Treatment Update of Port-Wine Stain: A Narrative Review.

BACKGROUND: Port-wine stain (PWS) is a congenital vascular malformation affecting 0.3–0.5% of normal population. These characteristic lesions arise due to the interplay of vascular, neural, and genetic factors. Treatment options include lasers, cosmetic tattooing, electrotherapy, cryosurgery, derma-abrasion, and skin grafting; however, none of these treatment alternatives appears to be satisfactory and is unable to provide consistent, satisfactory responses or even complete cures. Currently, laser is the treatment of choice, as it is comparatively safe and more effective than other procedures. The most commonly used modality is pulsed dye laser (PDL). The literature research includes peer-reviewed articles (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) to January 2020 and reference lists of respective articles. Only articles published in English language were included. J Drugs Dermatol. 20(5): doi:10.36849/JDD.5005.

Nonstandard Advance Directives in Emergency Medicine: What Should We Do?

BACKGROUND: Critically ill or injured emergency department or prehospital patients who lack decision-making capacity sometimes present with a non-standard advance directive, such as a "Do Not Resuscitate" tattoo or medallion. Emergency clinicians must immediately address the question of whether to withhold treatment based on what may or may not be a valid patient directive. DISCUSSION: Advance directives have been standardized for a good reason. Emergency department or prehospital healthcare providers must be able to immediately interpret and act on them without needing a legal interpretation. When faced with non-standard directives, physicians can follow them, ignore them, or simply use them as an additional piece of information about the individual's wishes for some situations at one point in his or her life. Absent the patient's input or that of aknowledgeable surrogate, both the patient's initial reasons for their non-standard directive and his or her present wishes concerning resuscitation cannot be independently known. Therefore, healthcare providers must initiate treatment while they buy time, attempt to return the patient to lucidity, and search for probative information regarding their current wishes concerning medical treatment. Without such additional information, the moral weight will always favor initiating treatment, since withholding treatment is often irreversible and any treatment instituted can later be withdrawn.

Adolescent and Young Adult Tattooing, Piercing, and Scarification.

Tattoos, piercing, and scarification are now commonplace among adolescents and young adults. This first clinical report from the American Academy of Pediatrics on voluntary body modification will review the methods used to perform the modifications. Complications resulting from body modification methods, although not common, are discussed to provide the pediatrician with management information. Body modification will be contrasted with nonsuicidal self-injury. When available, information also is presented on societal perceptions of body modification.

Growing trend of tattooing and its complications in Nigeria.

Tattoo, a Polynesian word meaning 'to mark', is a form of body modification done by inserting indelible ink into the dermis to change its pigmentation. Tattoos are done for social, cultural, and religious purposes. It has been in existence since the 18th century and was associated with sailors, lower class individuals, and criminals. However, since the late 20th century, tattooing has undergone a redefinition and shifted to an acceptable form of expression all over the world, including Nigeria, cutting across almost all age groups and socioeconomic class. This review is aimed at highlighting the indication, complications arising from the procedure as well as removal, and how to manage them. The dermatological complications associated with tattoos can occur either during inking or attempts at removal. Most times, tattoos are obtained through unsafe means by unauthorized personnel, and this is associated with numerous health risks. Of particular importance to the dermatologists are the hypersensitivity reactions, granulomatous skin disease, and formation of both keloid and hypertrophic scars. Treatment options vary and include use of silicone gel and intralesional steroids for hypertrophic and keloid scars, topical medication for hyperpigmentation, and use of LASER for tattoo removal. In conclusion, the trend of tattooing has become a widely accepted form of social expression all over the world and is gradually gaining ground in Nigeria. Patients frequently present to the dermatologists and physicians for solutions to the complications. It is important to proffer solutions and educate patients on the various health risks associated with tattooing.

Complications of decorative tattoo.

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.

[Tattooed people, who are you? Demographic and behavioral characteristics of tattooed individuals]. / Tatoués, qui êtes-vous ? Caractéristiques démographiques et comportementales des personnes tatouées.

Over the past 20 years, tattoos have become extremely popular in Western countries. In Germany for instance, 8.5% of the population (aged between 14 and 90 years) have tattoos. Trends in France are similar according to a recent poll (10%). However, tattoos are becoming increasingly common among the young, involving up to 25%, according to the individual country. Reasons for getting a tattoo are plentiful and personal. There is no specific profile of tattooed individuals nowadays but a rather wide spectrum of different types. Herein, we review the epidemiology of tattooed individuals in the light of the most recent publications on the subject.

Epidemiology of tattoos in industrialized countries.

In 1974, the first professional French tattooist C. Bruno wrote a book, entitled 'Tatoués, qui êtes-vous?', depicting his experience as a tattooist in the picturesque Pigalle tourist district of Paris. However, we have come a long way since then. Tattooing has gained tremendous visibility, notoriety and popularity in Western countries. In Germany, 8.5% of the population (aged between 14 and 90 years) has a tattoo. Similar trends have been found in France, Finland and Australia, where approximately 10% of the populations have at least one tattoo. However, the overall tattoo prevalences overseas and in Europe are even higher, especially among the youth, for whom it is up to 15-25% according to the country. Much has been written about the tattooed and tattooists. However, who are they currently? What motivates them to get tattooed and give tattoos? How do they see themselves? Why do some individuals remove their tattoos? Is there a 'profile' of the tattooed? Are they really 'risk takers'? And how do the nontattooed perceive them? Through a critical review of the literature, we will reconsider tattooing from an epidemiological aspect, challenge current beliefs and explore new insights into the motivations and fears of tattoo artists and their clients.

Tattoo reactions--an epidemic on the surge: a report of 3 cases.

Tattooing has been practiced in India since ancient era. It has tremendous religious and spiritual significance. In addition, tattooing for cosmetic purposes has become quite popular in recent times. With this increasing trend, there is also an increased risk of adverse effects. Here, we have described two cases of lichenoid reaction developing to red ink in double- colored tattoos and a case of sarcoidal reaction to green tattoo.

From body art to anticancer activities: perspectives on medicinal properties of henna.

Nature has been a rich source of therapeutic agents for thousands of years and an impressive number of modern drugs have been isolated from natural sources based on the uses of these plants in traditional medicine. Henna is one such plant commonly known as Persian Henna or Lawsonia inermis, a bushy, flowering tree, commonly found in Australia, Asia and along the Mediterranean coasts of Africa. Paste made from the leaves of Henna plant has been used since the Bronze Age to dye skin, hairs and fingernails especially at the times of festivals. In recent times henna paste has been used for body art paintings and designs in western countries. Despite such widespread use in dyeing and body art painting, Henna extracts and constituents possess numerous biological activities including antioxidant, anti-inflammatory, antibacterial and anticancer activities. The active coloring and biologically active principle of Henna is found to be Lawsone (2- hydroxy-1, 4-naphthoquinone) which can serve as a starting building block for synthesizing large number of therapeutically useful compounds including Atovaquone, Lapachol and Dichloroallyl lawsone which have been shown to possess potent anticancer activities. Some other analogs of Lawsone have been found to exhibit other beneficial biological properties such as antioxidant, anti-inflammatory, antitubercular and antimalarial. The ability of Lawsone to undergo the redox cycling and chelation of trace metal ions has been thought to be partially responsible for some of its biological activities. Despite such diverse biological properties and potent anticancer activities the compound has remained largely unexplored and hence in the present review we have summarized the chemistry and biological activities of Lawsone along with its analogs and metal complexes.

Tattooing: medical uses and problems.

Decorative tattooing is a custom thousands of years old and is growing in popularity today. Medical professionals may be less familiar with its medical applications-medical alert tattooing, reconstructive and cosmetic applications, endoscopic tattooing, corneal tattooing, tattooing in radiation oncology, and uses in forensic medicine. We review current medically related tattooing applications and discuss their potential risks and benefits.

Lifestyle and nickel allergy in a Swedish adolescent population: effects of piercing, tattooing and orthodontic appliances.

The aim of this study was to estimate the prevalence of life-style practices in adolescents and their association with nickel allergy. Upper secondary school pupils (n = 4,376; 15-23 years) were patch-tested for nickel aller-gy, follow-ing completion of a questionnaire (answered by 6,095). Almost 86% girls and 21% of boys reported piercing. More girls (6%) than boys (3%) had a tattoo. Twenty-six percent of the girls and 18% of the boys were regular smokers. Vegetarian/vegan diets were reported by 20% of girls and by 6% of boys. Piercing, female gender, and vocational programme increased the risk of nickel allergy, whereas orthodontic appliance treat-ment prior to piercing reduced the risk of nickel allergy. Pupils in vocational programmes had the highest prevalence of nickel allergy. Lifestyle behaviours are interconnected and cluster in subgroups of adolescents. Female sex, piercing and choice of educational programme are prominent lifestyle markers. A trend shift is observed, where more girls than boys report tattooing.

Decorative tattoos and reasons for their removal: a prospective study in 151 adults living in South of France.

BACKGROUND: Despite increasing demands for decorative tattooing in people of all ages, occupations and social classes, little is known regarding individuals' characteristics and behaviour with respect to tattooing. OBJECTIVE: The objective was to describe a large sample of French people asking for tattoo laser removal, to investigate their reasons for being tattooed and for tattoo removal, and to identify groups of subjects sharing similar characteristics. METHODS: A prospective exploratory study was conducted on 151 consecutive subjects asking for tattoo removal. RESULTS: The study population was composed of 65 women and 86 men, aged between 18 and 60 years. The reasons mentioned for tattoo removal included aesthetic, social, employment, family or partner pressure, change of lifestyle or partner and incompatibility with present attitudes and values. Four profiles were identified. Types 1 and 3 correspond to subjects with amateur tattoos more frequently reporting social reasons for tattoo removal, whereas types 2 and 4 correspond to subjects with studio tattoos who more frequently report aesthetic reasons. Types 1 and 4 are mainly composed of men (aged over forty and under forty, respectively), type 2 of women under thirty and type 3 of subjects of either sex aged over forty. CONCLUSIONS: These profiles could be used to target information campaigns about tattooing and tattoo removal techniques to avoid unwanted tattoos, and afterwards, possible disappointment after removal, as well as to target education programs on possible health risks. Furthermore, our findings open the way to focus further studies on more homogenous group of tattooed subjects.

Tattoo removal--state of the art.

Tattooing has been around since the early beginnings of modern civilization. The discovery of selective photothermolysis at last has made it possible to remove tattoos without leaving a scar. Q-switched neodymium: yttrium-aluminum-garnet, alexandrite, and ruby lasers with pulse durations in the nanosecond domain fulfill this need. Argon or cw-CO(2) lasers as well as intense pulsed light sources should not be used since they often produce significant scarring. This article provides an overview of current laser systems. Developments leading to new tattoo inks, feedback systems to detect the absorbance characteristics of tattoo inks, dermal clearing agents, and perhaps even lasers with shorter pulse-durations might improve the results in the future.

Cosmetic and reconstructive medical tattooing.

PURPOSE OF REVIEW: Cosmetic and reconstructive medical tattooing techniques are being used with a higher frequency than ever before. The volume of scientific research into its basics, however, is too small to prevent the present occurrence of complications. This review shows that most of the recent articles on the subject are in fact case reports and that many of the complications described result from the failure to conduct more research. RECENT FINDINGS: Recent findings include few and relatively unimportant new techniques, studies describing tattoo removal with laser, magnetic displacement and chemical irritants, more findings about infections and allergies, and complications with high field-strength magnetic resonance imaging scans. SUMMARY: Recent literature contains very few useful studies because generally they are not supported by sufficient scientific research.