Tattoos among professional football players in the 2018-2019 Spanish La Liga season.

INTRODUCTION: Data regarding tattoos among football players are limited. We investigated the prevalence and characteristics of tattoos among elite players over a full season in the Spanish La Liga. We assessed whether tattoos had any impact on the performance and behavior of players and teams on the pitch. MATERIALS AND METHODS: Demographic (age, geographic origin, position), performance (goal-scoring) and disciplinary data (yellow/red cards received) for 476 players and overall team statistics over the 2018-2019 season were analyzed according to the presence of visible tattoos (head and neck, upper arms, lower limbs) for each player. RESULTS: Of the 472 players analyzed, 160 (36%) had visible tattoos (upper limbs, 99%; lower limbs, 18.5%; head and neck, 12%), most of which were in black ink (83%). Players from South and Central America had the highest prevalence of visible tattoos (50%) and significantly more head and neck tattoos than Europeans (19% vs. 10% P=0.02). Tattoos were not significantly related to players' age or position. The mean number of goals scored was higher in the tattooed player group (2.7±4.6 goals vs. 1.9±3.3; P=0.013). There was a correlation between having tattoos and number of goals (Spearman rho 0.103, P=0.034). Tattooed players were more likely to have received≥1 yellow card (91% vs. 83.5%, P=0.03). There was no difference regarding red cards received (15 vs. 14%, P>0.05). The mean number of yellow cards was higher among players with tattoos than those without (4.4±3.2 vs. 3.6±3.2; P=0.01). However, the proportion of tattooed players in a team did not influence the overall team outcomes. The results were no longer significant when we included only players taking part in at least in 22 matches. CONCLUSION: Among footballers in La Liga, 36% had visible tattoos, with individual variations attributable to differences in geographic, social, cultural and religious background. Having tattoos was associated with certain aspects of individual performance and discipline. The question whether this factor should be taken into consideration by players' agents and team managers remains open.

Tattoo complications in treated and non-treated psoriatic patients.

BACKGROUND: Tattooing is a widespread phenomenon, with an estimated prevalence of 10-30% in Western populations. For psoriasis patients, current recommendations are to avoid having a tattoo if the disease is active and they are receiving immunosuppressive treatments. Although scientific data supporting these recommendations are lacking, dermatologists are often reluctant to advocate tattooing in psoriasis patients. OBJECTIVE: We aimed to evaluate the frequency of tattoo complications in patients with psoriasis and determine whether the occurrence of complications was associated with psoriasis status and treatments received at the time of tattooing. METHODS: We performed a multicentre cross-sectional study. Adults with psoriasis were consecutively included and classified as tattooed or non-tattooed. Prevalence of complications associated with tattoos was then evaluated according to psoriasis onset and treatments. The study was divided into three parts, in which data were collected through a series of questionnaires filled in by the dermatologist. Complications included pruritus, oedema, allergic reaction/eczema, infection/superinfection, granuloma, lichenification, photosensitivity, Koebner phenomenon and psoriasis flare after tattooing. Diagnosis of complications was made retrospectively. RESULTS: We included 2053 psoriatic patients, 20.2% had 894 tattoos. Amongst non-tattooed patients, 15.4% had wished to be tattooed, with psoriasis being stated as a reason for not having a tattoo by 44.0% and 5.7% indicating that they planned to have a tattoo in the future. Local complications, such as oedema, pruritus, allergy and Koebner phenomenon, were reported in tattoos in 6.6%, most frequently in patients with psoriasis requiring treatment at the time of tattooing (P < 0.0001). No severe complications were reported. CONCLUSIONS: The rate of tattoo complications in psoriasis patients was low. Although the risk of complications was highest amongst patients with psoriasis requiring treatment at the time of tattooing, all the complications observed were benign. These results can be helpful for practitioners to give objective information to patients.

[Cutaneous and mucosal manifestations of sexual practices]. / Manifestations cutanées et muqueuses des pratiques sexuelles.

Sexual activity may on occasion be associated with local trauma, infections or allergies. During visits, patients may be reluctant to report on the circumstances leading to such lesions. The dermatologist may be unfamiliar with these manifestations, especially where they occur outside the genital area. Our aim is to present the spectrum of genital and extra-genital signs associated with sexuality. The dermatologist must feel sufficiently confident to broach the patient's sexual history in order to avoid any diagnostic errors and unnecessary explorations.

[Tinea corporis within recent tattoos]. / Dermatophytose sur des tatouages récents.

INTRODUCTION: Tattoos are occasionally associated with cutaneous infections. Diagnosis can be challenging as the clinical presentation of such infections may differ from those on plain skin. Herein we report an atypical form of tinea corporis restricted to two recent tattoos during healing, caused by environmental contamination. We reviewed the literature for all cases of fungal infection after tattooing. PATIENTS AND METHODS: A 27-year-old female patient was seen for ring-shaped, erosive, oozing, pruritic and rapidly extensive skin lesions as well as infiltrated papular lesions occurring on tattoos done 6 and 12 days earlier. Fungal analysis revealed Microsporum canis. History-taking indicated that the patient's cat had ringworm and that the patient's sister also had skin lesions consistent with tinea corporis. DISCUSSION: Tinea on tattoos is rarely reported. We found ten additional cases in the literature, as well as five cases of less common fungal infections. These could be explained by the skin break created by the needle during tattooing resulting in an impaired skin barrier, or by accidental self-inoculation (e.g. foot-tattoos). The hypothesis of local immune deficiency induced by tattoo inks strikes us as rather improbable. Unlike usual cases of infections (pyogenic bacteria, mycobacteria, viral hepatitis), fungal infections are not related to a lack of hygiene on the part of the tattooist, but rather to contamination during the healing phase. Their clinical presentation may be atypical, resulting in diagnostic difficulties.

[French academic dermatology on Twitter]. / La dermatologie académique française sur Twitter.

INTRODUCTION: Dermatology journals and professional organizations are gradually opening up to social networks. We reviewed the activity of key accounts of dermatology journals and societies on Twitter and compared them specifically to the activity of French accounts. PATIENTS AND METHODS: This was an observational study on two given days, December 1, 2018 and May 3, 2019, involving 21 Twitter accounts of journals, of which all 17 were in dermatology, and 19 accounts of professional dermatology organizations, including 5 French accounts. The following data was collected: number of subscriptions, number of subscribers, total number of tweets, number of monthly tweets, and account activity (number of "likes", percentage of increase in subscribers and messages between the two studied periods). For the journals, we collected the 2017 Journal Impact Factor (WebofScience). RESULTS: The most popular dermatology journals on Twitter were JAMADermatology, JAAD and the BritishJournalofDermatology. There was a positive correlation between the impact factor and the number of subscribers (P=0.009, Pearson 0.714) and the number of tweets (P=0.001, Pearson 0.815), as well as a correlation between the number of subscribers and the number of tweets (P<0.001, Pearson 0.828). The American Dermatology Association, with two accounts, had 21,800 subscribers and 9814 subscribers. The Spanish Dermatology Association was second (6124 subscribers), ahead of the British (4833 subscribers). For France, the account with the most subscribers was that of the Union of Dermatologists-Venereologists (952 subscribers). The French Society of Dermatology had a modest 163 subscribers but was active, with a 47% increase in the number of tweets and a 49.5% increase in the number of subscribers. We found a positive correlation between the number of subscribers and the total number of tweets (P=0.006, Pearson 0.602) as well as the number of "likes" (P=0.02, Pearson 0.530). There was a correlation between the number of tweets and the number of "likes" (P<0.001, Pearson=0.897). CONCLUSION: There are many benefits for journals and professional associations in being present on social networks. However, we feel that there is striking under-use by French dermatology, as evidenced in the example of Twitter.

[Melanoma within tattoos: Two cases and a systematic literature review]. / Mélanomes sur tatouage : deux observations et revue systématique de la littérature.

BACKGROUND: There have been reports of malignant melanoma arising within tattoos. However, there is no clear relationship between tattoos and the development of cutaneous malignancies. We report two new cases of melanoma and provide a review of cases of melanoma reported in the medical literature. PATIENTS AND METHODS: Case No. 1: a 61-year-old patient consulted following the appearance one year ago of a nodular lesion measuring 4.5×3cm on a blue and red tattoo on his back. Complete excision of the lesion with histological analysis revealed an ulcerated nodular melanoma with a Breslow depth of 7mm. No secondary sites were found. Case No. 2: a 39-year-old patient with a blue tattoo on his left arm consulted following the appearance of a pigmented lesion a few months earlier. Surgical excision was immediately performed, confirming the diagnosis of SSM, with a Breslow depth of 0.9mm. There was no sign of relapse 9 years later. DISCUSSION: In our systematic review we noted 34 cases of melanoma occurring in tattoos. There was a high male prevalence (90.3%) and a relatively young mean age (45.9 years). Most tattoos were monochrome (71.0%). The average time between tattooing and onset of melanoma was 13.2 years. The most common sites of melanoma were the upper limbs (53.1%) and trunk (34.4%). Mean tumor size was 11.6mm. Histologic examination revealed 2 cases of melanoma in situ, and in 13 cases, the Breslow depth was 1mm or less. In 5 cases, macroscopic or microscopic lymph node metastasis (sentinel lymph node) was found at diagnosis, and in one case, in transit skin metastases were also observed at the time of diagnosis. We discuss the hypothetical pathogenic role of tattoos in melanoma.

[Reluctance determinants of dermatologists about tattooing in patients with psoriasis. An international study]. / Déterminants de la réticence des dermatologues vis-à-vis du tatouage chez les patients atteints de psoriasis. Une étude internationale.

BACKGROUND: Tattoos are an increasingly common phenomenon, with a prevalence of around 10-30 % of the population in Western countries. The "Tatou" project assessed the risks of tattooing for patients with psoriasis. The first part revealed strong opposition to tattoos in these patients on the part of dermatologists, despite fewer than a quarter of them having any personal experience of complications. The second part showed a very low rate (6.6 %) of local complications on tattoos in these patients as well as absence of severe complications. These observations led us to assess the reasons for reluctance about tattoos in the 468 dermatologists involved in the first part of the "Tatou" project. PATIENTS AND METHODS: We conducted a cross-sectional international study in France, Finland and Italy to evaluate the experience and opinions of dermatologists regarding tattoos in psoriasis patients via an anonymous questionnaire. We then examined the stated reasons for opposition to tattoos in order to establish the profiles of "tattoo-sceptical" dermatologists with regard to 4 different situations: active psoriasis, quiescent psoriasis, treatment with topical steroids and biotherapies. RESULTS: The opinion of dermatologists regarding tattoos was generally unfavourable (3.5±2.8/10), in particular, via multivariate analysis, among older dermatologists (P=0.01), dermatologists in private practice (P=0.04), and non-tattooed dermatologists (P<0.0001). In multivariate analysis, the main parameter affecting the position of practitioner with regard to tattoos was their personal opinion of tattoos (P<0.0001), regardless of disease activity or type of treatment. Italian, Finnish and female dermatologists exhibited greater reluctance but in a less consistent fashion. CONCLUSION: This analysis suggests a lack of objectivity among dermatologists opposed to tattoos probably stemming more from a poor opinion of this practice than from any fear of complications in their psoriatic patients.

Prevalence of and risk factors for dermatoporosis: a prospective observational study of dermatology outpatients in a Finnish tertiary care hospital.

BACKGROUND: Dermatoporosis describes the cutaneous signs and complications related to chronic cutaneous fragility related to ageing, chronic sun exposure and long-term use of topical and systemic corticosteroids. Chronic renal failure may be an additional cofactor. The prevalence of dermatoporosis is estimated around 32-37% in France among the elderly. OBJECTIVE: We evaluated the prevalence of dermatoporosis and its risk factors in outpatients who attended a consultation in the department of dermatology of Helsinki University Central Hospital. METHODS: A prospective observational study of 176 consecutive outpatients aged 60 years and older, who attended a consultation in the department of dermatology of Helsinki University Central Hospital. Data collection included age, gender, reason for consultation, local or systemic corticosteroid therapy, antiplatelet drugs and anticoagulant therapy, diabetes and chronic kidney failure (glomerular filtration rate < 60 mL/min/m2 ). The presence of dermatoporosis, location on the body and staging were collected. RESULTS: 30.7% presented dermatoporosis. Lesions were mainly located on the upper limbs (94%), and stage I was the most frequent (75.9% of the cases). Multivariate analysis revealed that dermatoporosis was significantly associated with ultrapotent topical corticosteroids (odds ratio (OR) 5.34, 95% CI 1.85-15.43, P = 0.002), oral corticosteroids (OR 3.22, 95% CI 1.18-8.80, P = 0.022), concomitant corticosteroid therapy, anticoagulant and chronic renal failure (OR 4.02, 95% CI 1.34-12.01, P = 0.013) and age (OR 1.05, 95% CI 1.01-1.10, P = 0.016). Patients with bullous pemphigoid were those with the highest prevalence of dermatoporosis in our cohort (64%). CONCLUSION: Acknowledging the selection bias in our study, the prevalence of dermatoporosis in a dermatology consultation in Finland seems as frequent as in France. These results prompt us to weigh the indications of long-term corticosteroids use in frail elderly patients.

Eruptive milia and acneiform hyperkeratosis with comedones (pseudo-epidermal cysts) within tattoos.

BACKGROUND: Milia are small, hard, white superficial epidermal cysts measuring a few millimetres that can occur during skin healing due to occlusion of pilosebaceous units. Milia rarely occur on tattoos. However, cases of allergic reactions with hyperkeratosis and open comedones have been described in the literature, sometimes under the term "epidermal cysts". PATIENTS AND METHODS: We saw three patients who developed milia, including a 32-year-old man with eruptive milia 10 weeks after getting a black, red and green tattoo on his upper arm. Topical tretinoin was applied. We encountered two further cases of eruptive milia on black/grey tattoos. A fourth patient presented a massive hyperkeratotic reaction with retention comedones on the red/pink area of a tattoo. DISCUSSION: The occurrence of milia and acneiform allergic reactions after tattooing is rare. We collated a total of 13 cases from the literature, of which 8 involved milia. This condition occurred within 3 months following tattooing, with no particular correlation with any given colour, and generally without any allergic reaction (except in one case). Reactions comprising excessive acneiform hyperkeratosis and open comedones were noted with pink and red inks and were a complication in a setting of allergic inflammatory reaction. However, the histopathology of these reactions is poorly described in the literature. It seems inappropriate to diagnose the condition as "epidermal cysts" since the lesions are not in fact simple cysts but rather retention lesions occurring during an inflammatory reaction and are thus different from post-traumatic milia.

Tattoo-associated uveitis with or without systemic sarcoidosis: a comparative review of the literature.

Sarcoidosis is a systemic disease of unknown aetiology characterized by the presence of non-caseating epithelioid cell granulomas in multiple organs, mainly the lungs and the lymphatic system. It is also one of the leading cause of inflammatory eye diseases. For the past 70 years, sarcoidal granulomas on tattoos and permanent make-up have been documented. They can be the first and sometimes unique cutaneous manifestation of systemic sarcoidosis. A few cases of sarcoidosis with uveitis and granulomatous reactions within tattoos have been described. However, since the end 60s, a singular entity has been reported associating isolated uveitis with granulomatous cutaneous reaction restricted to tattoos in the notable absence of systemic sarcoidosis. It remains unclear whether this entity must be distinguished from sarcoidosis. This review summarizes the currently available data on this topic and compares cases of sarcoidosis with granulomatous tattoo reaction and uveitis to the cases without notable sarcoidosis. We propose the acronym TAGU (TAttoo Granulomas with Uveitis) as an exclusion diagnosis that emcompasses the patients for whom we fail to find any sarcoidosis or other causes after extensive investigation.

Koebner's sheep in Wolf's clothing: does the isotopic response exist as a distinct phenomenon?

Until 1995, a case of psoriasis developing within the dermatome of a healed herpes zoster was taken as a Koebner phenomenon. In this year, however, the term 'isotopic response' was introduced by Wolf et al. to describe 'the occurrence of a new skin disorder at the site of another, unrelated and already healed skin disease', thus appearing 'on apparently unaffected and healthy skin'. Initially, the term was mainly related to herpes zoster, but today the name 'Wolf's isotopic response' is used to include a plethora of other triggering factors such as healed cutaneous leishmaniasis, tinea or varicella. For obvious reasons, such triggering factors cannot be taken as examples of 'unaffected and healthy skin'. Notably, the authors themselves have categorized the dermatome of a healed herpes zoster as a 'vulnerable area'. In a recent commentary, Wolf et al. have expanded the definition of healed skin diseases triggering an 'isotopic response'. They now included 'scars, pigment changes, color changes or various other minimal changes by the first disease'. Hence, there is no clear-cut criterion to distinguish the isotopic response from a Koebner reaction. Wolf et al. even argue that, if the triggered disorder precedes the appearance of generalized skin lesions, then it is not a Koebner reaction but 'Wolf's isotopic response'. In our view, such definition is unacceptable. All reactions of this kind represent examples of a Koebner phenomenon. Accordingly, the 'isotopic response' should today be taken as a historical error.