CO2 laser treatment causes local tattoo allergic reaction to become generalized

Identification of the pigments used in permanent makeup and their ability to elicit allergic contact dermatitis

BACKGROUND

Decorative tattoos are known to contain ingredients that may elicit allergic contact dermatitis; it is less well-known if permanent makeup pigments carry the same risk.

OBJECTIVE

Identify pigments used in permanent makeup inks sold in the United States and review cases of allergic contact dermatitis to these pigments.

METHODS

Using internet searches, permanent makeup inks sold in the United States were identified. Safety data sheets were used to catalog pigments used in permanent makeup. A subsequent literature search was performed to identify cases of allergic contact dermatitis to these pigments.

RESULTS

A total of 974 permanent makeup inks were reviewed, and 79 unique pigments were identified. The average product contained 4 pigments. Twenty of the pigments were inorganic metals, including carbon, iron, chromium, manganese, and molybdenum. Fifty-nine pigments were organic, of which most were azo, quinacridone, or anthraquinone dyes. A literature search revealed that 10 of the 79 pigments were associated with allergic contact dermatitis.

CONCLUSION

Permanent makeup primarily uses organic pigments, although some metallic pigments are still used. Physicians should also be aware that some of these pigments-both organic and inorganic-are known causes of allergic contact dermatitis. Of note, patch testing to these ingredients can be negative.

Immune Response in Laser Tattoo Removal: A Systematic Review

Introduction: The immune response to laser tattoo removal poses a significant challenge in its management, primarily due to its unpredictable nature, which can range from mild hypersensitivity reactions to severe anaphylaxis. Such responses can potentially hinder the effectiveness of laser tattoo removal procedures. Therefore, gaining a comprehensive understanding of the immune response to tattoo removal using laser techniques is of utmost importance to develop more efficient management strategies. This study aims to address this need by analyzing eight carefully selected articles obtained through a thorough literature review. Methods: To explore the immune response associated with laser techniques in tattoo removal, we employed a rigorous research methodology. A thorough literature review was conducted using reputable search engines such as Google Scholar, SagePub, and PubMed to collect relevant articles. Initially, 788 potential articles were identified through this process. Following meticulous scrutiny, only eight articles that met stringent inclusion criteria were selected for our study. This meticulous selection process ensures that the information presented here is derived from high-quality and pertinent research. Results: Based on the analysis of the eight selected articles, our findings illuminate the various immune responses that emerge following tattoo removal using laser techniques. These responses include hypersensitivity reactions, allergic manifestations, and, in certain instances, anaphylaxis. Hypersensitivity reactions typically manifested as erythema, edema, and pruritus, while allergic responses were observed in the form of urticaria. In summary, our study highlights that the immune response to laser tattoo removal primarily elicits hypersensitivity and, in some cases, anaphylaxis reactions. Conclusion: Our study underscores the significance of clinicians being vigilant regarding potential immune responses during laser tattoo removal. It is crucial to closely monitor patients to promptly address any adverse reactions. Further research holds the potential to enhance our understanding, paving the way for improved management strategies that can enhance patient safety and treatment success.

Id reaction and allergic contact dermatitis post-picosecond laser tattoo removal: A case report

The novel picosecond lasers have emerged as a mainstay device in laser tattoo removal alongside Q-switch lasers, considered the gold standard in the field. Here, we present a 45-year-old female who developed a severe reaction to both her treated and untreated tattoos after two picosecond laser treatments and subsequent widespread eczematous eruption. Skin biopsies revealed findings consistent with hypersensitivity to exogenous red pigment. The clinicopathologic findings were consistent with an id reaction (autoeczematization) associated with allergic contact dermatitis to tattoo pigment. This case report highlights the potential for tattoo hypersensitivity following picosecond laser treatment and the dilemma associated with tattoo removal in sensitized patients. Additional therapeutic approaches are needed to provide patients with a safe means of tattoo removal while mitigating the risk of hypersensitivity reactions.

Dermatologic Complications Following Cosmetic and Reconstructive Plastic Surgery: A Systematic Review of the Literature

PURPOSE

Plastic surgery procedures, including minimally invasive cosmetic procedures, continue to grow in popularity. Although dermatologic complications following plastic surgery procedures are rare, the authors have encountered several of these complications in their practice, including herpes simplex virus (HSV-1) and varicella zoster virus (VZV) infections, pyoderma gangrenosum (PG), contact dermatitis, and suture hypersensitivity. These cases prompted a systematic literature review of dermatologic complications following plastic surgery procedures.

METHODS

The authors conducted a systematic review of PubMed, MEDLINE, EMBASE, Scopus, Web of Science, and the Cochrane Library to identify relevant articles published from 1975 to 2021. Articles were independently reviewed by the authors to determine whether studies met inclusion criteria.

RESULTS

The majority of articles that met inclusion criteria represented level V evidence. The most robust evidence in the literature was for PG, for which there were 63 total studies. Pyoderma gangrenosum was most frequently reported following breast surgery (85.1%), while HSV-1 infections were frequently seen following minimally invasive procedures (84.6%). VZV reactivation was reported after a range of interventions, including pedicled flap surgeries and laser treatments. Other complications, such as suture hypersensitivity, were less frequently reported in the literature, usually as isolated case reports.

CONCLUSIONS

Dermatologic complications represent a rare but serious concern following plastic surgery procedures. While most dermatologic complications resolve with appropriate treatment, sequelae of these conditions can be devastating to the patient's overall outcome. Plastic surgeons performing procedures at a high risk of these complications should recognize the diagnostic criteria to facilitate appropriate treatment.

LEVEL OF EVIDENCE III

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

Ablative laser surgery for allergic tattoo reactions: a retrospective study

Patients with allergic tattoo reactions are burdened with itch and have a reduced quality of life. Conservative treatment is often insufficient and little is known about treatment options to remove the responsible allergen. We aimed to address the effectiveness and safety of ablative laser therapy including measurement of patient's satisfaction, in patients with allergic reactions to tattoos. A retrospective study was conducted including patients with allergic tattoo reactions who were treated with a 10,600 nm ablative CO2 laser, either by full-surface ablation or fractional ablation. Clinical information originated from medical files and a 25-item questionnaire. Sixteen tattoo allergy patients were treated with a CO2 laser between January 2010 and January 2018. Fourteen patients completed the questionnaire. Ten patients were satisfied with laser treatment. On a visual analogue scale, pruritus and burning improved with a median of 5.5 and 4 points in the full surface ablation group and 3 points on both parameters in the fractional ablation group. Despite the relatively small group of patients, our results suggest that CO2 laser ablation improves itching, burning and impact on daily life in tattoo allergy.

Lichenoid Reaction Pattern with Pseudoepitheliomatous Hyperplasia - A Rare Tattoo Reaction: A Case Report and Review of the Literature

Pseudoepitheliomatous hyperplasia is a benign histologic reaction pattern that in rare cases can occur shortly after a tattooing procedure. We describe a case of pseudoepitheliomatous hyperplasia in two tattoos on the same patient 1 year after filling with the same batch of red ink.

Patterns of Reactions to Red Pigment Tattoo and Treatment Methods

Tattoos are common and used extensively as either body art or cosmetic make-up; more rarely, they can be traumatic in nature. We have systemically analysed the literature for the patterns of red pigment tattoo reactions and their treatment options. Our search identified 18 articles; there was 1 non-randomised controlled trial, and the rest were small case studies. In total 139 patients were included within the studies. This review systematically analyses the different subsets of red tattoo reactions including lichenoid, dermatitis, granulomatous, pseudolymphomatous and miscellaneous reactions. The current evidence for the treatment for the above is presented. Dermatitis and lichenoid reactions appear to be the most common subtype of red pigment reactions with various treatment methods applied showing laser intervention to have some degree of success.

[Tattooing agents and adverse reactions]

BACKGROUND

Tattoos are regarded as body jewelry and have become widespread in all parts of society. Despite introduction of the tattooing agents' regulation (Tätowiermittelverordnung) in Germany in 2009, consumer protection is incomplete.

OBJECTIVES

Prevalence of tattoos and their legal basis, ingredients of tattooing agents, clinical findings of adverse reactions, pathogenesis and therapy.

METHODS

The work is based on a selective literature search in PubMed and on the clinical experience of the authors.

RESULTS

Adverse reactions by tattooing are a particular problem, because the causing substances are not biodegradable within the tissue. In addition to an agonizing pruritus, the clinical picture is characterized by erythematous plaques. Histopathology reveals different patterns of inflammation, including pseudolymphomatous reactions. Treatment is problematic. In many cases, extensive surgical excision is necessary, which is associated with cosmetic consequences.

CONCLUSION

A regulation to assess the safety of tattooing does not exist.

Laser tattoo removal

Tattooing has been a part of human culture since the earliest beginnings of modern civilization. What has changed over the millennia are the myriad of colors with which we can now express our thoughts, feelings, and desires through body art. What has not changed is human nature, and our propensity to change our minds about what it is we think, feel, and wish to express on the canvas of our skin. Our fickle nature results in the desire to change what has been placed as a permanent reminder of a friend, spouse, or as a work of art. The technology used to remove tattoos began with destructive methods of removal, which wreaked havoc not only on the tattoo but more prominently on the skin containing that tattoo. The discovery of selective photothermolysis, the ability to selectively remove target structures without disrupting the surrounding skin, made it at least possible to remove tattoos without destroying the surrounding skin and leaving a scar. Theory predicted that pulse durations in the nanosecond domain would be optimal for tattoo removal, and the Q-switched neodymium:yttrium-aluminum-garnet, alexandrite, and ruby lasers operate in this range and are the key tools for modern tattoo removal. Too often, the wrong devices operating in the millisecond range, such as intense pulsed light sources, or lasers that are nonselective, such as the carbon dioxide laser, are used to treat tattoos, resulting in significant scarring without complete removal of the tattoo. Although the Q-switched lasers are capable of removing tattoos without harming the skin, removal often takes numerous treatments and still can be incomplete, especially when attempting to remove multicolored tattoos. Developments leading to removable tattoo inks, feedback systems to detect the absorbance characteristics of tattoo inks, dermal clearing agents, and perhaps even shorter pulse-duration lasers should result in improvements in tattoo removal in the near future.

[Disseminated granulomatous type IV reaction after a tattoo]

Localized type-IV allergies to tattoo dyes are quite common. p-Phenylenediamine, which is used as a black pigment in temporary henna tattoos, is a particularly potent allergen. Generalized type IV reactions are very rare, however. Disseminated granulomatous reactions on tattoo dyes have so far not been reported in the literature. We describe the case of a 54-year-old female patient who had such a reaction pattern after a tattoo owing to a previously unknown sensitization to potassium dichromate.