo reaction. Binders and industrial biocides are frequently missing on ink declarations and should be patch tested. The pigment carbon black (C.I. 77266) is no skin sensitizer. Patch tests with culprit inks were usually positive with cheap ink products for non-professional use or with professionally used inks in patients with eczematous reactions characterized by papules and infiltration. Tape stripping before patch testing and patch test readings on Day 8 or 10 may improve the diagnostic quality. The meaningfulness of the categorical EU-wide ban of Pigment Green 7 and Pigment Blue 15:3 is not substantiated by the presented data.
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Affiliation(s)
- Steffen Schubert
- Information Network of Departments of Dermatology (IVDK), Institute at the University Medical Center Göttingen, Göttingen, Germany
| | - Nicolas Kluger
- Department of Dermatology, 'Tattoo' Consultation, Bichat-Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.,Department of Dermatology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Ines Schreiver
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Berlin, Germany
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Tattoo-Related Allergic Contact Dermatitis. CURRENT DERMATOLOGY REPORTS 2022. [DOI: 10.1007/s13671-022-00371-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Famele M, Lavalle R, Leoni C, Majorani C, Ferranti C, Palleschi L, Fava L, Draisci R, D'Ilio S. Quantification of Preservatives in Tattoo And Pmu Inks in The Frame of The New Requirements Under Reach Regulation. Contact Dermatitis 2022; 87:233-240. [PMID: 35289945 DOI: 10.1111/cod.14105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND According to the REACH restriction, tattoo and permanent make-up (PMU) inks placed on the EU market after 4th January 2022 shall not contain methylisothiazolinone (MI), benzisothiazolinone (BIT), octylisothiazolinone (OIT) or other skin sensitisers in concentrations ≥10 mg/kg and phenoxyethanol (PE) or other eye irritants or damaging substances in concentrations ≥100 mg/kg. In addition, preservatives and other substances enlisted in Annex II to Cosmetic Product Regulation shall not be present in concentrations ≥0.5 mg/kg. OBJECTIVES Quantification of 14 preservatives in 99 tattoo and 39 PMU inks from the Italian market and comparison with concentration limits set by REACH restriction. MATERIALS AND METHODS Inks were analysed by applying validated analytical methods based on liquid-chromatography techniques. RESULTS About 24.0% and 1.5% of the overall samples contained BIT and OIT respectively in concentrations ≥10 mg/kg; PE was detected at concentrations ≥100 mg/kg in 15.2% of samples. Number of non-compliant tattoo inks (49.5%) would be significantly greater than PMU samples (17.9%). CONCLUSIONS About 40.6% of the samples would be non-compliant with the restriction for the presence of preservatives above the permitted level. Additional concentration limits will apply to skin sensitising preservatives for proper labelling of inks under CLP Regulation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Marco Famele
- National Centre for Chemicals, Cosmetics and Consumer Health Protection, Istituto Superiore di Sanità, viale Regina Elena n. 299, Rome, Italy
| | - Roberta Lavalle
- National Centre for Chemicals, Cosmetics and Consumer Health Protection, Istituto Superiore di Sanità, viale Regina Elena n. 299, Rome, Italy
| | - Claudia Leoni
- National Centre for Chemicals, Cosmetics and Consumer Health Protection, Istituto Superiore di Sanità, viale Regina Elena n. 299, Rome, Italy
| | - Costanza Majorani
- National Centre for Chemicals, Cosmetics and Consumer Health Protection, Istituto Superiore di Sanità, viale Regina Elena n. 299, Rome, Italy
| | - Carolina Ferranti
- National Centre for Chemicals, Cosmetics and Consumer Health Protection, Istituto Superiore di Sanità, viale Regina Elena n. 299, Rome, Italy
| | - Luca Palleschi
- National Centre for Chemicals, Cosmetics and Consumer Health Protection, Istituto Superiore di Sanità, viale Regina Elena n. 299, Rome, Italy
| | - Luca Fava
- National Centre for Chemicals, Cosmetics and Consumer Health Protection, Istituto Superiore di Sanità, viale Regina Elena n. 299, Rome, Italy
| | - Rosa Draisci
- National Centre for Chemicals, Cosmetics and Consumer Health Protection, Istituto Superiore di Sanità, viale Regina Elena n. 299, Rome, Italy
| | - Sonia D'Ilio
- National Centre for Chemicals, Cosmetics and Consumer Health Protection, Istituto Superiore di Sanità, viale Regina Elena n. 299, Rome, Italy
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Rogowska P, Sobjanek M, Sławińska M, Nowicki RJ, Szczerkowska-Dobosz A. Tattoos Dermatological Complications: Analysis of 53 Cases from Northern Poland. Dermatology 2021; 238:799-806. [PMID: 34969030 DOI: 10.1159/000520752] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 11/07/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The frequency of tattoos varies from 10% to 30% across the population worldwide. The growing popularity of tattooing increases the number of cutaneous reactions connected with this procedure. As we have not found any previous studies in the literature concerning tattoo complications in Poland and other Eastern European countries, we believe this to be the first study of this kind. OBJECTIVE The primary objective of this study was to evaluate the clinical spectrum of complications associated with the procedure of permanent tattooing among patients from Northern Poland. METHODS Medical data of 53 patients who developed tattoo-related cutaneous conditions were analyzed. All of the patients were consulted in the Dermatology, Venereology and Allergology Clinic in Gdańsk in the years 2018-2021. Medical history, dermatological assessment, and photographic documentation of skin lesions were performed in each case. Dermoscopic examination was carried out in 16 cases and 20 skin biopsies of the tattoo reactions were performed. RESULTS Twenty-one patients (40%) presented tattoo ink hypersensitivity reactions, out of which 18 were triggered by the red ink. In 11 cases (21%), contact dermatitis has developed after tattooing, while 9 of the patients (17%) presented tattoo infectious complications, including local bacterial infections, common warts, molluscum contagiosum, and demodicosis. We collected 8 cases (15%) of papulonodular reactions in black tattoos, and in 6 of them, histology showed granuloma formation. In 2 cases (4%), symptoms of anaphylaxis were observed after the tattooing procedure, and in another 2 cases (4%), Koebner phenomenon in the tattoo was diagnosed. Dermoscopy was the clue to the diagnosis in 4 cases. CONCLUSIONS This is the first report presenting multiple cases of tattoo complications from Eastern Europe. The results of the study are consistent with other researches, showing a similar distribution of tattoo complications and that across the different pigments used, the red ink is most frequently responsible for tattoo reactions. We emphasize the usefulness of dermoscopic examination in the diagnosis of tattoo-related infections and draw the reader's attention to the rare, yet hazardous complications connected with peri-tattooing anaphylaxis.
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Affiliation(s)
- Patrycja Rogowska
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Michał Sobjanek
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Martyna Sławińska
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Roman J Nowicki
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Aneta Szczerkowska-Dobosz
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
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Pazos MD, Hu Y, Elani Y, Browning KL, Jiang N, Yetisen AK. Tattoo Inks for Optical Biosensing in Interstitial Fluid. Adv Healthc Mater 2021; 10:e2101238. [PMID: 34510804 DOI: 10.1002/adhm.202101238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/20/2021] [Indexed: 12/11/2022]
Abstract
The persistence of traditional tattoo inks presents an advantage for continuous and long-term health monitoring in point of care devices. The replacement of tattoo pigments with optical biosensors aims a promising alternative for monitoring blood biomarkers. Tattoo inks functionalization enables the control of interstitial biomarkers with correlated concentrations in plasma, to diagnose diseases, evaluate progression, and prevent complications associated with physio pathological disorders or medication mismatches. The specific biomarkers in interstitial fluid provide a new source of information, especially for skin diseases. The study of tattoo inks displays insufficient regulation in their composition, a lack of reports of the related complications, and a need for further studies on their degradation kinetics. This review focuses on tattoo optical biosensors for monitoring dermal interstitial biomarkers and discusses the clinical advantages and main challenges for in vivo implantation. Tattoo functionalization provides a minimally invasive, reversible, biocompatible, real-time sensing with long-term permanence and multiplexing capabilities for the control, diagnosis, and prevention of illness; it enables self-controlling management by the patient, but also the possibility of sending the records to the doctor.
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Affiliation(s)
- Martalu D Pazos
- Department of Chemical Engineering, South Kensington Campus, Imperial College London, London, SW7 2AZ, UK
- Leo Foundation Center for Cutaneous Drug Delivery, Department of Pharmacy, Copenhagen University, Copenhagen, 2100, Denmark
| | - Yubing Hu
- Department of Chemical Engineering, South Kensington Campus, Imperial College London, London, SW7 2AZ, UK
| | - Yuval Elani
- Department of Chemical Engineering, South Kensington Campus, Imperial College London, London, SW7 2AZ, UK
| | - Kathryn L Browning
- Leo Foundation Center for Cutaneous Drug Delivery, Department of Pharmacy, Copenhagen University, Copenhagen, 2100, Denmark
| | - Nan Jiang
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Ali K Yetisen
- Department of Chemical Engineering, South Kensington Campus, Imperial College London, London, SW7 2AZ, UK
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Ogura Y, Morimoto H, Otsuka M, Tokura Y. Paraphenylenediamine ingredient possibly contributes to granuloma formation in inflammatory tattoo. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2021. [DOI: 10.1002/cia2.12214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Yasuaki Ogura
- Department of Dermatology and Skin Oncology Chutoen General Medical Center Kakegawa Japan
- Allergic Disease Research Center Chutoen General Medical Center Kakegawa Japan
| | - Hiroki Morimoto
- Department of Dermatology and Skin Oncology Chutoen General Medical Center Kakegawa Japan
| | - Masaki Otsuka
- Department of Dermatology and Skin Oncology Chutoen General Medical Center Kakegawa Japan
| | - Yoshiki Tokura
- Department of Dermatology and Skin Oncology Chutoen General Medical Center Kakegawa Japan
- Allergic Disease Research Center Chutoen General Medical Center Kakegawa Japan
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Abstract
The art of tattooing is a popular decorative approach for body decoration and has a corrective value for the face. The tattooing procedure is characterized by placing exogenous pigments into the dermis with a number of needles. The process of creating traditional and cosmetic tattoos is the same. Colorants are deposited in the dermis by piercing the skin with needles of specific shape and thickness, which are moistened with the colorant. Colorants (pigments or dyes) most of the time include impurities which may cause adverse reactions. It is commonly known that tattoo inks remain in the skin for lifetime. It is also a fact that the chemicals that are used in permanent makeup (PMU) colorants may stay in the body for a long time so there is a significant long-term risk for harmful ingredients being placed in the body. Tattoo and PMU colorants contain various substances and their main ingredients and decomposition components may cause health risks and unwanted side effects to skin.
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Kluger N. Nickel and tattoos: Where are we? Contact Dermatitis 2021; 85:136-140. [PMID: 33880790 DOI: 10.1111/cod.13869] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 12/17/2022]
Abstract
Tattoos are not mentioned as a source of exposure to nickel. Traces of nickel are, however, almost inevitably found in tattoo inks as impurities and sometimes in tattooed skin. Whether nickel in tattoos has any health consequence is debated. We performed a narrative review of what is currently known about this topic. Today, nickel is frequently detected in inks, but at highly variable levels. It appears to be at higher concentrations in green, blue, and sometimes brown and violet inks. Only nickel allergy in tattooed individuals and nickel-associated tattoo ink allergy are addressed in the literature. Reports of tattoo ink allergy related to nickel are rare and heterogenous. Authors often neglect possible implications of other metals or dyes. A positive patch test is not enough to confirm the role of nickel in a reaction observed after tattooing. We found no report of any systemic complication attributed to nickel from tattoos. The Council of Europe ResAP(2008)1 bans the presence of nickel at high levels in tattoo inks, which is a safety net for individuals with nickel allergy. Large epidemiologic case-control studies with systematic biopsies on normal and inflamed tattoos and patch testing would help to understand the role of nickel in tattoo ink allergies.
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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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Kluger N. Looking back at fifteen years of publications on tattoos. Presse Med 2020; 49:104051. [PMID: 33069105 DOI: 10.1016/j.lpm.2020.104051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Nicolas Kluger
- "Tattoo" consultation, Department of dermatology, Bichat-Claude Bernard Hospital, 75018 Paris, France; University of Helsinki and Helsinki University Central Hospital, Department of Dermatology, Allergology and Venereology, Helsinki, Finland.
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