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Kluger N, Badawi A, Laubach HJ, Wolkerstorfer A, Cartier H. Laser tattoo removal and risks of cancer: A joint statement of the EADV tattoo and body art task force, European Society for Lasers and Energy-Based Devices (ESLD) and la Société Française des lasers en Dermatologie. J Eur Acad Dermatol Venereol 2023; 37:e1354-e1355. [PMID: 37441733 DOI: 10.1111/jdv.19332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023]
Affiliation(s)
- Nicolas Kluger
- Department of Dermatology, Allergology, and Venereology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- "Tattoo" Consultation, Department of Dermatology, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- EADV Task Force on Tattoos and Body Art, Lugano, Switzerland
| | - Ashraf Badawi
- European Society for Lasers and Energy-Based Devices (ESLD), Paris, France
- Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt
| | - Hans-Joachim Laubach
- European Society for Lasers and Energy-Based Devices (ESLD), Paris, France
- Department of Dermatology and Venereology, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Albert Wolkerstorfer
- European Society for Lasers and Energy-Based Devices (ESLD), Paris, France
- Department of Dermatology, Amsterdam UMC, The Netherlands
| | - Hugues Cartier
- EADV Task Force on Tattoos and Body Art, Lugano, Switzerland
- Centre Médical Saint-Jean, Arras, France
- Société Française des Lasers en Dermatologie, Société Française de Dermatologie, Paris, France
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2
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Tung F, Wu K, Wang H, Chen S. Characterizing different types of black fountain pen ink using the chemical approach. J CHIN CHEM SOC-TAIP 2023. [DOI: 10.1002/jccs.202300024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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3
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Bazin D. Nanomaterials in medicine: a concise review of nanomaterials intended to treat pathology, nanomaterials induced by pathology, and pathology provoked by nanomaterials. CR CHIM 2022. [DOI: 10.5802/crchim.194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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4
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Colboc H, Moguelet P, Letavernier E, Frochot V, Bernaudin JF, Weil R, Rouzière S, Senet P, Bachmeyer C, Laporte N, Lucas I, Descamps V, Amode R, Brunet-Possenti F, Kluger N, Deschamps L, Dubois A, Reguer S, Somogyi A, Medjoubi K, Refregiers M, Daudon M, Bazin D. Pathologies related to abnormal deposits in dermatology: a physico-chemical approach. CR CHIM 2022. [DOI: 10.5802/crchim.153] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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5
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Homolak J. In vitro analysis of catalase and superoxide dismutase mimetic properties of blue tattoo ink. Free Radic Res 2022; 56:343-357. [PMID: 35848745 DOI: 10.1080/10715762.2022.2102976] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Tattoo inks are comprised of different combinations of bioactive chemicals with combined biological effects that are insufficiently explored. Tattoos have been associated with oxidative stress; however, a recent N-of-1 study suggested that blue tattoos may be associated with suppressed local skin oxidative stress. The present study aimed to explore the attributes of the blue tattoo ink (BTI) that may explain its possible effects on redox homeostasis, namely the catalase (CAT) and superoxide dismutase (SOD)-mimetic properties that have been reported for copper(II) phthalocyanine (CuPC) - the main BTI constituent. Intenze™ Persian blue (PB) BTI has been used in the experiment. CAT and SOD-mimetic properties of PB and its pigment-enriched fractions were analyzed using the carbonato-cobaltate (III) formation-derived H2O2 dissociation and 1,2,3-trihydroxybenzene autoxidation rate assays utilizing simple buffers and biochemical matrix of normal skin tissue as chemical reaction environments. CuPC-based tattoo ink PB and both its blue and white pigment-enriched fractions demonstrate CAT and SOD-mimetic properties in vitro with effect sizes demonstrating a substantial dependence on the biochemical environment. PB constituents act as inhibitors of CAT but potentiate its activity in the biochemical matrix of the skin. CuPC-based BTI can mimic antioxidant enzymes, however chemical constituents other than CuPC (e.g. the photoreactive TiO2) seem to be at least partially responsible for the BTI redox-modulating properties.
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Affiliation(s)
- Jan Homolak
- Department of Pharmacology, University of Zagreb School of Medicine, Zagreb, Croatia.,Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia
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6
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Negi S, Bala L, Shukla S, Chopra D. Tattoo inks are toxicological risks to human health: A systematic review of its ingredients, fate inside skin, toxicity due to polycyclic aromatic hydrocarbons, primary aromatic amines, metals, and overview of regulatory frameworks. Toxicol Ind Health 2022; 38:417-434. [PMID: 35592919 DOI: 10.1177/07482337221100870] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Today, tattooing has become very popular among people all over the world. Tattooists, with the help of tiny needles, place tattoo ink inside the skin surface and unintentionally introduce a large number of unknown ingredients. These ingredients include polycyclic aromatic hydrocarbons (PAHs), heavy metals, and primary aromatic amines (PAAs), which are either unintentionally introduced along with the ink or produced inside the skin by different types of processes for example cleavage, metabolism and photodecomposition. These could pose toxicological risks to human health, if present beyond permissible limits. PAH such as Benzo(a)pyrene is present in carbon black ink. PAAs could be formed inside the skin as a result of reductive cleavage of organic azo dyes. They are reported to be highly carcinogenic by environmental protection agencies. Heavy metals, namely, cadmium, lead, mercury, antimony, beryllium, and arsenic are responsible for cancer, neurodegenerative diseases, cardiovascular, gastrointestinal, lungs, kidneys, liver, endocrine, and bone diseases. Mercury, cobalt sulphate, other soluble cobalt salts, and carbon black are in Group 2B, which means they may cause cancer in humans. Cadmium and compounds of cadmium, on the other hand, are in Group 1 (carcinogenic to humans). The present article addresses the various ingredients of tattoo inks, their metabolic fate inside human skin and unintentionally added impurities that could pose toxicological risk to human health. Public awareness and regulations that are warranted to be implemented globally for improving the safety of tattooing.
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Affiliation(s)
- Sandeep Negi
- School of Dental Sciences, Department of Biochemistry, 301429Babu Banarasi Das University, Lucknow, India.,Photobiology Laboratory, Systems Toxicology and Health Risk Assessment Group, 538266CSIR-Indian Institute of Toxicology Research (CSIR-IITR), Lucknow, India
| | - Lakshmi Bala
- School of Dental Sciences, Department of Biochemistry, 301429Babu Banarasi Das University, Lucknow, India
| | - Saumya Shukla
- School of Dental Sciences, Department of Biochemistry, 301429Babu Banarasi Das University, Lucknow, India.,Photobiology Laboratory, Systems Toxicology and Health Risk Assessment Group, 538266CSIR-Indian Institute of Toxicology Research (CSIR-IITR), Lucknow, India
| | - Deepti Chopra
- Photobiology Laboratory, Systems Toxicology and Health Risk Assessment Group, 538266CSIR-Indian Institute of Toxicology Research (CSIR-IITR), Lucknow, India
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7
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UTKU TÜRK EG, JANNUZZI AT, ALPERTUNGA B. Determination of the Phototoxicity Potential of Commercially Available Tattoo Inks Using the 3T3-neutral Red Uptake Phototoxicity Test. Turk J Pharm Sci 2022; 19:70-75. [DOI: 10.4274/tjps.galenos.2021.86344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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8
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Comparative Toxicological Evaluation of Tattoo Inks on Two Model Organisms. BIOLOGY 2021; 10:biology10121308. [PMID: 34943222 PMCID: PMC8698971 DOI: 10.3390/biology10121308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 12/12/2022]
Abstract
Tattooing is a technique that introduces colored substances under the skin in order to color it permanently. Decomposition products of tattoo pigments produce numerous damages for the skin and other organs. We studied the effects of a commercial red ink tattoo, PR170, on Xenopus laevis embryos and Daphnia magna nauplii using concentrations of 10, 20, and 40 mg/L. For Xenopus, we applied the FETAX protocol analyzing survival, malformations, growth, heart rate, and the expression of genes involved in the development. In D. magna, we evaluated the toxicity with an immobilization test. Moreover, we investigated the production of ROS, antioxidant enzymes, and the expression of the ATP-binding cassette in both models. Our results indicate that PR170 pigment has nanoparticle dimensions, modifies the survival and the ATP-binding cassette activity, and induces oxidative stress that probably produces the observed effects in both models. Deformed embryos were observed in Xenopus, probably due to the modification of expression of genes involved in development. The expression of pro-inflammatory cytokines was also modified in this amphibian. We think that these effects are due to the accumulation of PR170 and, in particular, to the presence of the azoic group in the chemical structure of this pigment. Further studies needed to better understand the effects of commercial tattoo inks.
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He R, Liu H, Fang T, Niu Y, Zhang H, Han F, Gao B, Li F, Xu F. A Colorimetric Dermal Tattoo Biosensor Fabricated by Microneedle Patch for Multiplexed Detection of Health-Related Biomarkers. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:e2103030. [PMID: 34719884 PMCID: PMC8693053 DOI: 10.1002/advs.202103030] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Indexed: 05/21/2023]
Abstract
Detection of biomarkers associated with body conditions provides in-depth healthcare information and benefits to disease management, where the key challenge is to develop a minimally invasive platform with the ability to directly detect multiple biomarkers in body fluid. Dermal tattoo biosensor holds the potential to simultaneously detect multiple health-related biomarkers in skin interstitial fluid because of the features of minimal invasion, easy operation, and equipment-free result reading. Herein, a colorimetric dermal tattoo biosensor fabricated by a four-area segmented microneedle patch is developed for multiplexed detection of health-related biomarkers. The biosensor exhibits color changes in response to the change of biomarker concentration (i.e., pH, glucose, uric acid, and temperature), which can be directly read by naked eyes or captured by a camera for semi-quantitative measurement. It is demonstrated that the colorimetric dermal tattoo biosensor can simultaneously detect multiple biomarkers in vitro, ex vivo, and in vivo, and monitor the changes of the biomarker concentration for at least 4 days, showing its great potential for long-term health monitoring.
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Affiliation(s)
- Rongyan He
- The Key Laboratory of Biomedical Information Engineering of Ministry of EducationXi'an Jiaotong University School of Life Science and TechnologyXi'an710049China
- Bioinspired Engineering and Biomechanics Center (BEBC)Xi'an Jiaotong UniversityXi'an710049China
| | - Hao Liu
- The Key Laboratory of Biomedical Information Engineering of Ministry of EducationXi'an Jiaotong University School of Life Science and TechnologyXi'an710049China
- Bioinspired Engineering and Biomechanics Center (BEBC)Xi'an Jiaotong UniversityXi'an710049China
| | - Tianshu Fang
- The Key Laboratory of Biomedical Information Engineering of Ministry of EducationXi'an Jiaotong University School of Life Science and TechnologyXi'an710049China
- Bioinspired Engineering and Biomechanics Center (BEBC)Xi'an Jiaotong UniversityXi'an710049China
| | - Yan Niu
- The Key Laboratory of Biomedical Information Engineering of Ministry of EducationXi'an Jiaotong University School of Life Science and TechnologyXi'an710049China
- Bioinspired Engineering and Biomechanics Center (BEBC)Xi'an Jiaotong UniversityXi'an710049China
| | - Huiqing Zhang
- Bioinspired Engineering and Biomechanics Center (BEBC)Xi'an Jiaotong UniversityXi'an710049China
- Key Laboratory of Thermo‐Fluid Science and Engineering of Ministry of EducationSchool of Energy & Power EngineeringXi'an Jiaotong UniversityXi'an710049China
| | - Fei Han
- The Key Laboratory of Biomedical Information Engineering of Ministry of EducationXi'an Jiaotong University School of Life Science and TechnologyXi'an710049China
- Bioinspired Engineering and Biomechanics Center (BEBC)Xi'an Jiaotong UniversityXi'an710049China
| | - Bin Gao
- Department of EndocrinologyTangdu HospitalAir Force Military Medical UniversityXi'an710038China
| | - Fei Li
- The Key Laboratory of Biomedical Information Engineering of Ministry of EducationXi'an Jiaotong University School of Life Science and TechnologyXi'an710049China
- Bioinspired Engineering and Biomechanics Center (BEBC)Xi'an Jiaotong UniversityXi'an710049China
| | - Feng Xu
- The Key Laboratory of Biomedical Information Engineering of Ministry of EducationXi'an Jiaotong University School of Life Science and TechnologyXi'an710049China
- Bioinspired Engineering and Biomechanics Center (BEBC)Xi'an Jiaotong UniversityXi'an710049China
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Nguyen HT, Doan EVL, Tran TNA, Vu TTP, Phan HN, Sobanko JF. Safety and Efficacy of Tattoo Removal Using a Dual-Wavelength 1064/532-nm Picosecond Laser in Patients With Fitzpatrick Skin Type III and IV. Lasers Surg Med 2021; 53:939-945. [PMID: 33027538 DOI: 10.1002/lsm.23333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/26/2020] [Accepted: 09/26/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate the safety and efficacy of a dual-wavelength 1064/532-nm picosecond-domain laser for tattoo removal in Vietnamese patients. STUDY DESIGN/MATERIALS AND METHODS This prospective clinical study enrolled 30 subjects with 52 decorative tattoos treated with up to six treatments of laser removal at intervals of 6-8 weeks. Safety and efficacy were assessed at each treatment session and at 4 weeks after the final session. A "good" response was defined as at least 75% clearance of tattoo pigments. RESULTS A significant reduction of tattoo appearance was achieved in all subjects. 88.5% of tattoos exhibited a "good" response to treatment by the end of the six sessions and more than 36% of tattoos exhibited better than "good" responses. Adverse events were common in the early period after treatment but did not persist in most patients. Only one case of prolonged hypopigmentation was reported. CONCLUSIONS Treatment using a 1064/532-nm picosecond laser is an effective approach for removal of decorative tattoos, which poses a minimal risk of long-term adverse events in patients with Fitzpatrick skin type III or IV. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
- Hao T Nguyen
- HCMC Hospital of Dermato-Venereology, Ho Chi Minh City, 700000, Vietnam
- Department of Dermatology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, 700000, Vietnam
- Department of Dermatology, Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh City, 700000, Vietnam
| | - Em V L Doan
- HCMC Hospital of Dermato-Venereology, Ho Chi Minh City, 700000, Vietnam
| | - Tu N A Tran
- HCMC Hospital of Dermato-Venereology, Ho Chi Minh City, 700000, Vietnam
| | - Thao T P Vu
- HCMC Hospital of Dermato-Venereology, Ho Chi Minh City, 700000, Vietnam
| | - Huy N Phan
- HCMC Hospital of Dermato-Venereology, Ho Chi Minh City, 700000, Vietnam
| | - Joseph F Sobanko
- Hospital of the University of Pennsylvania, Philadelphia, 19147, Pennsylvania
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11
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Leu FJ, Huang CL, Wu YS, Wang CC. Comparison of picosecond versus nanosecond Nd:YAG lasers for the removal of cosmetic tattoos in an animal model. Lasers Med Sci 2021; 37:1343-1350. [PMID: 34410571 DOI: 10.1007/s10103-021-03400-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/09/2021] [Indexed: 11/25/2022]
Abstract
Cosmetic tattoos are difficult to remove, and their response to picosecond laser treatment has seldom been investigated. We compared the efficacy and adverse effects of picosecond versus Q-switched lasers for the removal of cosmetic tattoos. White, flesh-colored, and brown inks were irradiated using 532/1064 nm picosecond and Q-switched Nd:YAG lasers, and their absorption spectra before and after laser irradiation were analyzed. Nine rats were tattooed with all three inks. Each tattoo was divided into three sections and treated at 1064 nm with a picosecond laser or Q-switched laser, or left untreated, in four sessions at 1-month intervals. Skin biopsies were taken from treated and untreated sites. In vitro study showed the 1064 nm picosecond laser caused the least paradoxical color shift. In vivo study showed that all white tattoos achieved poor response scores, six flesh-colored tattoos achieved fair to good response scores, and seven brown tattoos achieved good to excellent response scores with the picosecond laser. The picosecond laser was superior to the Q-switched laser for removing flesh-colored tattoos (P < 0.05), but the effectiveness for white and brown tattoos was similar for both lasers. The degree of paradoxical darkening when removing the white and flesh-colored tattoos was significantly lower with the picosecond than that with the Q-switched laser (P < 0.01). Transmission electron microscopy showed that many tattoo ink particles had decreased in size after irradiations with both pulse durations. The 1064 nm picosecond Nd:YAG laser causes mild paradoxical darkening and might be more appropriate for removal of flesh-colored and brown cosmetic tattoos.
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Affiliation(s)
- Fur-Jiang Leu
- Department of Pathology, Cardinal Tien Hospital, 362 Chung Cheng Rd, Hsin Tien District, New Taipei City, Taiwan
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Chuen-Lin Huang
- Department of Medical Research, Cardinal Tien Hospital, 362 Chung Cheng Rd, Hsin Tien District, New Taipei City, 231, Taiwan
- Graduate Institute of Physiology & Department of Physiology and Biophysics, National Defense Medical Center, Taipei, Taiwan
| | - Yen-Sheng Wu
- Electron Microscope Laboratory of Tzong Jwo Jang, Collage of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Chia-Chen Wang
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.
- Department of Medical Research, Cardinal Tien Hospital, 362 Chung Cheng Rd, Hsin Tien District, New Taipei City, 231, Taiwan.
- Department of Dermatology, Cardinal Tien Hospital, 362 Chung Cheng Rd, Hsin Tien District, New Taipei City, Taiwan.
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12
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Sadura F, Wróbel MS, Karpienko K. Colored Tattoo Ink Screening Method with Optical Tissue Phantoms and Raman Spectroscopy. MATERIALS 2021; 14:ma14123147. [PMID: 34201157 PMCID: PMC8227768 DOI: 10.3390/ma14123147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 12/30/2022]
Abstract
Due to the increasing popularity of tattoos among the general population, to ensure their safety and quality, there is a need to develop reliable and rapid methods for the analysis of the composition of tattoo inks, both in the ink itself and in already existing tattoos. This paper presents the possibility of using Raman spectroscopy to examine tattoo inks in biological materials. We have developed optical tissue phantoms mimicking the optical scattering coefficient typical for human dermis as a substitute for an in vivo study. The material employed herein allows for mimicking the tattoo-making procedure. We investigated the effect of the scattering coefficient of the matrix in which the ink is located, as well as its chemical compositions on the spectra. Raman surface line scanning has been carried out for each ink in the skin phantom to establish the spatial gradient of ink concentration distribution. This ensures the ability to detect miniature concentrations for a tattoo margin assessment. An analysis and comparison of the spectra of the inks and the tattooed inks in the phantoms are presented. We recommend the utilization of Raman spectroscopy as a screening method to enforce the tattoo ink safety legislations as well as an early medical diagnostic screening tool.
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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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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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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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Scalia S, Bertoni S, Dozzo A, Rimessi A, Pinton P, Passerini N, Albertini B. Glyceryl Tristearate-Based Lipid Microparticles Loaded with the Tattoo Colorant, Acid Red 87: Colorant Retention Capacity in Excised Porcine Skin. Skin Pharmacol Physiol 2021; 33:323-330. [PMID: 33494089 DOI: 10.1159/000512643] [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: 04/28/2020] [Accepted: 10/19/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND With the increasing diffusion of tattooing, the photolability of tattoo inks has become a critical issue, as available data indicated that several tattoo colorants are unstable under sunlight, generating potentially toxic photodegradation products. Therefore, it is desirable to enhance the photostability of coloring agents contained in tattoo inks. AIMS Lipid microparticles (LMs) highly loaded with Acid Red 87 (C.I. 45380), a colorant used in tattoo inks, were evaluated for their effect on the colorant photoinstability. In addition, the capacity of the LMs to retain the incorporated C.I. 45380 colorant after their intradermal administration in excised porcine skin was investigated. METHODS LMs loaded with C.I. 45380 were prepared using glyceryl tristearate as the lipidic material and phosphatidylcholine as the surfactant. Non-encapsulated C.I. 45380 or the colorant-loaded LMs were irradiated with a solar simulator for photodecomposition studies or introduced in the excised porcine skin mounted in Franz diffusion cells for stability evaluation in the dermal tissue. RESULTS AND CONCLUSION The colorant content of the microparticles was 17.7%, and their size ranged from 25 to 170 μm. The light-induced degradation of C.I. 45380 was significantly decreased by its incorporation in the LMs from 20.2 ± 5.8% to 1.9 ± 2.1%. Moreover, after intradermal injection of free or microencapsulated C.I. 45380 in the excised pig skin, the LMs reduced by 93.7% (from 24.6 to 1.5%) the quantity of the colorant diffused and hence lost in the Franz cell receptor fluid. Hence, the LM carrier efficiently retained the entrapped C.I. 45380 following incubation in the dermal region of the isolated porcine skin, which is in favor of a long-lasting tattoo. Based on these data, the incorporation of C.I. 45380 in the LMs could represent a potentially useful strategy to reduce the photodecomposition of the tattoo colorant and its harmful interactions with the skin tissue.
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Affiliation(s)
- Santo Scalia
- Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy,
| | - Serena Bertoni
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | | | - Alessandro Rimessi
- Department of Medical Sciences and Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, Ferrara, Italy
| | - Paolo Pinton
- Department of Medical Sciences and Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, Ferrara, Italy
| | - Nadia Passerini
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Beatrice Albertini
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
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Butterfield JL, Keyser SP, Dikshit KV, Kwon H, Koster MI, Bruns CJ. Solar Freckles: Long-Term Photochromic Tattoos for Intradermal Ultraviolet Radiometry. ACS NANO 2020; 14:13619-13628. [PMID: 32961057 DOI: 10.1021/acsnano.0c05723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
While tattooable nanotechnology for in-skin sensing and communication has been a popular concept in science fiction since the 1990s, the first tattooable intradermal nanosensors have only emerged in the past few years, and none have been demonstrated in human skin. We developed a photochromic tattoo that serves as an intradermal ultraviolet (UV) radiometer that provides naked-eye feedback about UV exposure in real time. These small tattoos, or "solar freckles", comprise dermally implanted colorimetric UV sensors in the form of nanoencapsulated leuco dyes that become more blue in color with increasing UV irradiance. We demonstrate the tattoos' functionality for both quantitative and naked-eye UV sensing in porcine skin ex vivo, as well as in human skin in vivo. Solar freckles offer an alternative and complementary approach to self-monitoring UV exposure for the sake of skin cancer prevention. Activated solar freckles provide a visual reminder to protect the skin, and their color disappears rapidly upon removal of UV exposure or application of topical sunscreen. The sensors are implanted in a minimally invasive procedure that lasts only a few seconds, yet remain functional for months to years. These semipermanent tattoos provide an early proof-of-concept for long-term intradermal sensing nanomaterials that provide users with biomedically relevant information in the form of an observable color change.
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Affiliation(s)
- Jesse L Butterfield
- Paul M. Rady Department of Mechanical Engineering, University of Colorado-Boulder, Boulder, Colorado 80309, United States
| | - Sean P Keyser
- Paul M. Rady Department of Mechanical Engineering, University of Colorado-Boulder, Boulder, Colorado 80309, United States
| | - Karan V Dikshit
- Materials Science & Engineering Program, University of Colorado-Boulder, Boulder, Colorado 80309, United States
| | - Hyejin Kwon
- Paul M. Rady Department of Mechanical Engineering, University of Colorado-Boulder, Boulder, Colorado 80309, United States
| | - Maranke I Koster
- Department of Dermatology, University of Colorado-Denver, Anschutz Medical Campus, Denver, Colorado 80217, United States
| | - Carson J Bruns
- Paul M. Rady Department of Mechanical Engineering, University of Colorado-Boulder, Boulder, Colorado 80309, United States
- ATLAS Institute, University of Colorado-Boulder, Boulder, Colorado 80309, United States
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Kurniadi I, Tabri F, Madjid A, Anwar AI, Widita W. Laser tattoo removal: Fundamental principles and practical approach. Dermatol Ther 2020; 34:e14418. [PMID: 33068020 DOI: 10.1111/dth.14418] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 11/28/2022]
Abstract
Tattoos have long become a part of human civilization. However, as the number of people who get tattoos increases, so is the number of people who wish to have their tattoos removed. Compared to other methods, laser-based devices are associated with the best efficacy and least side effects in tattoo removal. Lack of understanding of the fundamental principles of laser and managing its parameters may result in suboptimal result and increased risk of side effects. Recognizing and mastering multiple factors including skin types, nature and color of tattoos, and proper selection of laser parameters such as wavelength, fluence, and pulse, are central in achieving an optimal tattoo removal outcome. This review provides a comprehensive overview on the fundamental principle of laser and practical approaches in tattoo removal.
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Affiliation(s)
- Ivan Kurniadi
- Faculty of Medicine, Department of Dermatology and Venereology, Universitas Hasanuddin, Makassar, South Sulawesi, Indonesia
| | - Farida Tabri
- Faculty of Medicine, Department of Dermatology and Venereology, Universitas Hasanuddin, Makassar, South Sulawesi, Indonesia
| | - Asnawi Madjid
- Faculty of Medicine, Department of Dermatology and Venereology, Universitas Hasanuddin, Makassar, South Sulawesi, Indonesia
| | - Anis Irawan Anwar
- Faculty of Medicine, Department of Dermatology and Venereology, Universitas Hasanuddin, Makassar, South Sulawesi, Indonesia
| | - Widya Widita
- Faculty of Medicine, Department of Dermatology and Venereology, Universitas Hasanuddin, Makassar, South Sulawesi, Indonesia
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Study of Tattoo Colorants in Skin by Conventional and Polarized Light Microscopy. Am J Dermatopathol 2020; 42:932-938. [PMID: 33055540 DOI: 10.1097/dad.0000000000001824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Tattoos are a common practice in the 21st century. Although most modern pigments are organic and made of vegetable or plastic compounds, they still sometimes elicit an adverse reaction in the skin. Identifying the tattoo pigment in such biopsies is not always an easy task. To study how tattoo inks appear in the skin, we injected 14 different colors of commercial tattoo ink into normal skin obtained from a mastectomy specimen. One unstained section was obtained from each case, as well as one section stained with hematoxylin-eosin from each case. All sections were observed under the microscope. Stained and unstained sections were also examined under polarized light. We did not observe any modification of the ink color with the staining process with hematoxylin-eosin. However, some pigments appeared differently in stained and unstained sections than in the vial. Pink was the most difficult color to identify from the eosinophilic tissue. None of the colors showed any birefringent particles. However, in some unstained slides under polarized light, the color of the pigment appeared more similar to the one in the vial than in the stained slide.
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Abstract
Tattooing entails a high amount of tattoo colorants that is injected into skin. Tattoo colorants usually contain various substances of which the colouring component is the major ingredient that can be assigned to two different groups. Firstly, amorphous carbon particles (carbon black) are almost exclusively found in black tattoos. Secondly, tattooists use azo and polycyclic pigments to create nearly all colours of the visible spectrum. Due to their different but frequently complex chemistry, tattoo colorants usually contain various compounds like by-products and impurities which may exhibit health concerns. Professional tattooists inject that mixture into skin using the solid needles of tattoo machines. It is known that part of injected tattoo colorants is predominantly transported away from skin via lymphatic system. In addition to tattooing, exposure of tattooed skin to solar radiation or laser light may cause decomposition of pigment molecules leading to new and potential hazard chemical compounds. In light of the various hazard substances in the tattoo colorants and its decomposition products, tattooing might pose a health risk not only to skin but also to other organs of humans.
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Treatments of a phthalocyanine-based green ink for tattoo removal purposes: generation of toxic fragments and potentially harmful morphologies. Arch Toxicol 2020; 94:2359-2375. [PMID: 32472170 DOI: 10.1007/s00204-020-02790-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/20/2020] [Indexed: 02/04/2023]
Abstract
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.
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Battistini B, Petrucci F, De Angelis I, Failla CM, Bocca B. Quantitative analysis of metals and metal-based nano- and submicron-particles in tattoo inks. CHEMOSPHERE 2020; 245:125667. [PMID: 31877461 DOI: 10.1016/j.chemosphere.2019.125667] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/15/2019] [Accepted: 12/13/2019] [Indexed: 06/10/2023]
Abstract
Exposure to metals and metal-based nano- (NPs, 1-100 nm) and submicron-particles (SPs, 0.1-1 μm) contained in tattoo inks and related health safety is currently receiving a great deal of interest. Twenty inks of different brands and colours were sampled in Italy in 2019. The SemiQuant Inductively Coupled Plasma Mass Spectrometry (ICP-MS) analysis allowed quantifying the concentration of 18 metals (Al, As, Ba, Cd, Co, Cr, Cu, Fe, Hg, Mn, Mo, Ni, Pb, Sb, Se, Sn, Ti, Zn) in inks. The Single Particle ICP-MS was used to detect the diameters and concentration of NPs and SPs of 9 metals (Al, Co, Cr, Cu, Hg, Ni, Pb, Ti and Zn). Concentration of metals in tattoo inks were below the recommended concentrations reported in the Resolution ResAP (2008)1 indicating ink production have shifted to purer materials and best manufacturing practices. Regarding particles, Al was found at nano- (62-80 nm) and submicron-sizes (105-140 nm). Sizes of Cr, Cu, Pb and Zn were in the intervals 42-62 nm, 44-96 nm, 26-28 nm and 26-59 nm, respectively. Titanium was at submicron-diameters (166-383 nm). In addition, Cr and Ti particles accounted for the 47% and 80% of their total concentration, respectively. Tattooing practice exposed humans to metal-based NPs and SPs and the presence of a combination of particles of different metals and/or their dynamics (e.g., dissolution) may change their bioavailability and toxicity.
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Affiliation(s)
- Beatrice Battistini
- Department of Environment and Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Francesco Petrucci
- Department of Environment and Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Isabella De Angelis
- Department of Environment and Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Cristina Maria Failla
- Experimental Immunology Laboratory, Istituto Dermopatico dell'Immacolata, Via Monti di Creta 104, 00167, Roma, Italy
| | - Beatrice Bocca
- Department of Environment and Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
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Hutton Carlsen K, Larsen G, Serup J. Tattoo pigment agglomerates measured in skin biopsies by computerised light microscopy: Study of 161 patients with adverse reactions in black and red tattoos. Skin Res Technol 2019; 26:284-291. [PMID: 31799768 DOI: 10.1111/srt.12798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 08/22/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Black tattoo reactions are suggested to be foreign body reactions manifested as papulo-nodular inflammation that is associated with active sarcoidosis. AIM To study the morphology of black and red pigment agglomerates in skin biopsies from tattoo reactions, referenced to clinical diagnoses. METHOD Agglomerate count, area, width, height, circumference and circularity were measured in 161 patients by light microscopy (Olympus BX51™); 161 unstained skin biopsies from 64 black tattoo reactions and 97 reactions in red tattoos with allergy. Images (Jenoptic Gryphax RGB camera) were taken through a 40× objective using immersion oil. Computerised analysis of agglomerates was performed using ImageJ software. Student t test, chi-square test, Fisher Exact test, ANOVA and Bonferroni tests were applied. RESULTS Comparison of black and red pigment agglomerates showed no overall differences in count, area, width, height or circumference. However, in black tattoo reactions, the count of agglomerates was higher in patients with sarcoidosis (P = .009) vs no sarcoidosis. Black agglomerates were more circular shaped as compared to red, P = .023. In red tattoo reactions, agglomerates in patients with allergic cross-reactivity were slightly more circular (P = .036) vs patients with milder allergy. The count of red agglomerates was lower in patients clinically typed excessive hyperkeratosis (P = .041) compared with other clinical types of allergy. CONCLUSION Patients with reactions in black tattoos associated with sarcoidosis have increased count of pigment agglomerates vs those without associated sarcoidosis indicating that black pigment agglomeration is one among a number of factors triggering sarcoid tattoo complication. Circular shape of agglomerates may code for bioactivity.
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Affiliation(s)
- Katrina Hutton Carlsen
- Department of Dermatology, The "Tattoo Clinic", Bispebjerg University Hospital, Copenhagen, Denmark
| | | | - Jørgen Serup
- Department of Dermatology, The "Tattoo Clinic", Bispebjerg University Hospital, Copenhagen, Denmark
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Hutton Carlsen K, Larsen G, Serup J. Tattoo pigment agglomerates measured in commercial ink stock products by computerised light microscopy. Skin Res Technol 2019; 26:292-300. [PMID: 31762137 DOI: 10.1111/srt.12799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 08/22/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The incidence of clinical complications such as granuloma formation and sarcoidosis is often seen in black tattoos and may be associated with agglomeration of black pigment. AIM To measure count and dimensions of agglomerates in black tattoo inks vs red inks and to compare old inks and new inks of identical brands. METHOD Examination was performed by light microscopy (Olympus BX51™ ) with magnification 40X, immersion oil. Photographs (Jenoptik Gryphax RGB camera) were taken of each ink sample and analysed by ImageJ software; count, area, width, height, circumference and circularity index were measured. Agglomerates were defined as width and height of objects above 800 nm. Twenty-one new unopened black inks and 17 new unopened red inks were compared. Furthermore, five old black inks and five old red inks, that had been opened and stocked for over 2 years, were compared with new products of the same brands. RESULTS Black agglomerates were area wise and with respect to width, height and circumference significantly larger compared with red agglomerates and more circularly shaped. Count of agglomerates was lower in black inks than in red inks, in accordance with bigger dimensions of black agglomerates. Comparison of old and new inks indicated old inks have larger agglomerates but variable bottle size and storage conditions may have confounded results. CONCLUSION Pigment agglomerates in black tattoo ink stock products were sized larger than agglomerates in red inks. Agglomerates found directly in black inks may predispose to granuloma formation in black tattoos causing sarcoid reaction.
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Affiliation(s)
- Katrina Hutton Carlsen
- Department of Dermatology, The "Tattoo Clinic", Bispebjerg University Hospital, Copenhagen, Denmark
| | | | - Jørgen Serup
- Department of Dermatology, The "Tattoo Clinic", Bispebjerg University Hospital, Copenhagen, Denmark
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25
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Abstract
Introduction: Decorative tattooing involves the introduction of exogenous pigments and/or dyes into the dermis to produce a permanent design.Areas covered: This review provides an overview of the current aspects of cutaneous complications associated with permanent tattooing and permanent make-up based on the previous reviews of interest, case series, and case reports of interest. References for this review were found through a search of PubMed by use of the terms 'tattoo', 'tattoos', or 'tattooing'.Expert opinion: Complications include primarily infections, allergy to tattoo pigments, benign, and sometimes malignant tumors arising on tattoos and the localization of various dermatoses to tattoos. Immunocompromised patients and individuals with chronic conditions should be able to discuss with their physician and ask advice before getting tattooed. Tattoo color allergy still remains an unsolved issue. The identification of current culprit failed. It is most likely a byproduct that appears in situ in the skin during the life of the tattooed bearer. Studies involving expert centers are warranted to establish the best treatments for tattoo allergy. The risk of tattoo associated cancers appears to this author as largely overstated. However, case controls studies on large on cohorts of individuals with or without tattoos could help to evaluate whether tattoos have a possible in role in cancers.
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Affiliation(s)
- Nicolas Kluger
- Department of dermatology, allergology and venereology, Helsinki University Central Hospital, Helsinki, Finland.,"Tattoo" Consultation, Department of Dermatology, Bichat-Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
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26
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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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Zhang R, Jia C, Zhao L, Pan J, Niu Q, Liu R. Characterization of the interaction between carbon black and three important antioxidant proteins using multi spectroscopy and modeling simulations. CHEMOSPHERE 2019; 222:823-830. [PMID: 30743233 DOI: 10.1016/j.chemosphere.2019.02.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/18/2019] [Accepted: 02/05/2019] [Indexed: 06/09/2023]
Abstract
A major user of carbon black is the pigment and dyes industry, where carbon black is incorporated into paints, inks, printers, and plastics. However, little is known about the mechanism underlying the toxicity of carbon black to antioxidant proteins. Carbon black can cause oxidative stress to organisms after they invade into the body. Antioxidant proteins play a key role in keeping the organism from nanoparticle-induced oxidative damage and tend to bind with nanoparticles immediately after their invading into the biological environment, so it is meaningful to elucidate the toxicity of nanoparticles on the antioxidant proteins. In this study, the toxicity of carbon black (SB100) on three different antioxidant proteins (TF (transferrin), SOD (superoxide dismutase), and LYZ (lysozyme)) were investigated. The multi-spectra studies indicated that SB100 interacted with these three proteins and changed their structure in different ways. SB100 changed the microenvironment of fluorophores in SOD and LYZ by quenching the fluorescence spectra of the two enzymes, while changed that of TF by increasing the fluorescence intensity of TF. SB100 changed the secondary structure of these three proteins by decreasing the α-helix content of TF and increasing that of SOD and LYZ. Moreover, SB100 changed the hydrophobicity of the three proteins in different ways as well. And SOD exhibits a more severe activity inhibition than LYZ after exposed to SB100. In summary, SB100 caused different structural and functional changes to these three antioxidant enzymes.
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Affiliation(s)
- Rui Zhang
- School of Environmental Science and Engineering, China-America CRC for Environment & Health, Shandong University, 72# Jimo Binhai Road, Qingdao, Shandong Province, 266237, PR China
| | - Chenhao Jia
- School of Environmental Science and Engineering, China-America CRC for Environment & Health, Shandong University, 72# Jimo Binhai Road, Qingdao, Shandong Province, 266237, PR China
| | - Lining Zhao
- School of Environmental Science and Engineering, China-America CRC for Environment & Health, Shandong University, 72# Jimo Binhai Road, Qingdao, Shandong Province, 266237, PR China
| | - Jie Pan
- School of Environmental Science and Engineering, China-America CRC for Environment & Health, Shandong University, 72# Jimo Binhai Road, Qingdao, Shandong Province, 266237, PR China
| | - Qigui Niu
- School of Environmental Science and Engineering, China-America CRC for Environment & Health, Shandong University, 72# Jimo Binhai Road, Qingdao, Shandong Province, 266237, PR China
| | - Rutao Liu
- School of Environmental Science and Engineering, China-America CRC for Environment & Health, Shandong University, 72# Jimo Binhai Road, Qingdao, Shandong Province, 266237, PR China.
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28
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Minghetti P, Musazzi UM, Dorati R, Rocco P. The safety of tattoo inks: Possible options for a common regulatory framework. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 651:634-637. [PMID: 30245419 DOI: 10.1016/j.scitotenv.2018.09.178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 09/13/2018] [Accepted: 09/13/2018] [Indexed: 06/08/2023]
Abstract
Tattoo prevalence has been increasing in the last 25 years, but specific regulations on tattoo inks are still missing. In the European Union, no supranational regulation is available and only few national provisions cover them. In the United States, tattoo inks are classified as cosmetics but are not approved for injection into the dermis. Health risks for consumers may derive from microbiological contamination and the presence of toxic substances or nanomaterials. However, current regulations and non-binding recommendations, where present, only address the microbiological and chemical risks, completely overlooking nanotoxicity. The aim of this paper is to promote awareness of the risks associated with tattoo inks and the nanomaterials contained therein. In particular, the need for a harmonised regulation or, at least, a set of minimal requirements is highlighted to improve the safety of tattoo inks and market surveillance by regulatory authorities.
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Affiliation(s)
- Paola Minghetti
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, via G. Colombo, 71-20133 Milan, Italy.
| | - Umberto M Musazzi
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, via G. Colombo, 71-20133 Milan, Italy
| | - Rossella Dorati
- Department of Drug Sciences, Università di Pavia, Viale Taramelli, 12-27100 Pavia, Italy
| | - Paolo Rocco
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, via G. Colombo, 71-20133 Milan, Italy
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Arl M, Nogueira DJ, Schveitzer Köerich J, Mottim Justino N, Schulz Vicentini D, Gerson Matias W. Tattoo inks: Characterization and in vivo and in vitro toxicological evaluation. JOURNAL OF HAZARDOUS MATERIALS 2019; 364:548-561. [PMID: 30388639 DOI: 10.1016/j.jhazmat.2018.10.072] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/09/2018] [Accepted: 10/22/2018] [Indexed: 06/08/2023]
Abstract
Tattoo inks represent a growing market in the world economy, but this growth is associated with an increase in reports of adverse effects caused by the use of this product. In this study, four commercial tattoo inks (blue, green, red and black) were studied to characterize the composition and particle size and identify possible in vivo and in vitro toxicological effects on Daphnia magna and HaCaT cells, respectively. Compositional analysis confirmed the functional groups in the vehicles and organic pigments. The presence of nanoparticles was confirmed by image analysis. The toxicological evaluation indicated distinct results for blue and green inks for the parameters tested, despite the presence of similar levels of metals. The red ink, followed by the green, presented the highest toxicity, which may be related to pigments containing azo compounds and not to the metal fraction. Black ink was found to be the safest toxicologically. This paper provides an overview of the composition of tattoo inks and their toxicological effects in epidermal cells and in the environment.
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Affiliation(s)
- Miriam Arl
- Department of Sanitary and Environmental Engineering, Federal University of Santa Catarina State, Florianópolis, Brazil
| | - Diego José Nogueira
- Department of Sanitary and Environmental Engineering, Federal University of Santa Catarina State, Florianópolis, Brazil
| | - Jéssica Schveitzer Köerich
- Department of Sanitary and Environmental Engineering, Federal University of Santa Catarina State, Florianópolis, Brazil
| | - Naiara Mottim Justino
- Department of Sanitary and Environmental Engineering, Federal University of Santa Catarina State, Florianópolis, Brazil
| | - Denice Schulz Vicentini
- Department of Sanitary and Environmental Engineering, Federal University of Santa Catarina State, Florianópolis, Brazil
| | - William Gerson Matias
- Department of Sanitary and Environmental Engineering, Federal University of Santa Catarina State, Florianópolis, Brazil.
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Manso M, Pessanha S, Guerra M, Reinholz U, Afonso C, Radtke M, Lourenço H, Carvalho ML, Buzanich AG. Assessment of Toxic Metals and Hazardous Substances in Tattoo Inks Using Sy-XRF, AAS, and Raman Spectroscopy. Biol Trace Elem Res 2019; 187:596-601. [PMID: 29948912 DOI: 10.1007/s12011-018-1406-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/01/2018] [Indexed: 11/26/2022]
Abstract
Synchrotron radiation X-ray fluorescence spectroscopy, in conjunction with atomic absorption and Raman spectroscopy, was used to analyze a set of top brand tattoo inks to investigate the presence of toxic elements and hazardous substances. The Cr, Cu, and Pb contents were found to be above the maximum allowed levels established by the Council of Europe through the resolution ResAP(2008)1 on requirements and criteria for the safety of tattoos and permanent makeup. Raman analysis has revealed the presence of a set of prohibited substances mentioned in ResAP(2008)1, among which are the pigments Blue 15, Green 7, and Violet 23. Other pigments that were identified in white, black, red, and yellow inks are the Pigment White 6, Carbon Black, Pigment Red 8, and a diazo yellow, respectively. The present results show the importance of regulating tattoo ink composition.
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Affiliation(s)
- Marta Manso
- LIBPhys-UNL Laboratório de Instrumentação, Engenharia Biomédica e Física da Radiação, Departamento de Física, Faculdade de Ciências e Tecnologia (FCT), Universidade Nova de Lisboa, 2829-516, Costa de Caparica, Portugal.
| | - Sofia Pessanha
- LIBPhys-UNL Laboratório de Instrumentação, Engenharia Biomédica e Física da Radiação, Departamento de Física, Faculdade de Ciências e Tecnologia (FCT), Universidade Nova de Lisboa, 2829-516, Costa de Caparica, Portugal
| | - Mauro Guerra
- LIBPhys-UNL Laboratório de Instrumentação, Engenharia Biomédica e Física da Radiação, Departamento de Física, Faculdade de Ciências e Tecnologia (FCT), Universidade Nova de Lisboa, 2829-516, Costa de Caparica, Portugal
| | - Uwe Reinholz
- Federal Institute for Materials Research and Testing (BAM), Richard-Willstätter-Str. 11, 12489, Berlin, Germany
| | - Cláudia Afonso
- Division of Aquaculture and Upgrading, IPMA Portuguese Institute for the Sea and Atmosphere, Avenida Brasılia, 1449-006, Lisbon, Portugal
| | - Martin Radtke
- Federal Institute for Materials Research and Testing (BAM), Richard-Willstätter-Str. 11, 12489, Berlin, Germany
| | - Helena Lourenço
- Division of Aquaculture and Upgrading, IPMA Portuguese Institute for the Sea and Atmosphere, Avenida Brasılia, 1449-006, Lisbon, Portugal
| | - Maria Luísa Carvalho
- LIBPhys-UNL Laboratório de Instrumentação, Engenharia Biomédica e Física da Radiação, Departamento de Física, Faculdade de Ciências e Tecnologia (FCT), Universidade Nova de Lisboa, 2829-516, Costa de Caparica, Portugal
| | - Ana Guilherme Buzanich
- Federal Institute for Materials Research and Testing (BAM), Richard-Willstätter-Str. 11, 12489, Berlin, Germany
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Gubala V, Johnston LJ, Krug HF, Moore CJ, Ober CK, Schwenk M, Vert M. Engineered nanomaterials and human health: Part 2. Applications and nanotoxicology (IUPAC Technical Report). PURE APPL CHEM 2018. [DOI: 10.1515/pac-2017-0102] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
AbstractResearch on engineered nanomaterials (ENM) has progressed rapidly from the very early stages of studying their unique, size-dependent physicochemical properties and commercial exploration to the development of products that influence our everyday lives. We have previously reviewed various methods for synthesis, surface functionalization, and analytical characterization of ENM in a publication titled ‘Engineered Nanomaterials: Preparation, Functionalization and Characterization’. In this second, inter-linked document, we first provide an overview of important applications of ENM in products relevant to human healthcare and consumer goods, such as food, textiles, and cosmetics. We then highlight the challenges for the design and development of new ENM for bio-applications, particularly in the rapidly developing nanomedicine sector. The second part of this document is dedicated to nanotoxicology studies of ENM in consumer products. We describe the various biological targets where toxicity may occur, summarize the four nanotoxicology principles, and discuss the need for careful consideration of the biodistribution, degradation, and elimination routes of nanosized materials before they can be safely used. Finally, we review expert opinions on the risk, regulation, and ethical aspects of using engineered nanomaterials in applications that may have direct or indirect impact on human health or our environment.
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Çelik S, Ilçe A, Andsoy II. Knowledge and Protective Behaviors About Skin Cancer Among Nursing Students in the West Black Sea Region of Turkey. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:885-892. [PMID: 28229313 DOI: 10.1007/s13187-017-1188-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Skin cancer is an important health problem worldwide among cancer types and results in death at a minimum level in the case of early diagnosis. Therefore, the application of prevention programs is vital. Nurses by definition take responsibility for programs in prevention, early diagnosis, and screening for cancer. This study was conducted to determine the extent of skin cancer knowledge and protective behaviors among nursing students in the West Black Sea Region of Turkey. This cross-sectional, descriptive study was conducted between February and May 2015. The study sample consisted of 965 nursing students. Data were collected by means of a questionnaire form. Nursing students had a moderate level of knowledge, with average scores of 24.35 ± 3.66. The knowledge levels of first-year students were lowest compared with other years. It was determined that, among nursing students, the percentage of "negative behaviors" in response to skin cancer protective behaviors was higher than for "positive behaviors." The results of this study highlight the knowledge level and skin cancer protective behaviors of nursing students. Training, seminars, and workshops that teach about risk factors, early detection, protective behaviors, and skin self-examination skills could increase the knowledge level of nursing students.
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Affiliation(s)
- Sevim Çelik
- Nursing Department, Health Sciences Faculty, Bülent Ecevit University, İbn-i Sina Campus, Kozlu, Zonguldak, Turkey.
| | - Arzu Ilçe
- Nursing Department, Bolu School of Health, Abant İzzet Baysal University, Bolu, Turkey
| | - Işıl Işik Andsoy
- Nursing Department, School of Health, Karabük University, Karabük, Turkey
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Alsing KK, Johannesen HH, Hvass Hansen R, Dirks M, Olsen O, Serup J. MR scanning, tattoo inks, and risk of thermal burn: An experimental study of iron oxide and organic pigments: Effect on temperature and magnetic behavior referenced to chemical analysis. Skin Res Technol 2017; 24:278-284. [PMID: 29250836 DOI: 10.1111/srt.12426] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Tattooed persons examined with magnetic resonance imaging (MRI) can develop burning sensation suggested in the literature to be thermal burn from the procedure. MRI-induced thermal effect and magnetic behavior of known tattoo pigments were examined ex vivo. MATERIALS AND METHODS Magnetic resonance imaging effects on 3 commonly used commercial ink stock products marketed for cosmetic tattooing was studied. A main study tested 22 formulations based on 11 pigment raw materials, for example, one line of 11 called pastes and another called dispersions. Samples were spread in petri dishes and tested with a 0.97 T neodymium solid magnet to observe visual magnetic behavior. Before MRI, the surface temperature of the ink was measured using an infrared probe. Samples were placed in a clinical 3T scanner. Two scans were performed, that is, one in the isocenter and one 30 cm away from the center. After scanning, the surface temperature was measured again. Chemical analysis of samples was performed by mass spectroscopy. RESULTS Mean temperature increase measured in the isocenter ranged between 0.14 and 0.26°C (P < .01) and in the off-center position from -0.16 to 0.21°C (P < .01). Such low increase of temperature is clinically irrelevant. Chemical analysis showed high concentrations of iron, but also nickel and chrome were found as contaminants. High concentration of iron was not associated with any increase of temperature or any physical draw or move of ink. CONCLUSION The study could not confirm any clinically relevant temperature increase of tattoo pigments after MRI.
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Affiliation(s)
- K K Alsing
- Department of Dermatology, the Tattoo Clinic, Bispebjerg University Hospital, Copenhagen, Denmark
| | - H H Johannesen
- Department of Radiology, Research Group, Copenhagen University Hospital, Herlev, Denmark
| | - R Hvass Hansen
- Department of Radiology, Research Group, Copenhagen University Hospital, Herlev, Denmark
| | - M Dirks
- H-A-N GmbH, Esslingen, Germany
| | - O Olsen
- Medico Chemical Lab ApS, Vedbaek, Denmark
| | - J Serup
- Department of Dermatology, the Tattoo Clinic, Bispebjerg University Hospital, Copenhagen, Denmark
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Seok J, Choi SY, Kwon TR, Kim JH, Park KY, Li K, Kim HS, Kim BJ. Tattoo Granuloma Restricted to Red Dyes. Ann Dermatol 2017; 29:824-826. [PMID: 29200786 PMCID: PMC5705379 DOI: 10.5021/ad.2017.29.6.824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/09/2016] [Accepted: 11/30/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Joon Seok
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sun Young Choi
- Department of Dermatology, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Tae-Rin Kwon
- Department of Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jong Hwan Kim
- Department of Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kui Young Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kapsok Li
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hee Sung Kim
- Department of Pathology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Beom Joon Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
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Schreiver I, Hesse B, Seim C, Castillo-Michel H, Villanova J, Laux P, Dreiack N, Penning R, Tucoulou R, Cotte M, Luch A. Synchrotron-based ν-XRF mapping and μ-FTIR microscopy enable to look into the fate and effects of tattoo pigments in human skin. Sci Rep 2017; 7:11395. [PMID: 28900193 PMCID: PMC5595966 DOI: 10.1038/s41598-017-11721-z] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 08/29/2017] [Indexed: 11/26/2022] Open
Abstract
The increasing prevalence of tattoos provoked safety concerns with respect to particle distribution and effects inside the human body. We used skin and lymphatic tissues from human corpses to address local biokinetics by means of synchrotron X-ray fluorescence (XRF) techniques at both the micro (μ) and nano (ν) scale. Additional advanced mass spectrometry-based methodology enabled to demonstrate simultaneous transport of organic pigments, heavy metals and titanium dioxide from skin to regional lymph nodes. Among these compounds, organic pigments displayed the broadest size range with smallest species preferentially reaching the lymph nodes. Using synchrotron μ-FTIR analysis we were also able to detect ultrastructural changes of the tissue adjacent to tattoo particles through altered amide I α-helix to β-sheet protein ratios and elevated lipid contents. Altogether we report strong evidence for both migration and long-term deposition of toxic elements and tattoo pigments as well as for conformational alterations of biomolecules that likely contribute to cutaneous inflammation and other adversities upon tattooing.
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Affiliation(s)
- Ines Schreiver
- German Federal Institute for Risk Assessment (BfR), Department of Chemical and Product Safety, Max-Dohrn-Strasse 8-10, 10589, Berlin, Germany
| | - Bernhard Hesse
- European Synchrotron Radiation Facility (ESRF), 38043, Grenoble, Cedex 9, France
| | - Christian Seim
- Physikalisch-Technische Bundesanstalt, Department of X-ray Spectrometry, Abbestrasse 2-12, 10587, Berlin, Germany.,Technische Universität Berlin, Institute for Optics and Atomic Physics, Hardenbergstrasse 36, 10623, Berlin, Germany
| | | | - Julie Villanova
- European Synchrotron Radiation Facility (ESRF), 38043, Grenoble, Cedex 9, France
| | - Peter Laux
- German Federal Institute for Risk Assessment (BfR), Department of Chemical and Product Safety, Max-Dohrn-Strasse 8-10, 10589, Berlin, Germany
| | - Nadine Dreiack
- German Federal Institute for Risk Assessment (BfR), Department of Chemical and Product Safety, Max-Dohrn-Strasse 8-10, 10589, Berlin, Germany
| | - Randolf Penning
- Institute of Forensic Medicine, Ludwig-Maximilians University, Munich, Germany
| | - Remi Tucoulou
- European Synchrotron Radiation Facility (ESRF), 38043, Grenoble, Cedex 9, France
| | - Marine Cotte
- European Synchrotron Radiation Facility (ESRF), 38043, Grenoble, Cedex 9, France
| | - Andreas Luch
- German Federal Institute for Risk Assessment (BfR), Department of Chemical and Product Safety, Max-Dohrn-Strasse 8-10, 10589, Berlin, Germany.
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Occupational dermal exposure to nanoparticles and nano-enabled products: Part I—Factors affecting skin absorption. Int J Hyg Environ Health 2016; 219:536-44. [DOI: 10.1016/j.ijheh.2016.05.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/25/2016] [Accepted: 05/26/2016] [Indexed: 11/23/2022]
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Reiter O, Atzmony L, Akerman L, Levi A, Kershenovich R, Lapidoth M, Mimouni D. Picosecond lasers for tattoo removal: a systematic review. Lasers Med Sci 2016; 31:1397-405. [PMID: 27311768 DOI: 10.1007/s10103-016-2001-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
Abstract
Given that the pigment particles in tattoos have a relaxation time of <10 ns, picosecond lasers would be expected to be more effective than nanosecond lasers in tattoo removal. To systematically review the evidence regarding the effectiveness and safety of picosecond lasers for tattoo removal, Pubmed, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and reference lists were searched for relevant trials. The primary outcome was >70 % clearance of tattoo pigment. Secondary outcomes were 90-100 % clearance of tattoo pigment, number of laser sessions required, and adverse effects. Eight trials were included, six with human participants (160 participants) and 2 with animal models. Seven of the eight trials explored the usage of either 755, 758, 795, 1064, or 1064/532-nm picosecond lasers for black and blue ink tattoos. In the human trials, 69-100 % of tattoos showed over 70 % clearance of pigment after 1-10 laser treatments. Reported side effects included pain, hyperpigmentation and hypopigmentation, blister formation and transient erythema, edema, and pinpoint bleeding. Included articles varied in type of laser investigated, mostly non-comparative studies and with a medium to high risk of bias. There is sparse evidence that picosecond lasers are more effective than their nanosecond counterparts for mainly black and blue ink tattoo removal, with minor side effects.
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Affiliation(s)
- Ofer Reiter
- Department of Dermatology, Rabin Medical Center, Beilinson Campus, 39 Jabotinski St., Petach Tikva, Israel, 49100.
| | - Lihi Atzmony
- Department of Dermatology, Rabin Medical Center, Beilinson Campus, 39 Jabotinski St., Petach Tikva, Israel, 49100
| | - Lehavit Akerman
- Department of Dermatology, Rabin Medical Center, Beilinson Campus, 39 Jabotinski St., Petach Tikva, Israel, 49100
| | - Assi Levi
- Department of Dermatology, Rabin Medical Center, Beilinson Campus, 39 Jabotinski St., Petach Tikva, Israel, 49100
| | - Ruben Kershenovich
- Department of Dermatology, Rabin Medical Center, Beilinson Campus, 39 Jabotinski St., Petach Tikva, Israel, 49100
| | - Moshe Lapidoth
- Department of Dermatology, Rabin Medical Center, Beilinson Campus, 39 Jabotinski St., Petach Tikva, Israel, 49100.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Daniel Mimouni
- Department of Dermatology, Rabin Medical Center, Beilinson Campus, 39 Jabotinski St., Petach Tikva, Israel, 49100.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
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Schmitz I, Prymak O, Epple M, Ernert C, Tannapfel A. Plattenepithelkarzinom in Verbindung mit einer roten Tätowierung. J Dtsch Dermatol Ges 2016; 14:604-10. [DOI: 10.1111/ddg.12730_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Inge Schmitz
- Institut für Plastische Chirurgie, Georgius Agricola Stiftung Ruhr, Ruhr-Universität Bochum; Deutschland Germany
| | - Oleg Prymak
- Anorganische Chemie und Center for Nanointegration Duisburg-Essen [CeNIDE], Universität Duisburg-Essen; Deutschland Germany
| | - Matthias Epple
- Anorganische Chemie und Center for Nanointegration Duisburg-Essen [CeNIDE], Universität Duisburg-Essen; Deutschland Germany
| | - Carsten Ernert
- Klinik für plastische Chirurgie, Bergmannstrost Halle/Saale; Deutschland Germany
| | - Andrea Tannapfel
- Institut für Plastische Chirurgie, Georgius Agricola Stiftung Ruhr, Ruhr-Universität Bochum; Deutschland Germany
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Schmitz I, Prymak O, Epple M, Ernert C, Tannapfel A. Squamous cell carcinoma in association with a red tattoo. J Dtsch Dermatol Ges 2016; 14:604-9. [DOI: 10.1111/ddg.12730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Inge Schmitz
- Institute of Pathology; Georgius Agricola Foundation Ruhr; Ruhr University Bochum; Germany
| | - Oleg Prymak
- Inorganic Chemistry and Center for Nanointegration Duisburg-Essen (CeNIDE); University of Duisburg-Essen; Germany
| | - Matthias Epple
- Inorganic Chemistry and Center for Nanointegration Duisburg-Essen (CeNIDE); University of Duisburg-Essen; Germany
| | - Carsten Ernert
- Institute of Plastic Surgery; Bergmannstrost Halle/Saale; Germany
| | - Andrea Tannapfel
- Institute of Pathology; Georgius Agricola Foundation Ruhr; Ruhr University Bochum; Germany
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Hutton Carlsen K, Køcks M, Sepehri M, Serup J. Allergic reactions in red tattoos: Raman spectroscopy for 'fingerprint' detection of chemical risk spectra in tattooed skin and culprit tattoo inks. Skin Res Technol 2016; 22:460-469. [PMID: 26991512 DOI: 10.1111/srt.12287] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2015] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to assess the feasibility of Raman spectroscopy as a screening technique for chemical characterisation of tattoo pigments in pathologic reacting tattoos and tattoo ink stock products to depict unsafe pigments and metabolites of pigments. MATERIALS/METHODS Twelve dermatome shave biopsies from allergic reactions in red tattoos were analysed with Raman spectroscopy (A 785-nm 300 mW diode laser). These were referenced to samples of 10 different standard tattoo ink stock products, three of these identified as the culprit inks used by the tattooist and thus by history the source of the allergy. Three primary aromatic amine (PAA) laboratory standards (aniline, o-anisidine and 3,3'-dichlorobenzidine) were also studied. RESULTS Application of Raman spectroscopy to the shave biopsies was technically feasible. In addition, all ten inks and the three PAA standards could be discriminated. 10/12 shave biopsies provided clear fingerprint Raman signals which differed significantly from background skin, and Raman spectra from 8/12 biopsies perfectly matched spectra from the three culprit ink products. The spectrum of one red ink (a low cost product named 'Tattoo', claimed to originate from Taiwan, no other info on label) was identified in 5/12 biopsies. Strong indications of the inks 'Bright Red' and 'Crimson Red' were seen in three biopsies. The three PAA's could not be unambiguously identified. CONCLUSION This study, although on a small-scale, demonstrated Raman spectroscopy to be feasible for chemical analysis of red pigments in allergic reactions. Raman spectroscopy has a major potential for fingerprint screening of problematic tattoo pigments in situ in skin, ex vivo in skin biopsies and in tattoo ink stock products, thus, to eliminate unsafe ink products from markets.
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Affiliation(s)
- K Hutton Carlsen
- Department of Dermatology, The "Tattoo Clinic", Bispebjerg University Hospital, Copenhagen, Denmark.
| | - M Køcks
- Chemistry and Biotechnology, Danish Technological Institute, Aarhus, Denmark
| | - M Sepehri
- Centre of Wound Healing, Bispebjerg University Hospital, Copenhagen, Denmark
| | - J Serup
- Department of Dermatology, The "Tattoo Clinic", Bispebjerg University Hospital, Copenhagen, Denmark
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Laux P, Tralau T, Tentschert J, Blume A, Dahouk SA, Bäumler W, Bernstein E, Bocca B, Alimonti A, Colebrook H, de Cuyper C, Dähne L, Hauri U, Howard PC, Janssen P, Katz L, Klitzman B, Kluger N, Krutak L, Platzek T, Scott-Lang V, Serup J, Teubner W, Schreiver I, Wilkniß E, Luch A. A medical-toxicological view of tattooing. Lancet 2016. [PMID: 26211826 DOI: 10.1016/s0140-6736(15)60215-x] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
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.
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Affiliation(s)
- Peter Laux
- German Federal Institute for Risk Assessment (BfR), Department of Product Safety, Berlin, Germany
| | - Tewes Tralau
- German Federal Institute for Risk Assessment (BfR), Department of Product Safety, Berlin, Germany
| | - Jutta Tentschert
- German Federal Institute for Risk Assessment (BfR), Department of Product Safety, Berlin, Germany
| | - Annegret Blume
- German Federal Institute for Risk Assessment (BfR), Department of Product Safety, Berlin, Germany
| | - Sascha Al Dahouk
- German Federal Institute for Risk Assessment (BfR), Department of Product Safety, Berlin, Germany
| | - Wolfgang Bäumler
- Klinik und Poliklinik für Dermatologie, Universität Regensburg, Regensburg, Germany
| | | | | | | | | | | | | | - Urs Hauri
- Kantonales Laboratorium Basel-Stadt, Basel, Switzerland
| | - Paul C Howard
- US Food and Drug Administration, National Center for Toxicological Research, Jefferson, AR, USA
| | - Paul Janssen
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Linda Katz
- US Food and Drug Administration, College Park, MD, USA
| | - Bruce Klitzman
- Duke University Medical Center, Research Park, Durham, NC, USA
| | - Nicolas Kluger
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lars Krutak
- Smithsonian Institution, Washington, DC, USA
| | - Thomas Platzek
- German Federal Institute for Risk Assessment (BfR), Department of Product Safety, Berlin, Germany
| | | | - Jørgen Serup
- Bispebjerg University Hospital, Department of Dermatology, The Tattoo Clinic, Copenhagen, Denmark
| | | | - Ines Schreiver
- German Federal Institute for Risk Assessment (BfR), Department of Product Safety, Berlin, Germany
| | - Elena Wilkniß
- German Federal Institute for Risk Assessment (BfR), Department of Product Safety, Berlin, Germany
| | - Andreas Luch
- German Federal Institute for Risk Assessment (BfR), Department of Product Safety, Berlin, Germany.
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Kluger N. Self-reported tattoo reactions in a cohort of 448 French tattooists. Int J Dermatol 2015; 55:764-8. [PMID: 26499460 DOI: 10.1111/ijd.13030] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 01/13/2015] [Accepted: 03/04/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Self-reported complaints in people having tattoos, including swelling, itch, and photosensitivity, are frequent. Tattooists are usually heavily tattooed with multiple extended colored tattoos and constitute a specific population of interest. OBJECTIVES To assess the prevalence of cutaneous complications on tattoos among a cohort of French tattooists. METHODS An observational self-reported internet survey was performed among the tattooists of the French Tattoo Union in November 2013 to report on complaints about their tattoos. RESULTS Of the 448 respondents, 42.6% reported a "tattoo reaction" on a least one of their previous tattoos: transient itch (45.7%), wax-and-waning swelling (57%), and swelling after sun exposure (23%). A tattoo "allergy" on one color of the tattoo was found in 8%. Permanent itch, swelling, and cutaneous infection were rare. No skin cancer on tattoos was reported. The binary regression analysis revealed that the area of the tattooed body surface was the main driver of the risk of developing a tattoo reaction, mainly transient or permanent swelling triggered by sun exposure or not. The tattoo reaction, transient itch, and swelling on tattoos seemed to be associated with the sun protection habits of the tattooed individuals. CONCLUSION Professional tattooists have a high prevalence of minor complaints (transient itch and swelling) and photosensitivity on their tattoos such as in the general tattooed population.
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Affiliation(s)
- Nicolas Kluger
- Department of Dermatology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
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Bernstein EF, Schomacker KT, Basilavecchio LD, Plugis JM, Bhawalkar JD. A novel dual-wavelength, Nd:YAG, picosecond-domain laser safely and effectively removes multicolor tattoos. Lasers Surg Med 2015; 47:542-548. [PMID: 26175187 PMCID: PMC5034826 DOI: 10.1002/lsm.22391] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2015] [Indexed: 11/24/2022]
Abstract
Background and Objectives Although nanosecond‐domain lasers have been the mainstay of laser tattoo removal for decades, recent disruptive innovations in laser design have introduced a new class of commercial Q‐switched lasers that generate picosecond‐domain pulses. Study A picosecond‐domain, Nd:YAG laser with a KTP frequency‐doubling crystal was used to treat 31 decorative tattoos in 21 subjects. Safety and effectiveness were determined by blinded evaluation of digital images in this prospective clinical study. Results The average clearance overall as evaluated by blinded observers evaluating randomized digital photographs was 79 ± 0.9% (mean ± sem) after an average of 6.5 treatments. Of the 31 tattoos completing treatment, 6 had evidence of mild hyper‐ or hypo‐pigmentation by evaluation of photographs. Conclusion The 350 picosecond, 532 nm, and 450 picosecond 1,064 nm Nd:YAG laser is safe and effective for removing decorative tattoos. Lasers Surg. Med. 47:542–548, 2015. © 2015 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Eric F Bernstein
- Main Line Center for Laser Surgery, Ardmore, Pennsylvania, 19003
| | - Kevin T Schomacker
- Syneron-Candela Corporation, 530 Boston Post Road, Wayland, Massachusetts, 01778
| | | | - Jessica M Plugis
- Main Line Center for Laser Surgery, Ardmore, Pennsylvania, 19003
| | - Jayant D Bhawalkar
- Syneron-Candela Corporation, 530 Boston Post Road, Wayland, Massachusetts, 01778
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Lerche CM, Sepehri M, Serup J, Poulsen T, Wulf HC. Black tattoos protect against UVR-induced skin cancer in mice. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2015; 31:261-8. [DOI: 10.1111/phpp.12181] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/14/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Catharina M. Lerche
- Department of Dermatology; Copenhagen University Hospital; Bispebjerg Copenhagen Denmark
| | - Mitra Sepehri
- Wound Healing Center; Copenhagen University Hospital; Bispebjerg Copenhagen Denmark
| | - Jørgen Serup
- Department of Dermatology; Copenhagen University Hospital; Bispebjerg Copenhagen Denmark
| | - Thomas Poulsen
- Department of Pathology; Hospital of Southern Jutland; Soenderborg Denmark
| | - Hans Christian Wulf
- Department of Dermatology; Copenhagen University Hospital; Bispebjerg Copenhagen Denmark
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47
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Høgsberg T, Thomsen BM, Serup J. Histopathology and immune histochemistry of red tattoo reactions. Interface dermatitis is the lead pathology, with increase in T-lymphocytes and Langerhans cells suggesting an allergic pathomechanism. Skin Res Technol 2015; 21:449-58. [PMID: 26031754 DOI: 10.1111/srt.12213] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND The majority of tattoo reactions are affiliated to red pigmented areas and often suspected to be allergic in nature. A sizeable series of biopsies of such reactions has not previously been performed. The aim of this study was to type and grade epidermal and dermal changes in tattoo reactions to red/red nuances by microscopy and immunochemistry relevant for the assessment of a possible allergic pathomechanism. METHODS Skin biopsies were taken from red tattoo reactions, graded by conventional microscopy and stained for T and B-lymphocytes, Langerhans cells, macrophages and tumour necrosis factor (TNF)-α. RESULTS The study included 19 biopsies from 19 patients. The culprit colours were red/pink (n = 15) and purple/bordeaux (n = 4). Interface dermatitis was clearly the lead pathology found in 78% of samples, overlapped with granulomatous (in 32%) and pseudolymphomatous reaction patterns (in 32%). Epidermal hyperkeratosis (in 89%) was common as was leakage of red pigment across the dermo-epidermal junction, with transepidermal elimination (in 28%). The dermal cellular infiltration was dominated by T-lymphocytes (in 100%), Langerhans cells (in 95%) and macrophages (in 100%). TNF-α was common. CONCLUSION The predominant histological pattern of chronic tattoo reactions in red/red nuances is interface dermatitis. T-lymphocytes and Langerhans cells are increased suggesting an allergic pathomechanism. TNF-α may contribute to reactions. In many cases, overlapping reactive patterns were identified.
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Affiliation(s)
- T Høgsberg
- Department of Dermatology, Bispebjerg University Hospital, Copenhagen NV, Denmark
| | - B M Thomsen
- Department of Pathology, Bispebjerg University Hospital, Copenhagen NV, Denmark
| | - J Serup
- Department of Dermatology, Bispebjerg University Hospital, Copenhagen NV, Denmark
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48
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Brady BG, Gold H, Leger EA, Leger MC. Self-reported adverse tattoo reactions: a New York City Central Park study. Contact Dermatitis 2015; 73:91-9. [DOI: 10.1111/cod.12425] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 04/13/2015] [Accepted: 04/27/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Bobbi G. Brady
- Department of Medicine; Norwalk Hospital; Norwalk CT 06850
| | - Heidi Gold
- Department of Medicine; Maimonides Medical Center; Brooklyn NY 11219
| | - Elizabeth A. Leger
- Department of Natural Resources and Environmental Science; University of Nevada; Reno NV 89557 USA
| | - Marie C. Leger
- Ronald O. Perelman Department of Dermatology; New York University; New York NY 10016 USA
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49
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Grant CA, Twigg PC, Baker R, Tobin DJ. Tattoo ink nanoparticles in skin tissue and fibroblasts. BEILSTEIN JOURNAL OF NANOTECHNOLOGY 2015; 6:1183-1191. [PMID: 26171294 PMCID: PMC4464189 DOI: 10.3762/bjnano.6.120] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 04/22/2015] [Indexed: 06/04/2023]
Abstract
Tattooing has long been practised in various societies all around the world and is becoming increasingly common and widespread in the West. Tattoo ink suspensions unquestionably contain pigments composed of nanoparticles, i.e., particles of sub-100 nm dimensions. It is widely acknowledged that nanoparticles have higher levels of chemical activity than their larger particle equivalents. However, assessment of the toxicity of tattoo inks has been the subject of little research and ink manufacturers are not obliged to disclose the exact composition of their products. This study examines tattoo ink particles in two fundamental skin components at the nanometre level. We use atomic force microscopy and light microscopy to examine cryosections of tattooed skin, exploring the collagen fibril networks in the dermis that contain ink nanoparticles. Further, we culture fibroblasts in diluted tattoo ink to explore both the immediate impact of ink pigment on cell viability and also to observe the interaction between particles and the cells.
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Affiliation(s)
- Colin A Grant
- Advanced Materials Engineering, Faculty of Engineering and Informatics, University of Bradford, Bradford, BD7 1DP, United Kingdom
| | - Peter C Twigg
- Advanced Materials Engineering, Faculty of Engineering and Informatics, University of Bradford, Bradford, BD7 1DP, United Kingdom
| | - Richard Baker
- Centre for Skin Sciences, Faculty of Life Sciences, University of Bradford, Bradford, BD7 1DP, United Kingdom
| | - Desmond J Tobin
- Centre for Skin Sciences, Faculty of Life Sciences, University of Bradford, Bradford, BD7 1DP, United Kingdom
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Hutton Carlsen K, Serup J. Tattooing may cause life‐threatening latex allergy. J Eur Acad Dermatol Venereol 2015; 30:1242-4. [DOI: 10.1111/jdv.13171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- K. Hutton Carlsen
- Department of Dermatology The “Tattoo Clinic” Bispebjerg University Hospital Copenhagen Denmark
| | - J. Serup
- Department of Dermatology The “Tattoo Clinic” Bispebjerg University Hospital Copenhagen Denmark
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