Tattoos: risks and complications, clinical and histopathological approach

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.

Alergias a tatuajes y otras reacciones adversas

La realización de tatuajes es una práctica popular y creciente dentro de la población hoy en día, principalmente en los jóvenes. Sus complicaciones constituyen un motivo frecuente de consulta en la práctica médica, éstas se producen principalmente por los pigmentos utilizados, sobre todo los rojos con alto contenido de derivados mercuriales. Existen diferentes complicaciones producidas por los tatuajes, entre las cuales se pueden mencionar las siguientes: traumáticas, infecciosas, granulomatosas, alérgicas, dermatosis asociadas al área del tatuaje, tumorales y otras en las que podríamos incluir los queloides, colagenopatías perforantes reactivas entre otras. Las complicaciones relacionadas con las tintas rojas pueden ser: dermatitis de contacto alérgica y fotodermatitis, reacciones liquenoides, los granulomas de tipo cuerpo extraño con características sarcoidales y los pseudolinfomas. La prueba del parche parece inadecuada para identificar los tintes del tatuaje correspondientes como alergenos. Las reacciones alérgicas contra los tatuajes se desarrollan lentamente y es improbable que sean causadas por un alergeno directamente presente en la tinta del tatuaje. Las opciones de tratamiento médico incluyen corticoides tópicos, oclusivos o intralesionales, también se puede utilizar tacrolimus y factor de protección solar. Las opciones terapéuticas para la eliminación de tatuajes son: salabrasión, dermoabrasión, eliminación química. Otros métodos empleados son la electrocoagulación, la criocirugía, extirpación quirúrgica y los láseres. Cabe destacar la necesidad e importancia de una adecuada regulación nacional para que puedan realizarse medidas de protección sanitaria eficientes y controladas, en todos los aspectos relacionados con ésta práctica, pero principalmente prestando especial atención a las tintas utilizadas.

Tattooing is a popular and growing practice within the population today, especially in the young. Its complications are a frequent reason for consultation in medical practice, these are mainly produced by the pigments used, especially red with a high content of mercury derivatives. There are different complications produced by tattoos, among which we can mention the following: traumatic, infectious, granulomatous, allergic, dermatosis associated with the area of the tattoo, tumoral and others in which we could include keloids, reactive perforating collagenosis among others.Complications related to red inks may include: allergic contact dermatitis and photodermatitis, lichenoid reactions, granulomas of foreign body type with sarcoid characteristics and pseudolymphomas. The patch test seems inadequate to identify the corresponding tattoo dyes as allergens. Allergic reactions to tattoos develop slowly and are unlikely to be caused by an allergen directly present in the tattoo ink. Medical treatment options include topical, occlusive or intralesional steroids; tacrolimus and sun protection factor can also be used. The therapeutic options for the removal of tattoos are: salabrasión, dermabrasion, chemical elimination. Other methods used are electrocoagulation, cryosurgery, surgical removal and lasers. It is important to emphasize the need and importance of an adequate national regulation so that efficient and controlled sanitary protection measures can be carried out in all aspects related to this practice, but mainly paying particular attention to the inks used.

Study on the safety management of printing inks for food contact materials / 中国食品卫生杂志

Objective To provide suggestions for the safety management of printing inks and the establishment of food safety standard for food contact materials.Methods The laws,regulations and directives related to printing inks from different countries were collected and the differences among different management models were analyzed and compared.Results The safety management models of European Union,Switzerland,Germany,US and Japan were generalized and their experiences in the management measures of printing inks were summarized.Conclusion Safety standard of printing inks for food contact materials should be established on the basis of industry status and the various safety risks of different inks.Management experiences of other countries should be considered and the participation of industry associations should be encouraged.

Improvised double-embedding technique of minute biopsies: A mega boon to histopathology laboratory.

Introduction: Optimal orientation of minute mucosal biopsies is essential for a defi nite diagnosis in gastrointestinal pathology or to visualize neural plexuses in Hirschsprung disease. The problem of minute size of the biopsy and its orientation gets compounded when they are from neonates and mandates exhaustive strip cuts, thus delaying reporting. Aim: A modifi ed agar-paraffi n technique is aimed to make tissue embedding effi cient and user-friendly by inking mapping biopsies (one or more) either fresh or fi xed with surgical coloring inks followed by embedding fi rst in agar after orientation and followed thereafter by processing, re-embedding in paraffi n wax, sectioning and staining. Results: The tissues in agar paraffi n block were found to be well processed, fi rm, held secure and well preserved. The blocks were easy to cut, with serial sections of thickness 2-3 μ and easy to spread. The colored inks remained permanently on the tissues both in the block as well as on the sections which helped in easy identifi cation of tissues. Agar did not interfere with any stain such as Hematoxylin and Eosin or with histochemical stains, enzyme histochemistry or immunohistochemistry. Inking biopsies and pooling them in a block when obtained from the same patient reduced the number of tissue blocks. Conclusion: The modifi ed agar-paraffi n embedding technique is a simple reliable user friendly method that can greatly improve the quality of diagnostic information from minute biopsies by optimal orientation, better quality of sections, faster turnaround time and cost-effectiveness by economizing on the number of paraffi n blocks, manpower, chemical reagents and laboratory infrastructure

In search of the rainbow: Colored inks in surgical pathology.

Introduction: Although surgical pathologists are aware of the multiple advantages that coloured inks contribute to surgical pathology practice, these coloured inks are not available in India and importing them is not a viable proposition. A systematic search for locally available coloring agents was done, and resulted in identifying specific shades within a popular set of children's hobby colors of a particular brand. They retain their bright distinct colors on paraffin blocks and sections. These paints are available all over India, and are cheap, safe, and easy to use. Coloring gross specimen excision margins with different colors, adds precision to margin examination. It allows three-dimensional microscopic reconstruction of the tumor vis-a-vis its various neighboring anatomic structures. It allows postoperative comparison of tissue planes predicted by preoperative imaging. It maintains orientation of grossed and dissected specimens, enabling the pathologist to re-visit the grossed specimen, if required, and confidently allows further sampling if necessary. Aim: A systematic search for indigenous coloring agents was carried out, which included the dyes used in the histopathology laboratory, gelatin, commercially available paints, including acrylic paints and inks. Results: The study identified specific shades within a brand of acrylic colors that are easily available and simple to use, with good results on microscopic examination. Conclusion: Colored inks lend precision to margin examination. A set of easily procurable colors are available in our country, which are easy to use, with distinct bright colors, safe, and reliable.