Laser tattoo removal

Objective monitoring of laser tattoo removal in human volunteers using an innovative optical technique: A proof of principle

OBJECTIVES

Assess the suitability of the technique for objective monitoring of laser tattoo removal by an extended treatment protocol.

MATERIALS AND METHODS

One half of the tattoo in the first volunteer was treated with nanosecond and the other half with picosecond laser pulses at 1064 nm. In the second subject, four test areas were treated repeatedly using different radiant exposures from 1.5 to 6 J/cm2 . Measurements of diffuse reflectance spectra and photothermal radiometric transients were performed 4-20 weeks after each treatment session. Inverse Monte Carlo analysis based on a three-layer model of tattooed skin was applied to assess the tattoo characteristics and analyze their changes.

RESULTS

The results clearly indicate a gradual reduction of the ink content and an increase of the subsurface depth of the tattoo layer with all treatments at a radiant exposure of 3 J/cm2 or higher. The observed dependences on laser pulse duration, radiant exposure, and a number of treatments are in excellent agreement with visual fading of the tattoo.

CONCLUSIONS

The presented methodology enables noninvasive characterization of tattoos in human skin and objective monitoring of the laser removal treatment.

Tattoo Inks for Optical Biosensing in Interstitial Fluid

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.

Removal of a red tattoo on the lips using a 532-nm picosecond laser

Tattoos, which people choose to have performed for various reasons, can have multiple colors, ranging from conventional black to red, yellow, blue, and others. As tattoos have become increasingly popular, the need for tattoo removal has also grown, and the most commonly used method for removal is a laser. However, the extent to which various types of lasers remove different tattoo pigments is clearly important. Although extensive research has been done on black tattoos, red tattoos have not been adequately studied, and there are few case reports on red tattoos. We present a case of effective removal of a red tattoo from the lips using a picosecond laser.

High power Q-switched 1064 nm / 532 nm Nd:YAG Laser in tattoo removal: A systematic review

Q-switched 1064 nm/532 nm Nd: YAG Lasers present important characteristics which can contribute toward the removal of tattoos, for having the ability to reach only specific targets with minimal damage to the tissue. Despite reports of their clinical benefits, only a few scientific studies demonstrate the efficacy and safety of these types of lasers in the short and long term. To substantiate the effects, benefits, and safety of the application of Q-switched 1064 nm/532 nm Nd: YAG lasers, a systematic review was carried out from September to December of 2019, about the studies which report their use in the removal of tattoos, published in the last 20 years. Randomized clinical trials in humans were considered, as long as they evaluated the efficacy, safety, and benefits of the application of Q-switched 1064 nm/532 nm Nd: YAG lasers in the removal of black and color tattoos in different skin phototypes. One hundred and twenty-two articles were identified after the titles, abstracts were read, and duplicates were removed; six articles were left, which were included in the research (188 individuals). The Q-switched 1064 nm/532 nm Nd: YAG lasers seem promising in the short term, with minimal adverse effects; however, the efficacy and safety in the long term still present limitations. Consequently, future research is necessary, with better methodological standardization applied and with a follow-up for a longer period of evaluation of possible permanent adverse effects, to determine the standardization and safety of the therapy with the lasers Nd: YAG de 1064 nm/532 nm Q-switched.

Tattoos - more than just colored skin? Searching for tattoo allergens

During tattooing, a high amount of ink is injected into the skin. Tattoo inks contain numerous substances such as the coloring pigments, impurities, solvents, emulsifiers, and preservatives. Black amorphous carbon particles (carbon black), white titanium dioxide, azo or polycyclic pigments create all varieties of color shades in the visible spectrum. Some ingredients of tattoo inks might be hazardous and allergenic chemicals of unknown potential. In Germany, about 20 % of the general population is tattooed and related adverse reactions are increasingly reported. Since tattoo needles inevitably harm the skin, microorganisms can enter the wound and may cause infections. Non-allergic inflammatory reactions (for example cutaneous granuloma and pseudolymphoma) as well as allergic reactions may emerge during or after wound healing. Especially with allergies occurring after weeks, months or years, it remains difficult to identify the specific ingredient(s) that trigger the reaction. This review summarizes possible adverse effects related to tattooing with a focus on the development of tattoo-mediated allergies. To date, relevant allergens were only identified in rare cases. Here we present established methods and discuss current experimental approaches to identify culprit allergens in tattoo inks - via testing of the patient and in vitro approaches.

Treatments of a phthalocyanine-based green ink for tattoo removal purposes: generation of toxic fragments and potentially harmful morphologies

Since tattoos became overwhelmingly fashionable worldwide, the demand for removal has proportionally increased, Nd:YAG Q-switch laser being the most commonly used tool for the purpose. In this framework we investigated the composition and products of laser treatment of green tattoo ink, the Green Concentrate from Eternal. The ink characterization has been carried out by IR, UV-Vis, EDX spectroscopies, and SEM imaging. It revealed the presence of the pigment PG7, rather than PG36 as reported on the bottle label, along with non-fully halogenated analogues. The morphology is an extended sheath with embedded grains. Subsequent laser treatments were performed on both dried and extracted inks, dispersed either in water or in propan-2-ol, chosen for their different polarities, as it is the case in the skin layers. The products were analyzed by gas chromatography-mass spectrometry, UV-Vis spectroscopy, SEM imaging, and dynamic light scattering. The outcome is a complex fragmentation pattern that depends both on the solvent and on the initial aggregation state. The fragment compounds are toxic at various degrees according to the Classification Labelling and Packaging regulations. Several shapes of aggregates are produced as an effect of both downsizing and re-aggregation, with potentially harmful aspect ratios.

The effect of the perfluorodecalin patch on particle emission and skin temperature during laser-induced tattoo removal

Laser-based procedures for tattoo removals are popular due to high efficacy and a relatively moderate insult. However, it often requires multiple sessions to achieve a satisfactory effect. The perfluorodecalin (PFD) patch utilizes an optical clearing agent to speed up the removal process and may decrease skin insult and harmful particles emission during treatment. This study assessed in pigs the effect of the PFD patch in connection with laser treatment of skin with and without tattoos to determine whether the PFD patch provides benefit in lowering thermal skin insult and particle emission during treatment. Skin temperature measured by infrared thermometer during laser treatment or shortly thereafter showed a significant (approximately 40%) decrease with the PFD patch in sites with tattoos. For laser-treated sites without tattoos, there was a significant decrease of particles observed with the PFD patch. In laser-treated sites with tattoos, a strong trend was seen (approximately a twofold decrease) but did not reach statistical significance due to high variability. The present data show that the PFD patch limits the increase in skin temperature produced with laser during treatment. Moreover, it decreases the emission of particles in sites without tattoos and is suggestive of a similar effect in sites with tattoos.

High speed ink aggregates are ejected from tattoos during Q-switched Nd:YAG laser treatments

INTRODUCTION

Dark material has been observed embedded within glass slides following Q-switched Nd:YAG laser treatment of tattoos. It appears that these fragments are ejected at high speed from the skin during the treatment.

METHOD

Light microscopic analysis of the slides reveals aggregates of dark fragmented material, presumably tattoo ink, with evidence of fractured/melted glass. Photomicrographs reveal that the sizes of these aggregates are in the range 12 μm to 0.5 mm.

RESULTS

Tattoo ink fragments were clearly observed on the surface and embedded within glass slides. Surface aggregates were observed as a fine dust and were easily washed off while deeper fragments remained in situ. The embedded fragments were not visible to the unaided eye. Some fragments appeared to have melted yielding an "insect-like" appearance. These were found to be located between approximately 0.2 and 1 mm deep in the glass.

CONCLUSION

Given the particle masses and kinetic energies attained by some of these aggregates their velocities, when leaving the skin, may be hundreds to thousands of metres per second. However, the masses of the aggregates are minuscule meaning that laser operators may be subjected to these high-speed aggregates without their knowledge. These high-speed fragments of ink may pose a contamination risk to laser operators. Lasers Surg. Med. 9999:1-7, 2018. © 2018 Wiley Periodicals, Inc.

Laser Tattoo Removal: An Update

Tattoo art has been around for thousands of years in every culture and is currently flourishing in all age groups, social classes, and occupations. Despite the rising popularity of tattoos, demand for their removal has also increased. While various treatments, including surgical excision, dermabrasion, and chemical destruction have historically been applied, over the past 2 decades, lasers have revolutionized the way tattoos are treated and have become the gold standard of treatment. To achieve optimal cosmetic outcome of treatment, lasers emitting high energies and short pulses are required to adequately destroy tattoo ink. We review the history of laser tattoo removal, outlining the challenges inherent in developing lasers that can most effectively remove tattoo particles while safely protecting skin from unwanted injury.

A medical-toxicological view of tattooing

Long perceived as a form of exotic self-expression in some social fringe groups, tattoos have left their maverick image behind and become mainstream, particularly for young people. Historically, tattoo-related health and safety regulations have focused on rules of hygiene and prevention of infections. Meanwhile, the increasing popularity of tattooing has led to the development of many new colours, allowing tattoos to be more spectacular than ever before. However, little is known about the toxicological risks of the ingredients used. For risk assessment, safe intradermal application of these pigments needs data for toxicity and biokinetics and increased knowledge about the removal of tattoos. Other concerns are the potential for phototoxicity, substance migration, and the possible metabolic conversion of tattoo ink ingredients into toxic substances. Similar considerations apply to cleavage products that are formed during laser-assisted tattoo removal. In this Review, we summarise the issues of concern, putting them into context, and provide perspectives for the assessment of the acute and chronic health effects associated with tattooing.

Efficacy of the Q-switched Neodymium: Yttrium Aluminum Garnet Laser in the Treatment of Blue-black Amateur and Professional Tattoos

Background:

Q-switched neodymium: yttrium aluminum garnet (Nd: YAG) laser at a wavelength of 1064 nm primarily targets dermal melanin and black tattoo ink. Recent studies have shown that this laser is effective in treating black tattoos. There are few studies conducted in India for the same.

Aim:

The aim was to assess the effectiveness of Q-switched Nd: YAG laser (QSNYL) in the treatment of blue-black tattoos following 3 treatment sessions.

Materials and Methods:

This study, a prospective interventional study included a total of 12 blue-black tattoos. Following informed consent for the procedure, as well as for photographs, a questionnaire was administered, and improvement perceived by the patient was recorded. In addition, global assessment score (GAS) by a blinded physician was also recorded. Photographs were taken at baseline and at every follow-up. Each patient underwent three treatment sessions with 1064 nm QSNYL at 4–6 weekly intervals. Fluences ranged from 1.8 to 9 J/cm². The follow-up was done monthly for 4 months from the first treatment session. The response was assessed by patient assessment (PA) and GAS by comparing photographs.

Results:

After three treatment sessions, although no patient achieved clearance, most patients showed good response with few adverse effects. An average of 64.1% (GAS) and 54.2% (PA) improvement was observed in 12 tattoos. Tattoos more than 10-year-old showed quicker clearing than those less than 10-year-old. Amateur tattoos also showed a better response in comparison to professional tattoos.

Conclusion:

Totally, 1064 nm QSNYL is safe and effective for lightening blue-black tattoos in pigmented Indian skin. All patients achieved near complete clearance following the continuation of treatment (an average of six sessions) although this was spaced at longer intervals.

Formation of highly toxic hydrogen cyanide upon ruby laser irradiation of the tattoo pigment phthalocyanine blue

Since laser treatment of tattoos is the favored method for the removing of no longer wanted permanent skin paintings, analytical, biokinetics and toxicological data on the fragmentation pattern of commonly used pigments are urgently required for health safety reasons. Applying dynamic headspace-gas chromatography with mass spectrometric detection (DHS-GC/MS) and comprehensive two-dimensional gas chromatography coupled to time-of-flight mass spectrometry (GCxGC-ToF-MS), we identified 1,2-benzene dicarbonitrile, benzonitrile, benzene, and the poisonous gas hydrogen cyanide (HCN) as main fragmentation products emerging dose-dependently upon ruby laser irradiation of the popular blue pigment copper phthalocyanine in suspension. Skin cell viability was found to be significantly compromised at cyanide levels of ≥1 mM liberated during ruby laser irradiation of >1.5 mg/ml phthalocyanine blue. Further, for the first time we introduce pyrolysis-GC/MS as method suitable to simulate pigment fragmentation that may occur spontaneously or during laser removal of organic pigments in the living skin of tattooed people. According to the literature such regular tattoos hold up to 9 mg pigment/cm(2) skin.

Complications of Tattoos and Tattoo Removal: Stop and Think Before you ink

Tattooing is a process of implantation of permanent pigment granules in the skin. Tattoos can be decorative, medical or accidental. There has been a exponential increase in decorative tattooing as a body art in teenagers and young adults. Unfortunately there are no legislations to promote safe tattooing, hence complications are quite common. Superficial and deep local infections, systemic infections, allergic reactions, photodermatitis, granulomatous reactions and lichenoid reactions may occur. Skin diseases localised on the tattooed area, such as eczema, psoriasis, lichen planus, and morphea can be occasionally seen. When used as a camouflage technique, colour mismatch and patient dissatisfaction are common complications. On the other hand, regrets after a tattoo are also seen and requests for tattoo removal are rising. Laser tattoo removal using Q-switched lasers are the safest; however, complications can occur. Acute complications include pain, blistering, crusting and pinpoint hemorrhage. Among the delayed complications pigmentary changes, hypopigmentation and hyperpigmentation, paradoxical darkening of cosmetic tattoos and allergic reactions can be seen. Another common complication is the presence of residual pigmentation or ghost images. Scarring and textural changes are potential irreversible complications. In addition, tattoo removal can be a prolonged tedious procedure, particularly with professional tattoos, which are difficult to erase as compared to amateur tattoos. Hence the adage, stop and think before you ink holds very much true in the present scenario.

Tattoos on 18-year-old male adolescents--characteristics and associated factors

BACKGROUND

Prevalence of tattoos is around 10-26% in men and 10-22% in women, and can involve negative effects such as: regret, removal attempts, physical and biological changes of the skin and association with some viral diseases.

OBJECTIVE

to determine the prevalence, characteristics and factors associated with tattoos in recruiters joining the military.

METHODS

the recruiters were examined by dermatologists that documented the presence or absence of tattoos, as well as their sizes, colors, designs and patterns, and whether they needed a parent's consent to get a tattoo.

RESULTS

1,968 recruiters were examined and the prevalence of tattoos was 10.82% (213), 141 (66.20%) had a single tattoo, 44 (20.66%) two tattoos, 15 (7.04%) three tattoos, 9 (4.23%) four tattoos, and 4 (1.88%) had more than four. Of the total sample, 168 (80.77%) reported getting the first tattoo before the age of 18. 158 (74.53%) were monochromatic. In relation to size, 108 (50.70%) had tattoos of up to 10 cm, 75 (35.21%) had tattoos measuring between 11-20cm, while 30 had ones over 21cm (14.09%).

CONCLUSIONS

The population studied had a high prevalence of tattoos for their age, the percentage of complex (large and polychromatic) tattoos was also high.

Efficacy of serial excisions of melanocytic nevi on the face using a carbon dioxide laser: a cosmetic point of view

In cosmetic clinical practice, many patients express the desire for removal of melanocytic nevi, especially those on the face. The carbon dioxide (CO2) laser currently is the preferred for treatment of such lesions because of less scar formation, less bleeding, and simplicity of the procedure. However, if the diameter of the lesion is greater than 5 mm, many clinicians prefer surgical resection to laser resection because laser resection of relatively large nevi often results in the formation of a conspicuous dimple. The authors developed a serial laser excision method for melanocytic nevi larger than 5 mm, with division of the lesion into multiple segments, which allowed the ablated area to gain optimal granulation and reepithelialization, leading to a satisfactory cosmetic appearance. This novel procedure was performed for 25 patients with melanocytic nevi ranging from 5 to 10 mm in diameter. The lesions were divided into two segments in 21 patients, three segments in 3 patients, and four segments in 1 patient. The divided parts of the lesions were ablated by CO2 laser serially at intervals of 2-4 weeks. All the patients obtained optimal granulation and epithelialization in the treated lesions, and the final appearance was satisfactory. Although the therapeutic period was longer than for a surgical excision or a single laser treatment, the new treatment approach of serial excision by CO2 laser achieved favorable outcomes for the treatment of relatively large nevi 5-10 mm in size.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Application of silver sulfadiazine cream with early surgical intervention in patients suffering from combined burn-blast injury facial tattoos

Severe combined burn-blast injury is a great challenge to surgical teams due to its high mortality. It also results in unsightly traumatic tattoos.

The aims of these case reports were to clarify the clinical characteristic of the dynamite explosion burn-blast facial injuries and discuss appropriate management of these patients. We report two patients suffering from facial burn-blast injury following dynamite explosion in which after primary stabilization, silver sulfadiazine cream was applied to the wounds and 12 hours later the wounds were cleaned under general anesthesia with vigorous saline solution irrigation and brushing. The foreign particles were meticulously removed from wounds and simultaneous repairing of defects was done with nylon 6-0 sutures. We conclude application of silver sulfadiazine cream on facial burn-blast injury tattoos several hours before surgical removal of particles is highly efficacious in facilitating particle removal and attaining a good result following surgical intervention, and primary repair. Treatment of combined burn-blast tattoos is different from other types of tattoos not associated with burns. Debridement and removal of foreign particles under general anesthesia from skin immediately and primary reconstruction of wounds is essential. We recommend application of the topical agent silver sulfadiazine to wounds about 12 hours before surgical intervention.

Laser tattoo removal: a review

BACKGROUND

Tattoos have played an important role in human culture for thousands of years, and they remain popular today. The development of quality-switched (QS) lasers has revolutionized the removal of unwanted tattoos.

OBJECTIVES

To thoroughly review the literature on laser tattoo removal pertaining to its history, its theoretical basis, the various devices used, potential adverse effects, and future developments.

MATERIAL AND METHODS

An extensive literature review of publications related to tattoo removal was conducted.

RESULTS

Reports exist demonstrating the efficacy of laser removal of different tattoo types, including professional, amateur, traumatic, cosmetic, and medical. The literature supports the use of different QS lasers for removal of tattoos. Some colors have a more-complete response using particular wavelengths.

CONCLUSION

QS lasers can effectively and safely remove different types of unwanted tattoos.