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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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2
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Blando JD, Guigni BA. Potential chemical risks from tattoos and their relevance to military health policy in the United States. J Public Health Policy 2023; 44:242-254. [PMID: 36914711 PMCID: PMC10232601 DOI: 10.1057/s41271-023-00403-y] [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] [Accepted: 02/16/2023] [Indexed: 03/16/2023]
Abstract
We summarize and consolidate disparate sources of information about the practice of tattooing and its potential implications for military population health and policy. Each branch of the United States military has policies about tattoos for service members, but these have varied over time and do not cover health protection. The number of veterans receiving disability payments and the cost of those payments has been rising over time; the broad category of skin conditions accounts for 11% of disability claims. Any additional factor, such as tattoos that may increase the occurrence of adverse skin reactions, can substantially impact veteran benefit expenses and budgets. This may be a consideration for the military as it evaluates its policies related to tattoos among service members.
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Affiliation(s)
- James D Blando
- School of Community and Environmental Health, Old Dominion University, 4608 Hampton Blvd, Norfolk, VA, 23529, USA.
| | - Blas A Guigni
- Toxicology Directorate, Army Public Health Center, Aberdeen Proving Ground, MD, 21010, USA
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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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4
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Karadagli SS, Cansever I, Armagan G, Sogut O. Are Some Metals in Tattoo Inks Harmful to Health? An Analytical Approach. Chem Res Toxicol 2022; 36:104-111. [PMID: 36584178 PMCID: PMC9846827 DOI: 10.1021/acs.chemrestox.2c00323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Tattoo application is widely performed all over the world; however, injection of coloring substances into the skin as metals may pose a risk for allergies and other skin inflammations and systemic diseases. In this context, tattoo inks in green, black, and red colors of three brands were purchased. Before starting the analysis, the acid mixture suitable for microwave burning was determined, and according to these results, the inks were digested with nitric acid, hydrochloric acid, and hydrofluoric acid. Then, method validation was performed for tattoo inks using inductively coupled plasma-mass spectrometry. The relative contribution of metals to the tattoo ink composition was highly variable between colors and brands. Elements found in the main components of inks are as follows (in mg kg-1): Al, 1191.1-3424.9; Co, 0.04-1.07; Cu, 1.24-2523.4; Fe, 16.98-318.42; Ni, 0.63-17.53; and Zn, 2.6-46.9. It has been determined by the Environmental Protection Agency that in some products, especially the copper element is above the determined limit. The analysis results obtained were classified by chemometric analysis, and the color and brand relationship were determined. More toxicological studies are necessary to understand the effects of tattoo inks containing heavy metals and/or organic components.
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Affiliation(s)
- Sumru Sozer Karadagli
- Department
of Pharmaceutical Toxicology, Faculty of Pharmacy, Ege University, Izmir 35040, Turkey,
| | - Islam Cansever
- Central
Research Laboratories, Katip Celebi University, Izmir 35620, Turkey
| | - Guliz Armagan
- Department
of Biochemistry, Faculty of Pharmacy, Ege
University, Izmir 35040, Turkey
| | - Ozlem Sogut
- Department
of Analytical Chemistry, Faculty of Pharmacy, Ege University, Izmir 35040, Turkey
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5
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Colboc H, Bazin D, Reguer S, Lucas IT, Moguelet P, Amode R, Jouanneau C, Soria A, Chasset F, Amsler E, Pecquet C, Aractingi S, Bellot-Gurlet L, Deschamps L, Descamps V, Kluger N. Chemical characterization of inks in skin reactions to tattoo. JOURNAL OF SYNCHROTRON RADIATION 2022; 29:1436-1445. [PMID: 36345752 PMCID: PMC9641572 DOI: 10.1107/s1600577522008165] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/15/2022] [Indexed: 06/16/2023]
Abstract
Skin reactions are well described complications of tattooing, usually provoked by red inks. Chemical characterizations of these inks are usually based on limited subjects and techniques. This study aimed to determine the organic and inorganic composition of inks using X-ray fluorescence spectroscopy (XRF), X-ray absorption spectroscopy (XANES) and Raman spectroscopy, in a cohort of patients with cutaneous hypersensitivity reactions to tattoo. A retrospective multicenter study was performed, including 15 patients diagnosed with skin reactions to tattoos. Almost half of these patients developed skin reactions on black inks. XRF identified known allergenic metals - titanium, chromium, manganese, nickel and copper - in almost all cases. XANES spectroscopy distinguished zinc and iron present in ink from these elements in endogenous biomolecules. Raman spectroscopy showed the presence of both reported (azo pigments, quinacridone) and unreported (carbon black, phtalocyanine) putative organic sensitizer compounds, and also defined the phase in which Ti was engaged. To the best of the authors' knowledge, this paper reports the largest cohort of skin hypersensitivity reactions analyzed by multiple complementary techniques. With almost half the patients presenting skin reaction on black tattoo, the study suggests that black modern inks should also be considered to provoke skin reactions, probably because of the common association of carbon black with potential allergenic metals within these inks. Analysis of more skin reactions to tattoos is needed to identify the relevant chemical compounds and help render tattoo ink composition safer.
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Affiliation(s)
- Hester Colboc
- Sorbonne Université, Hôpital Rothschild, Service de Gériatrie-Plaies et Cicatrisation, Paris, France
- Sorbonne Université, UPMC Paris 06, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S 1155, F-75020 Paris, France
| | - Dominique Bazin
- Institut de Chimie Physique, Université Paris-Saclay, Orsay, France
| | - Solenn Reguer
- DiffAbs Beamline, Synchrotron SOLEIL, L’Orme des Merisiers, Départementale 128, 91190 Saint-Aubin, France
| | - Ivan T. Lucas
- Sorbonne Université, CNRS, Laboratoire Lise UMR 8235, Paris, France
| | - Philippe Moguelet
- Sorbonne Université, Hôpital Tenon, Anatomie et Cytologie Pathologiques, Paris, France
| | | | - Chantal Jouanneau
- Sorbonne Université, UPMC Paris 06, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S 1155, F-75020 Paris, France
| | - Angèle Soria
- Sorbonne Université, Hôpital Tenon, Service de Dermatologie-Allergologie, Paris, France
| | - François Chasset
- Sorbonne Université, Hôpital Tenon, Service de Dermatologie-Allergologie, Paris, France
| | - Emmanuelle Amsler
- Sorbonne Université, Hôpital Tenon, Service de Dermatologie-Allergologie, Paris, France
| | - Catherine Pecquet
- Sorbonne Université, Hôpital Tenon, Service de Dermatologie-Allergologie, Paris, France
| | - Sélim Aractingi
- Université de Paris, Hôpital Cochin, Service de Dermatologie, Paris, France
| | | | - Lydia Deschamps
- Université de Paris, Hôpital Bichat, Service d’Anatomie et Cytologie Pathologique, Paris, France
| | - Vincent Descamps
- Université de Paris, Hôpital Bichat, Service de Dermatologie, Paris, France
| | - Nicolas Kluger
- Université de Paris, Hôpital Bichat, Service de Dermatologie, Paris, France
- Department of Dermatology, Allergology and Venereology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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6
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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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7
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Szulia A, Antoszewski B, Zawadzki T, Kasielska-Trojan A. When Body Art Goes Awry-Severe Systemic Allergic Reaction to Red Ink Tattoo Requiring Surgical Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10741. [PMID: 36078458 PMCID: PMC9517851 DOI: 10.3390/ijerph191710741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 06/15/2023]
Abstract
The aim of this report is to present a case of a patient who developed unusual systemic hypersensitivity reaction to a red-pigmented tattoo and to discuss diagnostic difficulties in case of systemic reactions to tattoo ink. The patient reported erythroderma on his arms and chest accompanied by plaque elevation of red parts of his most recently performed forearm tattoo as his primary symptoms. His health condition entailed a prolonged topical and intravenous immunosuppressive therapy, which proved ineffective. Over a year after emergence of initial symptoms, he presented to the Plastic Surgery Clinic with generalized erythroderma, systemic lymphadenopathy, elevation and granuloma formation in red tattoos on his forearm and complaints of fatigue and inability to participate fully in work-related and social activities. The patient underwent six staged excisions with direct closures, flap plasties and full-thickness skin grafts. Following completion of each surgical resection, the patient's symptoms gradually subsided. We find this case illustrative of a clinical challenge that delayed hypersensitivity reactions to red tattoos may pose. Furthermore, we provide insights on management of hypersensitivity reactions. This report underlines the importance of social awareness of and public health approach to tattoo complications as key to successful prevention, identification and treatment of adverse reactions to tattoos.
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Affiliation(s)
- Agata Szulia
- The Military Medical Faculty, Medical University of Lodz, 90-419 Lodz, Poland
| | - Bogusław Antoszewski
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Medical University of Lodz, Kopcinskiego 22, 90-153 Lodz, Poland
| | - Tomasz Zawadzki
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Medical University of Lodz, Kopcinskiego 22, 90-153 Lodz, Poland
| | - Anna Kasielska-Trojan
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Medical University of Lodz, Kopcinskiego 22, 90-153 Lodz, Poland
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8
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Rudraiah PS, Duadi H, Fixler D. Diffused reflectance measurements to detect tattoo ink location in skin using the crossover point. JOURNAL OF BIOPHOTONICS 2022; 15:e202200003. [PMID: 35067001 DOI: 10.1002/jbio.202200003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
Tattoos are highly trendy in western culture, but many people regret their tattoos for many reasons. It is essential to be aware of the ink location in advance to reduce the long and short-term side effects. In this study, diffuse reflectance (DR) experiments were conducted on two-layer (2L) tissue-mimicking phantoms, where ink was sandwiched between the layers. An appreciable difference in the DR profile was found between the 2L phantom with and without the tattoo ink using the crossover point (Cp) method. Our technique was applied to ex vivo porcine skin. A point of intersection was found, between the skin and the tattooed skin. In the shorter wavelengths (500-600 nm), a distinguishable 2L behavior was found, and in longer wavelengths (600-850 nm), a single layer behavior was found between the tattooed skin before and after the intersection. In biological tissue, this Cp indeed finds the tattoo ink without harm to the surrounding skin.
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Affiliation(s)
- Pavitra Sokke Rudraiah
- Faculty of Engineering and Institute of Nanotechnology and Advanced Materials, Bar Ilan University, Ramat Gan, Israel
| | - Hamootal Duadi
- Faculty of Engineering and Institute of Nanotechnology and Advanced Materials, Bar Ilan University, Ramat Gan, Israel
| | - Dror Fixler
- Faculty of Engineering and Institute of Nanotechnology and Advanced Materials, Bar Ilan University, Ramat Gan, Israel
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9
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Lahouel I, Salah NB, Machghoul S, Belhadjali H, Youssef M, Zili J. Allergic contact dermatitis post microblading eyebrow tattooing: A manifestation of pre-existing nickel sensitization. J Cosmet Dermatol 2022; 21:5270-5271. [PMID: 35290705 DOI: 10.1111/jocd.14920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Ines Lahouel
- Department of dermatology, Fattouma Bourguiba University Hospital, University of Monastir, Research Laboratory LR20SP03A, Monastir, Tunisia
| | - Nesrine Ben Salah
- Department of dermatology, Fattouma Bourguiba University Hospital, University of Monastir, Research Laboratory LR20SP03A, Monastir, Tunisia
| | - Samia Machghoul
- Department of dermatology, Fattouma Bourguiba University Hospital, University of Monastir, Research Laboratory LR20SP03A, Monastir, Tunisia
| | - Hichem Belhadjali
- Department of dermatology, Fattouma Bourguiba University Hospital, University of Monastir, Research Laboratory LR20SP03A, Monastir, Tunisia
| | - Monia Youssef
- Department of dermatology, Fattouma Bourguiba University Hospital, University of Monastir, Research Laboratory LR20SP03A, Monastir, Tunisia
| | - Jameleddine Zili
- Department of dermatology, Fattouma Bourguiba University Hospital, University of Monastir, Research Laboratory LR20SP03A, Monastir, Tunisia
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Brungs C, Schmid R, Wolf C, Berg T, Korf A, Heuckeroth S, Hayen H, van der Bent S, Maijer K, Rustemeyer T, Karst U. Tattoo Pigment Identification in Inks and Skin Biopsies of Adverse Reactions by Complementary Elemental and Molecular Bioimaging with Mass Spectral Library Matching. Anal Chem 2022; 94:3581-3589. [PMID: 35179876 DOI: 10.1021/acs.analchem.1c04922] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Tattooing has become increasingly popular throughout society. Despite the recognized issue of adverse reactions in tattoos, regulations remain challenging with limited data available and a missing positive list. The diverse chemical properties of mostly insoluble inorganic and organic pigments pose an outstanding analytical challenge, which typically requires extensive sample preparation. Here, we present a multimodal bioimaging approach combining micro X-ray fluorescence (μXRF) and laser desorption ionization-mass spectrometry (LDI-MS) to detect the elemental and molecular composition in the same sample. The pigment structures directly absorb the laser energy, eliminating the need for matrix application. A computational data processing workflow clusters spatially resolved LDI-MS scans to merge redundant information into consensus spectra, which are then matched against new open mass spectral libraries of tattoo pigments. When applied to 13 tattoo inks and 68 skin samples from skin biopsies in adverse tattoo reactions, characteristic signal patterns of isotopes, ion adducts, and in-source fragments in LDI-MS1 scans yielded confident compound annotations across various pigment classes. Combined with μXRF, pigment annotations were achieved for all skin samples with 14 unique structures and 2 inorganic pigments, emphasizing the applicability to larger studies. The tattoo-specific spectral libraries and further information are available on the tattoo-analysis.github.io website.
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Affiliation(s)
- Corinna Brungs
- Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstr. 30, 48149 Münster, Germany
| | - Robin Schmid
- Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstr. 30, 48149 Münster, Germany
| | - Carina Wolf
- Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstr. 30, 48149 Münster, Germany
| | - Tanja Berg
- Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstr. 30, 48149 Münster, Germany
| | - Ansgar Korf
- Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstr. 30, 48149 Münster, Germany
| | - Steffen Heuckeroth
- Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstr. 30, 48149 Münster, Germany
| | - Heiko Hayen
- Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstr. 30, 48149 Münster, Germany
| | - Sebastiaan van der Bent
- Tattoo Clinic (Tattoo Poli), Department of Dermatology, Alrijne Hospital, Houtlaan 55, 2334 CK Leiden, The Netherlands
| | - Karen Maijer
- Tattoo Clinic (Tattoo Poli), Department of Dermatology, Alrijne Hospital, Houtlaan 55, 2334 CK Leiden, The Netherlands
| | - Thomas Rustemeyer
- Department of Dermatology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Uwe Karst
- Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstr. 30, 48149 Münster, Germany
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11
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van der Bent SAS, Rauwerdink D, Oyen EMM, Maijer KI, Rustemeyer T, Wolkerstorfer A. Complications of tattoos and permanent makeup: overview and analysis of 308 cases. J Cosmet Dermatol 2021; 20:3630-3641. [PMID: 34605159 DOI: 10.1111/jocd.14498] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Worldwide 10-20% of the population is tattooed. However, tattoo complications can occur, such as allergic tattoo reactions, infections, and manifestations of autoimmune dermatoses. Despite the growing popularity of tattoos and changes in tattoo ink composition over the last decades, little is known about these complications, its clinical aspects, pathomechanism, and relative occurrence. OBJECTIVE The aim of this article is to describe the types and clinical aspects of dermatological tattoo complications, its relative occurrence and underlying conditions. METHODS We performed a retrospective cohort study enrolling all patients with tattoo complications from the Tattoo Clinic. Tattoo complications were categorized into infections, inflammatory tattoo reactions, neoplasms, or miscellaneous reactions and correlated to clinical data. RESULTS Of the total of 326 patients, 301 patients were included with 308 complications. The majority of the complications were chronic: 91.9%. Allergic red tattoo reactions and chronic inflammatory black tattoo reactions (CIBTR) accounted for 50.2% and 18.2%, respectively, of all tattoo complications. Of these CIBTR reactions, extracutaneous involvement was found in 21.4%, including tattoo-associated uveitis (7.1%) and systemic sarcoidosis (14.2%). Of all black tattoo reactions, systemic sarcoidosis was found in 7.8%. CONCLUSION Tattoos can cause a wide range in complications that may start years after getting the tattoo. The most frequent tattoo reactions are allergic red tattoo reactions and chronic inflammatory black tattoo reactions, making these the most relevant for the dermatologist. CIBTR have a high percentage of multi-organ involvement, and therefore, screening for sarcoidosis, including ocular involvement, is advised.
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Affiliation(s)
- S A S van der Bent
- Tattoo Clinic (Tattoo poli), Department of Dermatology, Alrijne Hospital, Leiden, The Netherlands.,Academic Tattoo Clinic Amsterdam, Department of Dermatology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - D Rauwerdink
- Tattoo Clinic (Tattoo poli), Department of Dermatology, Alrijne Hospital, Leiden, The Netherlands
| | - E M M Oyen
- Academic Tattoo Clinic Amsterdam, Department of Dermatology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - K I Maijer
- Department of Dermatology, Tergooi Hospital, Hilversum, The Netherlands
| | - T Rustemeyer
- Academic Tattoo Clinic Amsterdam, Department of Dermatology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - A Wolkerstorfer
- Academic Tattoo Clinic Amsterdam, Department of Dermatology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
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12
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Wang X, Josefsson L, Meschnark S, Lind ML, Emmer Å, Goessler W, Hedberg YS. Analytical survey of tattoo inks-A chemical and legal perspective with focus on sensitizing substances. Contact Dermatitis 2021; 85:340-353. [PMID: 34089526 DOI: 10.1111/cod.13913] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/28/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tattoo inks have been reported to elicit allergic contact dermatitis. OBJECTIVES To investigate the labels and the contents of metals and pigments in tattoo inks, considering restrictions within the European Union. METHODS Seventy-three tattoo inks currently available on the market, either bought or donated (already used), were investigated for trace metals and pigments by inductively coupled plasma mass spectrometry and by matrix-assisted laser desorption/ionization time of flight tandem mass spectrometry. RESULTS Ninety-three percent of the bought tattoo inks violated European, legal requirements on labeling. Fifty percent of the tattoo inks declared at least one pigment ingredient incorrectly. Sixty-one percent of the inks contained pigments of concern, especially red inks. Iron, aluminium, titanium, and copper (most in green/blue inks) were the main metals detected in the inks. The level of metal impurities exceeded current restriction limits in only a few cases. Total chromium (0.35-139 μg/g) and nickel (0.1-41 μg/g) were found in almost all samples. The levels of iron, chromium, manganese, cobalt, nickel, zinc, lead, and arsenic were found to covary significantly. CONCLUSIONS To prevent contact allergy and toxic reactions among users it is important for tattoo ink manufacturers to follow the regulations and decrease nickel and chromium impurities.
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Affiliation(s)
- Xuying Wang
- Division of Surface and Corrosion Science, Department of Chemistry, School of Engineering Sciences in Chemistry, Biotechnology, and Health, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Leila Josefsson
- Division of Applied Physical Chemistry, Department of Chemistry, School of Engineering Sciences in Chemistry, Biotechnology, and Health, KTH Royal Institute of Technology, Stockholm, Sweden
| | | | - Marie-Louise Lind
- Centre for Occupational and Environmental Medicine, Stockholm, Sweden
| | - Åsa Emmer
- Division of Applied Physical Chemistry, Department of Chemistry, School of Engineering Sciences in Chemistry, Biotechnology, and Health, KTH Royal Institute of Technology, Stockholm, Sweden
| | | | - Yolanda S Hedberg
- Division of Surface and Corrosion Science, Department of Chemistry, School of Engineering Sciences in Chemistry, Biotechnology, and Health, KTH Royal Institute of Technology, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm, Sweden.,Department of Chemistry, The University of Western Ontario, London, Ontario, Canada.,Lawson Health Research Institute, The University of Western Ontario, London, Ontario, Canada
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13
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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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14
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Weiß KT, Schreiver I, Siewert K, Luch A, Haslböck B, Berneburg M, Bäumler W. Tattoos – mehr als nur kolorierte Haut? Auf der Suche nach Tattoo‐Allergenen. J Dtsch Dermatol Ges 2021; 19:657-671. [PMID: 33979044 DOI: 10.1111/ddg.14436_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/14/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Katharina T Weiß
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg
| | - Ines Schreiver
- Abteilung Chemikalien- und Produktsicherheit, Bundesinstitut für Risikobewertung (BfR), Berlin
| | - Katherina Siewert
- Abteilung Chemikalien- und Produktsicherheit, Bundesinstitut für Risikobewertung (BfR), Berlin
| | - Andreas Luch
- Abteilung Chemikalien- und Produktsicherheit, Bundesinstitut für Risikobewertung (BfR), Berlin
| | - Birgit Haslböck
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg
| | - Mark Berneburg
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg
| | - Wolfgang Bäumler
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg
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15
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Weiß KT, Schreiver I, Siewert K, Luch A, Haslböck B, Berneburg M, Bäumler W. Tattoos - more than just colored skin? Searching for tattoo allergens. J Dtsch Dermatol Ges 2021; 19:657-669. [PMID: 33955682 DOI: 10.1111/ddg.14436] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/14/2020] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Katharina T Weiß
- Department of Dermatology and Allergology, University of Regensburg, Regensburg, Germany
| | - Ines Schreiver
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Berlin, Germany
| | - Katherina Siewert
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Berlin, Germany
| | - Andreas Luch
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Berlin, Germany
| | - Birgit Haslböck
- Department of Dermatology and Allergology, University of Regensburg, Regensburg, Germany
| | - Mark Berneburg
- Department of Dermatology and Allergology, University of Regensburg, Regensburg, Germany
| | - Wolfgang Bäumler
- Department of Dermatology and Allergology, University of Regensburg, Regensburg, Germany
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16
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Abstract
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.
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Affiliation(s)
- Christa De Cuyper
- Dermatology, AZ Sint-Jan Brugge-Oostende AV, Meiboomstraat 15, 8370 Blankenberge, Belgium.
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17
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da Silva AB, Miniter M, Thom W, Hewitt RE, Wills J, Jugdaohsingh R, Powell JJ. Gastrointestinal Absorption and Toxicity of Nanoparticles and Microparticles: Myth, Reality and Pitfalls explored through Titanium Dioxide. CURRENT OPINION IN TOXICOLOGY 2020; 19:112-120. [PMID: 32566805 PMCID: PMC7305030 DOI: 10.1016/j.cotox.2020.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Daily oral exposure to vast numbers (>1013/adult/day) of micron or nano-sized persistent particles has become the norm for many populations. Significant airborne particle exposure is deleterious, so what about ingestion? Titanium dioxide in food grade form (fgTiO2) , which is an additive to some foods, capsules, tablets and toothpaste, may provide clues. Certainly, exposed human populations accumulate these particles in specialised intestinal cells at the base of large lymphoid follicles (Peyer's patches) and it's likely that a degree of absorption goes beyond this- i.e. lymphatics to blood circulation to tissues. We critically review the evidence and pathways. Regarding potential adverse effects, our primary message, for today's state-of-art, is that in vivo models have not been good enough and at times woeful. We provide a 'caveats list' to improve approaches and experimentation and illustrate why studies on biomarkers of particle uptake, and lower gut/mesenteric lymph nodes as targets, should be prioritized.
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Affiliation(s)
- Alessandra Barreto da Silva
- Biomineral Research Group, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
| | - Michelle Miniter
- Biomineral Research Group, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
| | - William Thom
- Biomineral Research Group, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
| | - Rachel E Hewitt
- Biomineral Research Group, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
| | - John Wills
- Biomineral Research Group, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
| | - Ravin Jugdaohsingh
- Biomineral Research Group, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
| | - Jonathan J Powell
- Biomineral Research Group, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
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18
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Serup J, Hutton Carlsen K, Dommershausen N, Sepehri M, Hesse B, Seim C, Luch A, Schreiver I. Identification of pigments related to allergic tattoo reactions in 104 human skin biopsies. Contact Dermatitis 2019; 82:73-82. [PMID: 31626330 PMCID: PMC6973263 DOI: 10.1111/cod.13423] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/08/2019] [Accepted: 10/17/2019] [Indexed: 12/13/2022]
Abstract
Background Red tattoos are prone to allergic reactions. The identity of the allergen(s) is mostly unknown. Objectives Chemical analysis of human skin biopsies from chronic allergic reactions in red tattoos to identify culprit pigment(s) and metals. Material and methods One hundred four dermatome biopsies were analyzed by matrix‐assisted laser desorption/ionization tandem mass spectrometry (MALDI‐MS/MS) for identification of commonly used organic pigments. Metal concentrations were assessed by inductively coupled plasma (ICP)‐MS and x‐ray fluorescence (XRF). Fourteen patients had cross‐reactions in other red tattoos. Results In total, the identified pigments were mainly azo Pigment Red (P.R.) 22 (35%), P.R. 210 (24%), P.R. 170 (12%), P.R. 5 (0.9%), P.R. 112 (0.9%), and Pigment Orange (P.O.) 13 (11%). P.R. 122 (0.9%) and Pigment Violet (P.V.) 23 (8%) were also common. P.R. 22, P.R. 170, and P.R. 210 also dominated in patients with cross‐reactions. In 22% of the biopsies, no red pigment was detected. Element analysis indicated the presence of the sensitizers nickel and chromium. Conclusions P.R. 22, P.R. 170, and P.R. 210 were identified as the prevailing pigments behind chronic allergic reactions in red tattoos. The epitope causing the reaction might be a pigment‐degradation product. Metal contamination may derive from different sources, and its role in red tattoo allergy cannot be ascertained.
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Affiliation(s)
- Jørgen Serup
- Department of Dermatology, The "Tattoo Clinic", Bispebjerg University Hospital, Copenhagen, Denmark
| | - Katrina Hutton Carlsen
- Department of Dermatology, The "Tattoo Clinic", Bispebjerg University Hospital, Copenhagen, Denmark
| | - Nils Dommershausen
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Berlin, Germany
| | - Mitra Sepehri
- Department of Plastic and Reconstructive Surgery, Herlev University Hospital, Herlev, Denmark
| | - Bernhard Hesse
- The European Synchrotron (ESRF), Grenoble Cedex 9, France.,Xploraytion GmbH, Berlin, Germany
| | - Christian Seim
- Xploraytion GmbH, Berlin, Germany.,Institute for Optics and Atomic Physics, Technische Universität Berlin, Berlin, Germany
| | - Andreas Luch
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Berlin, Germany
| | - Ines Schreiver
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Berlin, Germany
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19
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Rubio L, Guerra E, Garcia-Jares C, Lores M. Body-decorating products: Ingredients of permanent and temporary tattoos from analytical and european regulatory perspectives. Anal Chim Acta 2019; 1079:59-72. [DOI: 10.1016/j.aca.2019.06.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 12/26/2022]
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20
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Verbraucherschutz und Risikobewertung — allergieauslösende Substanzen in Verbraucherprodukten. ALLERGO JOURNAL 2019. [DOI: 10.1007/s15007-019-1901-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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21
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Schreiver I, Hesse B, Seim C, Castillo-Michel H, Anklamm L, Villanova J, Dreiack N, Lagrange A, Penning R, De Cuyper C, Tucoulou R, Bäumler W, Cotte M, Luch A. Distribution of nickel and chromium containing particles from tattoo needle wear in humans and its possible impact on allergic reactions. Part Fibre Toxicol 2019; 16:33. [PMID: 31451117 PMCID: PMC6710876 DOI: 10.1186/s12989-019-0317-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/09/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Allergic reactions to tattoos are amongst the most common side effects occurring with this permanent deposition of pigments into the dermal skin layer. The characterization of such pigments and their distribution has been investigated in recent decades. The health impact of tattoo equipment on the extensive number of people with inked skin has been the focus of neither research nor medical diagnostics. Although tattoo needles contain high amounts of sensitizing elements like nickel (Ni) and chromium (Cr), their influence on metal deposition in skin has never been investigated. RESULTS Here, we report the deposition of nano- and micrometer sized tattoo needle wear particles in human skin that translocate to lymph nodes. Usually tattoo needles contain nickel (6-8%) and chromium (15-20%) both of which prompt a high rate of sensitization in the general population. As verified in pig skin, wear significantly increased upon tattooing with the suspected abrasive titanium dioxide white when compared to carbon black pigment. Additionally, scanning electron microscopy of the tattoo needle revealed a high wear after tattooing with ink containing titanium dioxide. The investigation of a skin biopsy obtained from a nickel sensitized patient with type IV allergy toward a tattoo showed both wear particles and iron pigments contaminated with nickel. CONCLUSION Previously, the virtually inevitable nickel contamination of iron pigments was suspected to be responsible for nickel-driven tattoo allergies. The evidence from our study clearly points to an additional entry of nickel to both skin and lymph nodes originating from tattoo needle wear with an as yet to be assessed impact on tattoo allergy formation and systemic sensitization.
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Affiliation(s)
- Ines Schreiver
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Max-Dohrn-Strasse 8-10, 10589, Berlin, Germany.
| | - Bernhard Hesse
- The European Synchrotron, CS 40220, 38043, Grenoble Cedex 9, France
- Xploraytion GmbH, Bismarckstrasse 10-12, 10625, Berlin, Germany
| | - Christian Seim
- Xploraytion GmbH, Bismarckstrasse 10-12, 10625, Berlin, Germany
- Department of X-ray Spectrometry, Physikalisch-Technische Bundesanstalt, Abbestrasse 2-12, 10587, Berlin, Germany
- Institute for Optics and Atomic Physics, Technical University Berlin, Hardenbergstrasse 36, 10623, Berlin, Germany
| | | | - Lars Anklamm
- Helmut Fischer GmbH Institut für Elektronik und Messtechnik, Industriestrasse 21, 71069, Sindelfingen, Germany
| | - Julie Villanova
- The European Synchrotron, CS 40220, 38043, Grenoble Cedex 9, France
| | - Nadine Dreiack
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Max-Dohrn-Strasse 8-10, 10589, Berlin, Germany
| | - Adrien Lagrange
- Xploraytion GmbH, Bismarckstrasse 10-12, 10625, Berlin, Germany
- Institute of Materials Science and Technologies, Technical University Berlin, Strasse des 17. Juni 135, 10623, Berlin, Germany
| | - Randolph Penning
- Institute of Forensic Medicine, Ludwig-Maximilians University, Nussbaumstrasse 26, 80336, Munich, Germany
| | | | - Remi Tucoulou
- The European Synchrotron, CS 40220, 38043, Grenoble Cedex 9, France
| | - Wolfgang Bäumler
- Department of Dermatology, University of Regensburg, Franz Josef Strauß Allee 11, 93042, Regensburg, Germany
| | - Marine Cotte
- The European Synchrotron, CS 40220, 38043, Grenoble Cedex 9, France
- Laboratory of Molecular and Structural Archaeology (LAMS), Sorbonne University, CNRS, UMR8220, Paris, France
| | - Andreas Luch
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Max-Dohrn-Strasse 8-10, 10589, Berlin, Germany
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22
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Consumer protection and risk assessment: sensitising substances in consumer products. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s40629-019-0093-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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23
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Uter W, Werfel T, White IR, Johansen JD. Contact Allergy: A Review of Current Problems from a Clinical Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061108. [PMID: 29844295 PMCID: PMC6025382 DOI: 10.3390/ijerph15061108] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/20/2018] [Accepted: 05/26/2018] [Indexed: 12/17/2022]
Abstract
Contact allergy is common, affecting 27% of the general population in Europe. Original publications, including case reports, published since 2016 (inclusive) were identified with the aim of collating a full review of current problems in the field. To this end, a literature search employing methods of systematic reviewing was performed in the Medline® and Web of Science™ databases on 28 January 2018, using the search terms (“contact sensitization” or “contact allergy”). Of 446 non-duplicate publications identified by above search, 147 were excluded based on scrutiny of title, abstract and key words. Of the remaining 299 examined in full text, 291 were deemed appropriate for inclusion, and main findings were summarised in topic sections. In conclusion, diverse sources of exposures to chemicals of widely-differing types and structures, continue to induce sensitisation in man and may result in allergic contact dermatitis. Many of the chemicals are “evergreen” but others are “newcomers”. Vigilance and proper investigation (patch testing) are required to detect and inform of the presence of these haptens to which our populations remain exposed.
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Affiliation(s)
- Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, 91054 Erlangen, Germany.
| | - Thomas Werfel
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, 30625 Hannover, Germany.
| | - Ian R White
- St John's Institute of Dermatology, Guy's Hospital, London SE1 9RT, UK.
| | - Jeanne D Johansen
- Department of Dermatology and Allergy, National Allergy Research Centre, Copenhagen University Hospital Herlev and Gentofte, 2900 Hellerup, Denmark.
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24
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Hofmann SC, Plett M, Jansen S, Thomas P, Thölken KFM. Titanium hypersensitivity causing painful intra-abdominal oedema after staple-fixed inguinal hernia repair. Contact Dermatitis 2018. [PMID: 29521457 DOI: 10.1111/cod.12985] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Silke C Hofmann
- Centre for Dermatology, Allergy and Dermatosurgery, Helios University Hospital Wuppertal, University Witten/Herdecke, Wuppertal, Germany
| | - Maria Plett
- Centre for Dermatology, Allergy and Dermatosurgery, Helios University Hospital Wuppertal, University Witten/Herdecke, Wuppertal, Germany
| | - Stefan Jansen
- Centre for Visceral Surgery, Helios University Hospital Wuppertal, University Witten/Herdecke, Wuppertal, Germany
| | - Peter Thomas
- Department of Dermatology and Allergy, Ludwig-Maximilians-University, Munich, Germany
| | - Karisa F M Thölken
- Centre for Dermatology, Allergy and Dermatosurgery, Helios University Hospital Wuppertal, University Witten/Herdecke, Wuppertal, Germany
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25
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Abstract
Contact sensitization is the initial process involved in the development of an allergic reaction to xenobiotic environmental substances. Here, we briefly describe the differences between irritant and allergic contact dermatitis. Then, we highlight the essential steps involved in the development of an ACD reaction, i.e., the protein binding of haptens, genetic factors influencing the penetration of sensitizers into the skin, the different mechanisms driving the initial development of an inflammatory cytokine micromilieu enabling the full maturation of dendritic cells, the role of pre- and pro-haptens, antigen presentation and T cell activation via MHC and CD1 molecules, dendritic cell (DC) migration, and potential LC contribution as well as the different T cell subsets involved in ACD. In addition, we discuss the latest publications regarding factors that might influence the sensitizing potential such as repeated sensitizer application, penetration enhancers, humidity of the skin, microbiota, Tregs, and phthalates. Last but not least, we briefly touch upon novel targets for drug development that might serve as treatment options for ACD.
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Affiliation(s)
- Philipp R Esser
- Allergy Research Group, Department of Dermatology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 7, 79104, Freiburg im Breisgau, Germany.
| | - Stefan F Martin
- Allergy Research Group, Department of Dermatology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 7, 79104, Freiburg im Breisgau, Germany
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