Retrospective clinical evaluation of Q-switched Nd:YAG laser safety and efficacy in tattoo removal: A new perspective on the Kirby-Desai scale.

BACKGROUND: With nearly 50% of the population in the United States, Italy, and Sweden tattooed with at least one tattoo, the demand for its removal has risen by 32% since 2011. Traditional removal methods, such as Q-switched (QS) laser-based tattoo removal, can be lengthy, requiring up to 20 sessions. AIM: This study presents a retrospective clinical evaluation of seven short-pulsed QS, dual-wavelength Nd:YAG laser, as an efficient alternative, that can potentially reduce the number of sessions needed as calculated by a founded scale. METHODS: The QS modality delivers high-intensity pulses in four wavelengths, ideal for removing multicolored tattoos, of which two were used. We studied 11 patients who underwent 3-8 treatments (average 5.09) every 2-3 months. Each tattoo was assessed using the Kirby-Desai scale, considering the following factors: location, Fitzpatrick skin type, ink amount, layering, scarring, tissue changes, and tattoo color. Follow-ups were conducted after 6 months and at 4-5 years following last session. RESULTS: The long-term follow-up presented a significantly higher tattoo removal efficiency than the short-term follow-up (p < 0.001), indicating a sustained process of ink breakdown and elimination. Notably, the actual number of treatments were significantly lower than that predicted by the Kirby-Desai scale (average 5.09 vs. 9.9, p < 0.001). No severe adverse events were reported. CONCLUSIONS: In conclusion, the QS Nd:YAG laser offers a safe and effective alternative for tattoo removal, requiring fewer treatments than initially expected.

Chemical characterization of inks in skin reactions to tattoo.

Skin reactions are well described complications of tattooing, usually provoked by red inks. Chemical characterizations of these inks are usually based on limited subjects and techniques. This study aimed to determine the organic and inorganic composition of inks using X-ray fluorescence spectroscopy (XRF), X-ray absorption spectroscopy (XANES) and Raman spectroscopy, in a cohort of patients with cutaneous hypersensitivity reactions to tattoo. A retrospective multicenter study was performed, including 15 patients diagnosed with skin reactions to tattoos. Almost half of these patients developed skin reactions on black inks. XRF identified known allergenic metals - titanium, chromium, manganese, nickel and copper - in almost all cases. XANES spectroscopy distinguished zinc and iron present in ink from these elements in endogenous biomolecules. Raman spectroscopy showed the presence of both reported (azo pigments, quinacridone) and unreported (carbon black, phtalocyanine) putative organic sensitizer compounds, and also defined the phase in which Ti was engaged. To the best of the authors' knowledge, this paper reports the largest cohort of skin hypersensitivity reactions analyzed by multiple complementary techniques. With almost half the patients presenting skin reaction on black tattoo, the study suggests that black modern inks should also be considered to provoke skin reactions, probably because of the common association of carbon black with potential allergenic metals within these inks. Analysis of more skin reactions to tattoos is needed to identify the relevant chemical compounds and help render tattoo ink composition safer.

Understanding the chemical and mineralogical composition of commercial henna and jagua tattoos and dyes-a multi-analytical approach.

Temporary tattoos and dyes constitute a great analytical challenge in relation to the regulatory control of their ingredients. Most of these commercial products are not labeled according to their content and their chemical nature is highly diverse. Therefore, it is necessary to analyze these complex samples to evaluate the potential presence of metallic impurities, to ensure the safety of cosmetic products contributing to health protection. This study proposes a multi-analytical methodology, which includes handheld X-ray fluorescence (h-XRF) and X-ray diffraction (XRD), complemented by variable pressure scanning electron microscopy coupled with energy-dispersive X-ray spectrometry (VP-SEM-EDS) to fully characterize 34 commercial samples of jagua and henna tattoos and dyes. The approach allowed the identification of the main constituents providing complementary compositional data and differences between sample types were established. In addition, information on the degree of natural pigments homogeneity was also obtained. The results' discussion considering the current European cosmetics regulation may be useful to support the drafting of safety requirements and specific regulation.

Tattoo-like dermatitis left after fire-needle therapy.

Traditional Chinese medical theory holds that fire acupuncture can relieve neuropathic pain, and in many Asian countries, acupuncture has been used as one of the methods to relieve herpes zoster nerve pain. Sometimes, the patterns left on the skin by the needles may be very confusing to the practitioner who sees the patient. Recently, we saw a patient with puzzling tattoo-like dermatitis on his skin, and upon further questioning, he had recently undergone a fire-needle treatment and was left with this pattern.

A Practical Approach to Cosmetic Tattoo Removal with the Nd:YAG Laser.

The Q-switched neodymium-yttrium aluminium garnet (Nd:YAG) laser remains the gold standard method for tattoo removal including cosmetic tattoos. Modern picosecond lasers are referenced to the Nd:YAG laser and essentially do the same job. Persons with cosmetic tattoos in the face are especially eager to achieve perfect removal or correction and from start are critical to suboptimal results. Customers mostly request complete removal; sometimes the goal is fast treatment and bleaching to prepare for a cover up tattoo. Removal or correction of eyebrows is the largest group, followed by lip tattoos and eyeliners. The article gives a systematic and stepwise introduction to routine cosmetic tattoo removal by laser in an Austrian private medical practice. Rationales and selection of customers who can benefit from treatment, preparation, performance, and aftercare is reviewed. Emphasis is given to qualified power adjustment of the laser equipment and the treatment strategy, e.g. the delicate navigation between efficient removal and the risk of short-term and long-term adverse effects. Treatment relies on a partnership between provider and customer. Over the months of treatment, customers gain more insight into the possibilities of treatment, so that they get an understanding of the realistic results that can be achieved. Therefore, customers are also satisfied even with results that are not always optimal since best treatment was given a fair chance.

Ceratopigmentação (tatuagem corneana): utilização de técnicas combinadas para melhora estética em olhos de pacientes com opacidades corneanas / Keratopigmentation (corneal tattooing): use of combined techniques for aesthetic improvement in eyes of patients with corneal opacities

RESUMO Objetivo: Relatar, por meio de uma série de casos, a percepção de pacientes com opacidade corneana sobre a eficácia da tatuagem na melhoria estética de seus olhos, utilizando a combinação de duas técnicas. Métodos: Oito pacientes responderam a um inquérito sobre sua satisfação estética com o procedimento, o desconforto pós-operatório e o impacto social observado após a cirurgia. Resultados: Todos os pacientes consideraram-se muito satisfeitos com os resultados. Em relação ao grau de desconforto no pós-operatório, 75% disseram ter tido pouco desconforto, e 25% relataram desconforto moderado. Todos os pacientes relataram melhora significativa no bem-estar social e pessoal. Da mesma forma, todos os pacientes disseram que repetiriam o procedimento. Conclusão: A tatuagem corneana surge como um método alternativo às lentes de contato e às próteses oculares em pacientes cegos com leucomas, trazendo resultados estéticos satisfatórios, duradouros e que podem promover impactos sociais na vida desses pacientes.

ABSTRACT Objective: To report, through a case series, the perception of patients about the effectiveness of corneal tattooing in the cosmetic improvement of their eyes with leukomas, using a combination of two techniques. Methods: Eight patients answered a survey regarding their cosmetic appearance satisfaction regarding the procedure, postoperative discomfort, and social impact observed after surgery. Results: All patients considered themselves very satisfied with the cosmetic results. Regarding the degree of postoperative discomfort, 75% said they had little discomfort, while 25% reported moderate discomfort. All patients reported significant improvement in social and personal well-being. Likewise, all patients said they would repeat the procedure. Conclusion: Corneal tattooing appears as an alternative method to contact lenses and ocular prostheses in impaired eyes with leukomas, bringing satisfactory and long-lasting cosmetic improvement that can promote social impacts for these patients.

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.

Fast tattoo removal using Q-Switching ND-YAG laser technique with multi pass sessions.

Laser therapy is the gold standard method to remove unwanted tattoos. It is available and widely accessible. This study was done to assess the efficacy of the R20 method (multi-time separated passes in one session for 20 min) using Q-switched ND: YAG laser for the removal of tattoos and was compared with the traditional method. Forty patients with 40 Tattoos were included. These tattoos were separated into two halves left and right. One half was treated with a single pass and the other half with R20. Both halves were treated using Q-switched ND-YAG laser with 10 J/cm2, 1.064 µm, 8 ns pulse width, and 3 mm spot size. The treatment regimen included three sessions at three-week intervals. Tattoo bleaching was evaluated in each session by means of using the imaging process by two dermatologists. It could be concluded that the treatment with traditional single-pass is less effective than the R20 method in the three-month period. Epidermal healing period needs more than three weeks with the R20 method. The amateur tattoos have a significantly better response than professional tattoos. The R20 method is better than the traditional method to remove a tattoo, where most tattoos can be removed in one session. Amateur tattoo is removed faster compared to professional tattoo using R20 method because amateur tattoo affects the skin surface.

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.

Increased Tattoo Fading in a Single Laser Tattoo Removal Session Enabled by a Rapid Acoustic Pulse Device: A Prospective Clinical Trial.

BACKGROUND AND OBJECTIVES: The ability to provide improved tattoo fading using multiple laser passes in a single office laser tattoo removal session is limited. In part, this is due to the loss of laser effectiveness caused by epidermal and dermal vacuole "whitening" generated during the initial laser pass at the tattoo site. The Rapid Acoustic Pulse (RAP) device generates acoustic shock wave pulses that clear epidermal and dermal vacuoles to enable multiple laser passes in a single office laser tattoo removal session. The objectives of this study were to determine if the RAP device, when used as an accessory to the 1064 nm Nd:YAG Q-switched (QS) laser can enable delivery of multiple laser passes in a single office laser tattoo removal session, and therefore result in increased tattoo fading compared to the clinical standard single-pass QS laser tattoo removal session. STUDY DESIGN/MATERIALS AND METHODS: The RAP device was evaluated in a single-center (SkinCare Physicians), prospective, IRB approved study. A total of 32 black ink tattoos, from 21 participants, were divided into three zones and treated with either multiple QS laser passes, each followed by 1 minute of RAP device application (Laser + RAP) in zone one and single-pass QS laser treatment (Laser-Only) in zone two, separated by an untreated control zone. The treatment sites were assessed for the number of laser passes and adverse events immediately, 6 weeks, and 12 weeks following the treatment session. Photographs of the treatment sites were assessed for percent fading at 12 weeks post-treatment by three blinded reviewers. RESULTS: When the RAP device was applied as an accessory to the QS laser in a multi-pass laser tattoo removal treatment, an average of 4.2 laser passes were delivered in a single session, with no unexpected or serious RAP device-related adverse events. At the 12-week follow-up, tattoos treated with Laser + RAP showed a statistically significant increase in average fading (44.2%) compared with tattoos treated with Laser-Only (24.8%) (P < 0.01). Additionally, a significantly higher overall proportion of tattoos treated with Laser + RAP (37.5%) had a response of >50% fading compared with tattoos treated with QS Laser-Only (9.4%) (P < 0.01) as well as a response of >75% fading from Laser + RAP treatment (21.9%) compared with Laser-Only treatment (3.1%) (P < 0.05). CONCLUSIONS: The RAP device, applied as an accessory to the 1064 nm Nd:YAG QS laser, safely enables multiple QS laser treatments in a single office laser tattoo removal session by clearing the whitening caused by the previous QS laser pass. Enabling multiple QS laser passes results in a statistically significant increase in tattoo fading in a single office laser tattoo removal session compared to the clinical standard single-pass QS laser tattoo removal session. © 2019 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

Tattoo Removal as a Resettlement Service to Reduce Incarceration Among Mexican Migrants.

In Mexico, tattooed migrants face discrimination and are at high-risk of incarceration, thus, we assessed whether receiving laser tattoo removal affected the likelihood of incarceration. In 2015-2016, 89 adults ages ≥ 18 years with visible tattoos were recruited at a free-clinic to receive laser tattoo removal or assigned to the wait-list; all completed baseline and 6-month questionnaires. Overall, 97.8% of participants ever migrated to the USA. In multivariate analyses restricted to migrants (n = 87), those receiving laser tattoo removal [Adjusted Odds Ratio (AOR) 0.27, 95% CI 0.07-0.89] and possessing a Mexican Voting card (AOR 0.14; 95% CI 0.03-0.58) were significantly less likely than wait-list participants to be incarcerated at 6-months. Previously incarcerated participants were significantly more likely to be incarcerated at follow-up. Tattoo removal may reduce incarceration among Mexican migrants. Future studies can assess other health and social benefits of tattoo removal for migrants/deportees returning to Mexico.

Combination of Dual Wavelength Picosecond and Nanosecond Pulse Width Neodymium-Doped Yttrium-Aluminum-Garnet Lasers for Tattoo Removal.

BACKGROUND AND OBJECTIVES: Tattoo removal by laser has been mostly performed using Q-switched laser, which has nanosecond pulse width. In recent years, the efficacy of treatment with picosecond pulse width laser has also been reported. STUDY DESIGN/MATERIALS AND METHODS: Using a picosecond-domain, neodymium-doped yttrium-aluminum-garnet laser with a potassium-titanyl-phosphate frequency-doubling crystal, we performed a retrospective clinical study with combination treatment using pulse widths of 750 ps and 2 ns. The number of treatments was compared with the Kirby-Desai score. Tissue changes immediately after laser irradiation at 2 ns and 750 ps were compared using an electron microscope. RESULTS: The combination treatment using pulse widths of 2 ns and 750 ps was safe and more effective than the Q-switched neodymium-doped yttrium-aluminum-garnet laser treatment. Tattoo removal was possible with significantly fewer treatment numbers than the Kirby-Desai score, without adverse events. The results from the scanning electron microscope revealed that ink particles irradiated by 750 ps were more dispersed than those by 2 ns. CONCLUSIONS: The combination treatment with pulse widths of 2 ns and 750 ps and 1064 nm and 532 nm wavelengths using the neodymium-doped yttrium-aluminum-garnet laser was safe and effective and can be a useful option for tattoo removal. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.