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Kassirer S, Marini L, Zachary CB, Sarnoff DS, Landau M. Esthetic and medical tattooing: Part I: Tattooing techniques, implications, and adverse effects in healthy populations and special groups. J Am Acad Dermatol 2024:S0190-9622(24)00964-2. [PMID: 38980248 DOI: 10.1016/j.jaad.2024.05.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 07/10/2024]
Abstract
Tattooing, the introduction of exogenous pigments into the skin, has a rich history spanning thousands of years, with cultural, cosmetic, and medical significance. With the increasing prevalence of tattoos, understanding their potential complications and contraindications is of growing importance. The most common complications are hypersensitivity reactions, which may vary in morphology and timing. Infectious complications are often due to inadequate aseptic and hygienic practices during the tattooing process or healing period. Tattoo pigment can present diagnostic challenges, affecting cancer diagnosis and imaging. This CME article explores the history, cultural significance, epidemiology, chemistry, technique, contraindications, and complications of tattoos. Appreciating these factors can help individuals considering tattoos understand the safety and potential risks of their body art, and provide physicians with a thorough understanding of tattooing if consulted.
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Affiliation(s)
- Samuel Kassirer
- American Medical Program, Tel Aviv University Faculty of Medicine, Tel Aviv, Israel
| | - Leonardo Marini
- Diplomate General Surgery and Dermatology, Medical and Scientific Director, SDC The Skin Doctors Center, Trieste, Italy
| | | | - Deborah S Sarnoff
- Clinical Professor, Ronald O. Perelman Department of Dermatology at NYU Grossman School of Medicine, New York, New York
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2
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Baselga M, Güemes A, Yus C, Alejo T, Sebastián V, Arribas D, Mendoza G, Monleón E, Arruebo M. Melanin-Based Nanoparticles for Lymph Node Tattooing: Experimental, Histopathological and Ultrastructural Study. NANOMATERIALS (BASEL, SWITZERLAND) 2024; 14:1149. [PMID: 38998754 PMCID: PMC11243654 DOI: 10.3390/nano14131149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/02/2024] [Accepted: 07/02/2024] [Indexed: 07/14/2024]
Abstract
In breast cancer, Targeted Axillary Dissection (TAD) allows for the selective excision of the sentinel lymph node (SLN) during primary tumor surgery. TAD consists of the resection of labelled SLNs prior to neoadjuvant chemotherapy (NACT). Numerous clinical and preclinical studies have explored the use of carbon-based colloids for SLN tattooing prior to NACT. However, carbon vectors show varying degrees of inflammatory reactions and, in about one fifth of cases, carbon particles migrate via the lymphatic pathway to other nodes, causing the SLN to mismatch the tattooed node. To overcome these limitations, in this study, we explored the use of melanin as a staining endogenous pigment. We synthesized and characterized melanin-loaded polymeric nanoparticles (Mel-NPs) and used them to tattoo lymph nodes in pig animal models given the similarity in the size of the human and pig nodes. Mel-NPs tattooed lymph nodes showed high identification rates, reaching 83.3% positive identification 16 weeks after tattooing. We did not observe any reduction in the identification as time increased, implying that the colloid is stable in the lymph node tissue. In addition, we performed histological and ultrastructural studies to characterize the biological behavior of the tag. We observed foreign-body-like granulomatous inflammatory responses associated with Mel-NPs, characterized by the formation of multinucleated giant cells. In addition, electron microscopy studies showed that uptake is mainly performed by macrophages, and that macrophages undergo cellular damage associated with particle uptake.
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Affiliation(s)
- Marta Baselga
- Institute for Health Research Aragon (IIS Aragón), 50009 Zaragoza, Spain
| | - Antonio Güemes
- Institute for Health Research Aragon (IIS Aragón), 50009 Zaragoza, Spain
- Department of Surgery, University of Zaragoza, 50009 Zaragoza, Spain
| | - Cristina Yus
- Institute for Health Research Aragon (IIS Aragón), 50009 Zaragoza, Spain
- Instituto de Nanociencia y Materiales de Aragon, CSIC-University of Zaragoza, 50009 Zaragoza, Spain
- Department of Chemical Engineering, University of Zaragoza, Campus Río Ebro, 50018 Zaragoza, Spain
| | - Teresa Alejo
- Institute for Health Research Aragon (IIS Aragón), 50009 Zaragoza, Spain
- Instituto de Nanociencia y Materiales de Aragon, CSIC-University of Zaragoza, 50009 Zaragoza, Spain
- Department of Chemical Engineering, University of Zaragoza, Campus Río Ebro, 50018 Zaragoza, Spain
| | - Víctor Sebastián
- Institute for Health Research Aragon (IIS Aragón), 50009 Zaragoza, Spain
- Instituto de Nanociencia y Materiales de Aragon, CSIC-University of Zaragoza, 50009 Zaragoza, Spain
- Department of Chemical Engineering, University of Zaragoza, Campus Río Ebro, 50018 Zaragoza, Spain
| | - Dolores Arribas
- Institute for Health Research Aragon (IIS Aragón), 50009 Zaragoza, Spain
- Department of Surgery, University of Zaragoza, 50009 Zaragoza, Spain
| | - Gracia Mendoza
- Institute for Health Research Aragon (IIS Aragón), 50009 Zaragoza, Spain
| | - Eva Monleón
- Institute for Health Research Aragon (IIS Aragón), 50009 Zaragoza, Spain
- Department of Human Anatomy and Histology, University of Zaragoza, 50009 Zaragoza, Spain
- Centro de Encefalopatías y Enfermedades Transmisibles Emergentes, University of Zaragoza, 50009 Zaragoza, Spain
| | - Manuel Arruebo
- Institute for Health Research Aragon (IIS Aragón), 50009 Zaragoza, Spain
- Instituto de Nanociencia y Materiales de Aragon, CSIC-University of Zaragoza, 50009 Zaragoza, Spain
- Department of Chemical Engineering, University of Zaragoza, Campus Río Ebro, 50018 Zaragoza, Spain
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Chalarca-Cañas D, Caviedes-Cleves MA, Correa-Londoño LA, Ospina-Gómez JP, Velásquez-Lopera MM. Tattoos: risks and complications, clinical and histopathological approach. An Bras Dermatol 2024; 99:491-502. [PMID: 38521707 PMCID: PMC11221160 DOI: 10.1016/j.abd.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/16/2023] [Accepted: 07/23/2023] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Skin modification through tattoos is as old as humanity itself. However, this trend is on the rise, and with the use of different types of pigments and application practices, both cutaneous and systemic complications can arise. Adverse reactions can be grouped into five classes: inflammatory, infectious, neoplastic, aesthetic, and miscellaneous. On histopathology, inflammatory reactions can exhibit a lichenoid pattern or present as spongiotic dermatitis, granulomatous reactions, pseudolymphoma, pseudoepitheliomatous hyperplasia, or scleroderma/morphea-like changes. This article reviews tattoo complications, including their clinical and histopathological characteristics. METHODS An open search was conducted on PubMed using the terms "tattoo", "complications", and "skin". No limits were set for period, language, or publication type of the articles. RESULTS Reactions to tattoos are reported in up to 67% of people who get tattooed, with papulonodular and granulomatous reactions being the most common. Some neoplastic complications have been described, but their causality is still debated. Any pigment can cause adverse reactions, although red ink is more frequently associated with them. Patients with pre-existing dermatoses may experience exacerbation or complications of their diseases when getting tattoos; therefore, this procedure is not recommended for this patient group. CONCLUSIONS Dermatological consultation is recommended before getting a tattoo, as well as a histopathological examination in case of complications. In patients who develop cutaneous inflammatory reactions following tattooing, additional studies are recommended to investigate systemic diseases such as sarcoidosis, pyoderma gangrenosum, atopic dermatitis, and neoplasms. It is important for physicians to be trained in providing appropriate care in case of complications.
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Affiliation(s)
- David Chalarca-Cañas
- Department of Dermatology, School of Medicine, University of Antioquia, Medellín, Colombia.
| | | | - Luis A Correa-Londoño
- Department of Dermatology, School of Medicine, University of Antioquia, Medellín, Colombia
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Sozer Karadagli S, Kaftan G, Cansever I, Armagan G, Sogut O. Tattoo inks: evaluation of cellular responses and analysis of some trace metals. Biometals 2024; 37:495-505. [PMID: 38038794 DOI: 10.1007/s10534-023-00564-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/12/2023] [Indexed: 12/02/2023]
Abstract
After tattoo application, inks remain in the skin, mostly in the dermal layer, and manufacturers use inks that have not been adequately evaluated for safety in tattoo production. In this study, the metal contents (Cd, Hg, Pb, and Cr) of tattoo inks available in the Turkish market were determined and the relationship between cell viability and inflammatory response of the detected metal levels was investigated. Nine tattoo inks (3 colors) from 3 different brands abbreviated as E, I, and W were examined. ICP-MS was used for element analysis. The viability of human keratinocyte cells was determined by the WST-1 assay following ink exposures at various dilutions. IL-18 levels were measured in cell culture supernatant by ELISA method following ink or metal (Cd, Cr, Hg, and Pb) exposures. The concentrations of trace elements were found in inks as follows: Cd, 0.0641-1.3857; Hg, 0.0204-0.2675; Pb, 0.8527-6.5981; Cr, 0.1731-45.3962 µg mL-1. It was observed that the levels of Pb and especially Cr in the samples exceeded the limit values. Tattoo inks reduced the cell viability in a dose- and color-dependent manner. IL-18 release was significantly increased in all groups except Cr and black ink of brand I treated cells (p < 0.05). Our results show that the metal contents of tattoo inks exceed Council of Europe Resolution values in some samples and some inks induce immune system activation (IL-18 secretion) and cytotoxic effects. It is thought that these findings may contribute to the toxic/adverse effects of tattoo inks commonly used.
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Affiliation(s)
- Sumru Sozer Karadagli
- Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Ege University, Izmir, Turkey.
| | - Gizem Kaftan
- Faculty of Pharmacy, Department of Biochemistry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Islam Cansever
- Central Research Laboratories, Katip Celebi University, Izmir, Turkey
| | - Guliz Armagan
- Faculty of Pharmacy, Department of Biochemistry, Ege University, Izmir, Turkey
| | - Ozlem Sogut
- Faculty of Pharmacy, Department of Analytical Chemistry, Ege University, Izmir, Turkey
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Kühn LM, Beiteke U, Nashan D. [Useful knowledge regarding tattoos]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00105-023-05184-9. [PMID: 37314452 DOI: 10.1007/s00105-023-05184-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 06/15/2023]
Abstract
The number of people with tattoos has continued to increase in recent years. In the USA about 23% and in Europe 9-12% of the population have tattoos. In the German media (2019) and by the infoportal Statista (2017), it is assumed that 21-25% of citizens have tattoos and that the trend is increasing (Statista 2018: 36%). Men and women wear tattoos equally. The age group 20-29 years dominates with almost 50% having tattoos. The following article describes the new regulations especially the REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals) regulation, legal basis, and governmental controls on the subject of "tattoos". The composition of tattooing agents and testing options relevant for the user before and for the performance of tattooing are presented. Dermatologically associated diseases and testing procedures are listed. Since 70% of the population denies knowledge of this information even when they have tattoos themselves, this update is written as an overview for treating physicians and users.
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Affiliation(s)
- L M Kühn
- Hautklinik, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Deutschland.
| | - U Beiteke
- Hautklinik, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Deutschland
| | - D Nashan
- Hautklinik, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Deutschland
- Hautarztpraxis, Müllheim, Deutschland
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6
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Schubert S, Kluger N, Schreiver I. Hypersensitivity to permanent tattoos: Literature summary and comprehensive review of patch tested tattoo patients 1997-2022. Contact Dermatitis 2023; 88:331-350. [PMID: 36772861 DOI: 10.1111/cod.14291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 02/01/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023]
Abstract
We outline constituents of tattoo and permanent make-up ink with regard to inflammatory tattoo reactions and population-based confounders. The comprehensive review of patch-tested tattoo patients between 1997 and 2022 shows that tattoo allergy cannot be reliably diagnosed via patch testing with today's knowledge. Weak penetration and slow haptenization of pigments, unavailability of pigments as test allergens and a lack of knowledge concerning relevant epitopes hamper the diagnosis of tattoo allergy. Patch testing p-phenylenediamine and disperse (textile) dyes is not able to close this gap. Sensitization to metals was associated with all types of tattoo complications, although often not clinically relevant for the tattoo reaction. Binders and industrial biocides are frequently missing on ink declarations and should be patch tested. The pigment carbon black (C.I. 77266) is no skin sensitizer. Patch tests with culprit inks were usually positive with cheap ink products for non-professional use or with professionally used inks in patients with eczematous reactions characterized by papules and infiltration. Tape stripping before patch testing and patch test readings on Day 8 or 10 may improve the diagnostic quality. The meaningfulness of the categorical EU-wide ban of Pigment Green 7 and Pigment Blue 15:3 is not substantiated by the presented data.
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Affiliation(s)
- Steffen Schubert
- Information Network of Departments of Dermatology (IVDK), Institute at the University Medical Center Göttingen, Göttingen, Germany
| | - Nicolas Kluger
- Department of Dermatology, 'Tattoo' Consultation, Bichat-Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.,Department of Dermatology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Ines Schreiver
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Berlin, Germany
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Stolecka-Warzecha A, Chmielewski Ł, Wilczyński S, Koprowski R. In vitro hyperspectral analysis of tattoo dyes. Skin Res Technol 2023; 29:e13268. [PMID: 36704880 PMCID: PMC9838748 DOI: 10.1111/srt.13268] [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: 08/01/2022] [Accepted: 12/18/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND There is no method that can guarantee effective, quick, and noninvasive removal of tattoo dyes. Laser methods are considered to be the method of choice. In this study, an attempt was made to determine the in vitro spectral characteristics of selected dyes used in permanent makeup and tattoos and to analyze the obtained parameters in terms of laser treatments optimization. MATERIALS AND METHODS Hyperspectral analysis was performed to determine the spectral characteristics of the dye on the entire surface of the slide. Seven dyes used in permanent makeup and tattoos were analyzed in vitro. The maximum reflectance and the wavelength for a given dye were determined for the maximum reflectance in the studied wavelength range: 400-1000 nm. The optical properties of the dyes were determined based on visible light imaging using camera. RESULTS The maximum radiation reflectance ranges from 634 to 732 nm for the tested dyes. Visually very similar colors may differ significantly in the wavelength for which the maximum absorption of the radiation occurs. White and yellow dyes are characterized by the highest reflectance value. The black dye is characterized by the lowest reflectance coefficient. Low reflectance of black dye results in more safe and effective removal treatments. CONCLUSION The homogeneity of radiation absorption can be identified using methods of analysis and processing of images in visible light. Optimization of the wavelength of which the maximum absorption/reflectance of radiation occurs may allow us to increase the effectiveness of laser treatments for removing permanent makeup and tattoos.
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Affiliation(s)
- Anna Stolecka-Warzecha
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - Łukasz Chmielewski
- Department of Motion Organ Reconstruction Surgery, Provincial Specialist Hospital Megrez, Tychy, Poland
| | - Sławomir Wilczyński
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - Robert Koprowski
- Institute of Biomedical Engineering, Faculty of Science and Technology, University of Silesia in Katowice, Sosnowiec, Poland
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Sethy M, Behera B, Dash S, Palit A, Nayak AK, Ayyanar P. Clinicodermoscopic and immunopathological profile of non-infectious non-eczematous inflammatory tattoo reactions: A retrospective study from a tertiary care centre of East India. Indian J Dermatol Venereol Leprol 2022:1-10. [DOI: 10.25259/ijdvl_85_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 07/01/2022] [Indexed: 11/05/2022]
Abstract
Introduction
Tattoo-associated complications are on the rise due to the popularity of decorative tattoos in recent years. The exact pathogeneses of various tattoo reaction patterns are still unclear, and their dermoscopic details are sparsely reported.
Aim
We aimed to retrospectively study the clinical, dermoscopic and immunopathological details of patients with non-infectious, non-eczematous inflammatory tattoo reaction patterns in a tertiary care centre of East India.
Method
The clinical, dermoscopic and pathological details of all the patients who had non-infectious, non-eczematous inflammatory tattoo reactions were collected. In all the cases, immunohistochemistry was done for CD1a, CD3, CD4, CD8, FoxP3, CD20 and CD56.
Results
A total of five patients of skin phototypes IV and V and six tattoo reactions were analysed. Five lesions had reactions at the site of a black tattoo, and one at the site of red tattoo. Clinically, the patients presented with erythematous or blue-grey flat-topped to verrucous papules and plaques. Dermoscopic features were dominated by a central white to pink-white structureless area, a peripheral grey-white to bluish-white structureless area, white scales, comedo-like opening with keratotic plugging, milia-like cysts and shiny white structures. Pathologically, except for one lesion that only showed a lichenoid reaction pattern in the red tattoo, all had a combination of reaction patterns. Immunohistochemistry showed increased epidermal and dermal Langerhans cells, predominantly CD8 positive T cells in the epidermis and dermis, sparse dermal B cells and CD4 positive T cells, reduced T regulatory cells and a complete absence of CD56 positive NK cells.
Limitations
Small sample size was the limitation of the study.
Conclusion
The clinical morphology and dermoscopy may not differentiate between various types of non-infectious non-eczematous inflammatory tattoo reactions. The immunological profile supports a delayed hypersensitivity reaction due to contact sensitisation to tattoo pigment, and CD8 positive T cells play a central role in executing various pathological reaction patterns, both in the epidermis and dermis.
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Affiliation(s)
| | | | - Siddhartha Dash
- Department of Dermatology, AIIMS, Bhubaneswar, Odisha, India
| | - Aparna Palit
- Department of Dermatology, AIIMS, Bhubaneswar, Odisha, India
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Othman S, Elfanagely O, Klifto K, Fowler C, Pugliese DJ, Kovach SJ. Surgical Excision and Reconstruction of Tattoo Following Hypersensitivity. EPLASTY 2022; 22:e15. [PMID: 35811643 PMCID: PMC9118029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Hypersensitivity reaction in a tattoo secondary to red ink is a relatively rare complication, particularly as the biochemical composition of tattoo dye has been refined. Most hypersensitivity reactions are amenable to conservative management, but less common is the necessity for full surgical excision and reconstruction. METHODS A 50-year-old female patient with a chronic tattoo granuloma causing excessive pruritus, erythema, and ulceration, refractory to conservative and minimally invasive techniques, underwent full surgical excision and skin-graft reconstruction of the areas affected by the red dye. Additionally, literature was reviewed for similar reports requiring excision. RESULTS The patient reports complete symptomatic resolution and satisfaction with the result. The literature reveals a small set of cases reporting a necessity for surgical excision following red-ink hypersensitivity. CONCLUSIONS Tattoo hypersensitivity secondary to a red ink-induced allergic reaction is relatively rare. Most cases are amenable to conservative treatment; however, surgical excision and reconstruction provides a viable option in cases refractory to traditional and less invasive management.
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Affiliation(s)
| | - Omar Elfanagely
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania; Philadelphia, PA
| | - Kevin Klifto
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania; Philadelphia, PA
| | - Cody Fowler
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania; Philadelphia, PA
| | - Douglas J Pugliese
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania; Philadelphia, PA
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Korn L, Bonny-Noach H, Koren G, Nissanholtz-Gannot R. Factors associated with medical complications after body art among Israeli adults: a retrospective study. Isr J Health Policy Res 2021; 10:39. [PMID: 34465378 PMCID: PMC8408962 DOI: 10.1186/s13584-021-00474-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Body-art, including tattoos and piercings, is steadily increasing world-wide but with relatively limited reporting of adverse outcomes. The objective of the present study was to identify correlates that would facilitate a preventative strategy to minimize adverse effects of body-art. METHODS We examined patterns of body-art, health risk and perceptions among 921 participants (54% female, mean age of 35; SD = 10.8) through in-person questionnaire. RESULTS A significantly lower frequency of those with body-art acknowledged that not all venues (parlors, clinics, etc.) are safe in terms of health and hygiene (84.7%t vs. 96.6%, p < .001) as compared to those without body-art. Similarly, knowledge of the need for a Ministry of Health certification was reported with lower frequency (77.2% vs. 94.5%, p < .001) among those with body-art. Those who experienced medical complications reported higher frequencies of smoking cigarettes and hookah as well as using ecstasy (MDMA). The risk of medical complication after body-art was 4 times higher in those who used ecstasy (OR = 3.97; CI 1.0-14.4; p < 0.05). In addition, it was more than 3 times higher for street or home tattooing as compared to studio or a licensed medical center (OR = 3.59; CI 1.32-9.76; p < .01), as well as almost 3 times higher among those who did not receive information before performing body-art (OR = 2.70; CI 1.05-6.92; p < .05) and who had somebody other than themselves decide on the body-art design (OR = 2.68; CI 1.00-7.19; p < .05). CONCLUSIONS A targeted informational-preventative program should be developed, informed by the risks highlighted in this study. In addition, it would be necessary to draft policies related to regulation and enforcement in order to more effectively manage body-art service provision. The Ministry of Health should supervise and guide tattooists and practitioners regarding the health risks of body-art and offer training and raise awareness among potential clients.
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Affiliation(s)
- Liat Korn
- Department of Health Systems Management, School of Health Sciences, Ariel University, Ariel, Israel
| | - Hagit Bonny-Noach
- Department of Criminology, School of Social Sciences, Ariel University, Ariel, Israel
| | - Gideon Koren
- Adelson Faculty of Medicine, Ariel University, Ariel, Israel and Motherisk Israel Program, Shamir Hospital, Be’er Ya’akov, Israel
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Zengarini C, Ferrari T, Orioni G, Mussi M, Patrizi A, Misciali C, Raone B. Cutaneous pseudolymphoma related to violet tattoo ink successfully treated with intralesional corticosteroid. Ital J Dermatol Venerol 2021; 157:290-291. [PMID: 34282865 DOI: 10.23736/s2784-8671.21.07064-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Corrado Zengarini
- Dermatology IRCCS Policlinico di Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Tiziano Ferrari
- Dermatology IRCCS Policlinico di Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy -
| | - Gionathan Orioni
- Dermatology IRCCS Policlinico di Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Martina Mussi
- Dermatology IRCCS Policlinico di Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Dermatology IRCCS Policlinico di Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Cosimo Misciali
- Dermatology IRCCS Policlinico di Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Beatrice Raone
- Dermatology IRCCS Policlinico di Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
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12
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Agarwal P, Jagati A, Mehta R, Vadher P, Rathod S, Bodar P. Histopathological evaluation of cutaneous reactions to tattoos: Study at a tertiary care center. J Cutan Pathol 2021; 48:870-876. [PMID: 33527478 DOI: 10.1111/cup.13973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/05/2021] [Accepted: 01/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tattooing has been around for many years and is becoming an increasingly common fashion trend. As there are often few regulatory laws regarding the practice, an increase in the incidence of cutaneous reactions to tattoo inks is noted. These include allergic reactions, granulomatous dermatitis, infections, lichenoid dermatoses, and sometimes malignancy. The present study examines the histopathological changes seen in patients with cutaneous reactions to tattoo ink. METHOD A prospective observational study was conducted over 18 months in the dermatology clinic of a tertiary care center in western India. The study population included 22 patients with cutaneous reactions over the tattoos. Punch biopsy specimens were sent to study the pattern of histopathological response. RESULTS All 22 patients studied were between the ages of 17 and 35 years. The mean duration of development of reaction was 8.1 months. Most of the reactions were seen in black ink tattoos performed by amateurs. Perivascular and spongiotic dermatitis suggestive of allergic response was the most common feature on histopathology. Granulomatous response and lichenoid response were seen in five and three biopsies, respectively. CONCLUSION Legalization is needed for this practice to prevent tattoo reactions. Histopathological evaluation is important as tattoo reactions may be associated with skin infections and malignancies.
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Affiliation(s)
- Pooja Agarwal
- Department of Skin & VD, Smt SCL General Hospital, Ahmedabad, India
| | - Ashish Jagati
- Department of Skin & VD, Smt SCL General Hospital, Ahmedabad, India
| | - Rupal Mehta
- Department of Pathology, AMC MET Medical College, Ahmedabad, India
| | - Priyanka Vadher
- Department of Skin & VD, Smt SCL General Hospital, Ahmedabad, India
| | - Santosh Rathod
- Department of Skin & VD, Smt SCL General Hospital, Ahmedabad, India
| | - Priyanka Bodar
- Department of Skin & VD, Smt SCL General Hospital, Ahmedabad, India
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13
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Zeng X, Xiang W. Oral bullous lichenoid tattoo reaction against red dyes on the lips. Int J Dermatol 2019; 58:e133-e135. [PMID: 30924139 DOI: 10.1111/ijd.14454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Xiaofang Zeng
- Department of Dermatology, Third Hospital of Hangzhou, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wenzhong Xiang
- Department of Dermatology, Third Hospital of Hangzhou, Hangzhou, China
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14
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Sauvageau AP, Mojeski JA, Bax MJ, Bogner PN. Delayed-onset pseudoepitheliomatous hyperplasia reaction to red tattoo pigment resembling squamous cell carcinoma. JAAD Case Rep 2019; 5:222-224. [PMID: 30809565 PMCID: PMC6374962 DOI: 10.1016/j.jdcr.2018.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Andrew P Sauvageau
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Jacob A Mojeski
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Michael J Bax
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Paul N Bogner
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, New York.,Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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15
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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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16
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Wilson WT, O'Boyle M, Leach WJ. Unusual complication of a tattoo in an immunosuppressed patient. BMJ Case Rep 2018; 2018:bcr-2018-224968. [PMID: 29914878 DOI: 10.1136/bcr-2018-224968] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Tattooing for decorative body art is becoming more popular and, as a result, so are tattoo-related complications. Patients are unlikely to discuss tattoos with medical professionals, even though these might be relevant. Long-term immunosuppressed patients are often young adults who may wish to consider tattooing. It is well recognised that immunosuppressed patients are at increased risk of infection including cutaneous mycobacterial infections. They therefore represent a group that is at a potentially higher risk of tattoo-related complications and warrant special consideration.We present the first documented case of inflammatory myopathy as a complication following tattooing in an immunosuppressed individual. This unusual case presented as distal thigh and medial knee pain and it was only after some time that a link to the tattoo was made. This serves as a reminder to consider tattoo-related complications in the differential diagnosis of unusual atraumatic musculoskeletal pain, especially in immunosuppressed individuals.
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Affiliation(s)
| | - Mannix O'Boyle
- Trauma and Orthopaedics, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - William J Leach
- Trauma and Orthopaedics, NHS Greater Glasgow and Clyde, Glasgow, UK
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17
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González-Villanueva I, Silvestre Salvador J. Diagnostic Tools to Use When We Suspect an Allergic Reaction to a Tattoo: A Proposal Based on Cases at Our Hospital. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2017.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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18
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Diagnostic Tools to Use When We Suspect an Allergic Reaction to a Tattoo: A Proposal Based on Cases at Our Hospital. ACTAS DERMO-SIFILIOGRAFICAS 2017; 109:162-172. [PMID: 29197467 DOI: 10.1016/j.ad.2017.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/10/2017] [Accepted: 10/30/2017] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Tattooing has become a popular practice in western countries, particularly among younger populations. Tattoos, however, can cause complications, such as infections, allergic or foreign-body reactions, and even systemic inflammatory responses. PATIENTS AND METHODS We conducted a retrospective study of all patients seen for tattoo-related complications at our skin allergy unit between January 2002 and December 2016. RESULTS We studied 23 patients. Nine of these experienced early complications, all related to infection. The other 14 patients developed late reactions. Ten were diagnosed with probable allergic contact dermatitis to ink, but the suspect allergen was identified in just 3 cases and confirmed in just 1 of these. There were 2 cases of cutaneous sarcoidosis, 1 case of foreign body granuloma, and 1 case of neuropathy. CONCLUSIONS Complications resulting from tattoos are relatively common dermatology complaints. Drawing from our experience, we propose a diagnostic algorithm designed to guide dermatologists in evaluating different reactions to tattoos and prescribing appropriate treatment.
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19
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Islam PS, Chang C, Selmi C, Generali E, Huntley A, Teuber SS, Gershwin ME. Medical Complications of Tattoos: A Comprehensive Review. Clin Rev Allergy Immunol 2016; 50:273-86. [DOI: 10.1007/s12016-016-8532-0] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Almodovar-Real A, Sánchez-López J, Navarro-Triviño F, Fernández-Pugnaire MA. [Lichenoid reaction to red pigment in a tattoo]. Semergen 2016; 42:e115-e117. [PMID: 26858227 DOI: 10.1016/j.semerg.2015.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 12/18/2015] [Accepted: 12/21/2015] [Indexed: 10/22/2022]
Affiliation(s)
- A Almodovar-Real
- Unidad de Gestión Clínica de Dermatología, Hospital Universitario San Cecilio, Granada, España.
| | - J Sánchez-López
- Unidad de Gestión Clínica de Dermatología, Hospital Universitario San Cecilio, Granada, España
| | - F Navarro-Triviño
- Unidad de Gestión Clínica de Dermatología, Hospital Universitario San Cecilio, Granada, España
| | - M A Fernández-Pugnaire
- Unidad de Gestión Clínica de Dermatología, Hospital Universitario San Cecilio, Granada, España
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21
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Godinho MM, Aguinaga F, Grynszpan R, Lima VM, Azulay DR, Cuzzi T, Ramos-E-Silva M, Manela-Azulay M. Granulomatous reaction to red tattoo pigment treated with allopurinol. J Cosmet Dermatol 2015. [PMID: 26211454 DOI: 10.1111/jocd.12149] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Granulomatous reactions to tattoo ink are most commonly associated with mercury sulfide, a component of red pigments. Treatment options show limited results. Allopurinol, an inhibitor of xanthine oxidase, has been reported as a successful alternative treatment to granulomatous disorders, such as sarcoidosis and granulomatous reactions to fillers and tattoos. We report a case of granulomatous reaction to red tattoo pigment treated with allopurinol for 6 months. Good clinical improvement could be noticed during this time. Two months after we stopped the treatment, the lesion recurred. Allopurinol emerges as an important drug for the management of granulomatous reactions caused by tattoo pigments. Based on the significant clinical improvement noticed during its use, we recommend new studies to elucidate all the potential benefits of the use of allopurinol for the treatment of granulomatous reactions to tattoo ink.
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Affiliation(s)
- Mariana Marteleto Godinho
- Sector of Dermatology and Post-Graduation Course in Dermatology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Felipe Aguinaga
- Sector of Dermatology and Post-Graduation Course in Dermatology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rachel Grynszpan
- Sector of Dermatology and Post-Graduation Course in Dermatology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Victor Maselli Lima
- Sector of Plastic Surgery, Ivo Pitanguy Institute/Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - David Rubem Azulay
- Sector of Dermatology and Post-Graduation Course in Dermatology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tullia Cuzzi
- Sector of Pathology and Post-Graduation Course, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcia Ramos-E-Silva
- Sector of Dermatology and Post-Graduation Course in Dermatology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mônica Manela-Azulay
- Sector of Dermatology and Post-Graduation Course in Dermatology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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22
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Abstract
Decorative tattoo is a popular practice that is generally safe when performed in the professional setting but can be associated with a variety of inflammatory, infectious, and neoplastic complications, risks that may be increased with current trends in home tattooing. Modern tattoo inks contain azo dyes and are often of unknown composition and not currently regulated for content or purity. Biopsy of most (if not all) tattoo reactions presenting to the dermatologist is recommended, given recent clusters of nontuberculous mycobacterial infections occurring within tattoo, as well as associations between tattoo reactions and systemic diseases such as sarcoidosis.
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Affiliation(s)
- Michi M Shinohara
- Divisions of Dermatology and Dermatopathology, University of Washington School of Medicine, Seattle, Washington.
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23
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Khunger N, Molpariya A, Khunger A. Complications of Tattoos and Tattoo Removal: Stop and Think Before you ink. J Cutan Aesthet Surg 2015; 8:30-6. [PMID: 25949020 PMCID: PMC4411590 DOI: 10.4103/0974-2077.155072] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Tattooing is a process of implantation of permanent pigment granules in the skin. Tattoos can be decorative, medical or accidental. There has been a exponential increase in decorative tattooing as a body art in teenagers and young adults. Unfortunately there are no legislations to promote safe tattooing, hence complications are quite common. Superficial and deep local infections, systemic infections, allergic reactions, photodermatitis, granulomatous reactions and lichenoid reactions may occur. Skin diseases localised on the tattooed area, such as eczema, psoriasis, lichen planus, and morphea can be occasionally seen. When used as a camouflage technique, colour mismatch and patient dissatisfaction are common complications. On the other hand, regrets after a tattoo are also seen and requests for tattoo removal are rising. Laser tattoo removal using Q-switched lasers are the safest; however, complications can occur. Acute complications include pain, blistering, crusting and pinpoint hemorrhage. Among the delayed complications pigmentary changes, hypopigmentation and hyperpigmentation, paradoxical darkening of cosmetic tattoos and allergic reactions can be seen. Another common complication is the presence of residual pigmentation or ghost images. Scarring and textural changes are potential irreversible complications. In addition, tattoo removal can be a prolonged tedious procedure, particularly with professional tattoos, which are difficult to erase as compared to amateur tattoos. Hence the adage, stop and think before you ink holds very much true in the present scenario.
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Affiliation(s)
- Niti Khunger
- Department of Dermatology, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | - Anupama Molpariya
- Department of Dermatology, Pt. Madan Mohan Malviya Hospital, Malviya Nagar, New Delhi, India
| | - Arjun Khunger
- Department of Dermatology, Maulana Azad Medical College, LN Hospital, New Delhi, India
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24
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Mikkelsen CS, Holmgren HR, Arvesen KB, Jarjis RD, Gunnarsson GL. Severe scratcher-reaction: an unknown health hazard? Dermatol Reports 2015; 7:5816. [PMID: 25918618 PMCID: PMC4387333 DOI: 10.4081/dr.2015.5816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 03/19/2015] [Accepted: 03/19/2015] [Indexed: 12/23/2022] Open
Abstract
Tattoos are well known to cause skin problems and the number of reported adverse reactions after tattooing has increased. Illegally imported tattoo ink is unrestrained and can contain unknown ingredients and contamination thereby posing a serious health hazard. We present a case illustrating the risk of pronounced phototoxic allergic reaction and other severe complications after using home kit tattoo ink.
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Affiliation(s)
| | | | | | - Reem Dina Jarjis
- Department of Plastic Surgery, Aalborg University Hospital , Denmark
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