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.

Las reacciones alérgicas frente a las tintas de los tatuajes, un nuevo reto diagnóstico / Allergic Reactions to Tattoo Inks: A New Diagnostic Challenge

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¿Qué procedimientos diagnósticos deberíamos realizar ante una sospecha de reacción alérgica a un tatuaje? Propuesta basada en nuestra casuística / Diagnostic Tools to Use When We Suspect an Allergic Reaction to a Tattoo: A Proposal Based on Cases at Our Hospital

INTRODUCCIÓN: Los tatuajes se han convertido en una práctica muy popular en los países occidentales, sobre todo entre los más jóvenes. Las complicaciones asociadas a esta técnica incluyen procesos infecciosos, alérgicos, reacciones a cuerpo extraño e incluso procesos inflamatorios sistémicos. PACIENTES Y MÉTODOS: Se ha realizado un estudio retrospectivo de todos los pacientes que acudieron a la consulta de Alergia cutánea por manifestar complicaciones en un tatuaje desde enero de 2002 a diciembre de 2016. RESULTADOS: Se han incluido a 23 pacientes. De ellos, 9 presentaron complicaciones de forma precoz y en todos ellos la etiología fue infecciosa. De los 14 pacientes con reacciones tardías, 10 fueron diagnosticados de probable dermatitis de contacto alérgica a la tinta, sin embargo solo en 3 de los casos se pudo apuntar al alérgeno probablemente culpable y tan solo en uno de ellos se pudo demostrar. Se detectaron dos casos de sarcoidosis cutánea, uno de reacción granulomatosa a cuerpo extraño, y un caso de reacción neuropática en una paciente. CONCLUSIONES: Las complicaciones asociadas a los tatuajes son un motivo de consulta relativamente frecuente en las consultas de Dermatología. Proponemos un algoritmo diagnóstico basado en nuestra casuística, que ayude a orientar las distintas reacciones a tatuaje y con ello a iniciar las medidas terapéuticas oportunas

INTRODUCTION: Tattooing has become a popular practice in western countries, particularly among younger populations. Tattoos, however, can cause complications, such as infections, allergic or foreign-body reactions, and even systemic inflammatory responses. PATIENTS AND METHODS: We conducted a retrospective study of all patients seen for tattoo-related complications at our skin allergy unit between January 2002 and December 2016. RESULTS: We studied 23 patients. Nine of these experienced early complications, all related to infection. The other 14 patients developed late reactions. Ten were diagnosed with probable allergic contact dermatitis to ink, but the suspect allergen was identified in just 3 cases and confirmed in just 1 of these. There were 2 cases of cutaneous sarcoidosis, 1 case of foreign body granuloma, and 1 case of neuropathy. CONCLUSIONS: Complications resulting from tattoos are relatively common dermatology complaints. Drawing from our experience, we propose a diagnostic algorithm designed to guide dermatologists in evaluating different reactions to tattoos and prescribing appropriate treatment

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.

Reacciones granulomatosas a los tatuajes rojos: presentación de 5 lesiones / Granulomatous Reactions to Red Tattoo Pigments: A Description of 5 Cases

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Adenopatía pigmentada por tinta de tatuaje como hallazgo accidental en cirugía de mama. Caso clínico / Pigmented adenopathy by tattoo ink as an accidental finding in breast surgery. Case report

Damos a conocer el hallazgo de una adenopatía axilar pigmentada durante la realización de una mastectomía bilateral profiláctica en una paciente de 35 años. El estudio anatomopatológico reveló pigmento compatible con tinta en el interior del ganglio. Esto, junto con la presencia de un tatuaje próximo a la axila de la paciente, permitió identificar el tatuaje como causa de la coloración de la adenopatía. Discutimos el diagnóstico diferencial a realizar en casos similares. Hasta un tercio de la población joven en España se ha realizado algún tatuaje, y las series de autopsias muestran la alta incidencia de presencia de pigmento en ganglios próximos a esos tatuajes. Creemos necesario realizar un correcto diagnóstico diferencial con melanoma y otras etiologías en pacientes tatuados para llevar a cabo una adecuada indicación quirúrgica (AU)

We report the finding of an axillary pigmented adenopathy during a bilateral profilactic mastectomy in a 35- year-old patient. The anatomopathologycal analysis revealed pigmentation compatible with ink inside the lymphatic node. The presence of a tattoo close to the axillary region of the patient made us identify the tattoo as the cause of the adenopathy coloration. We discuss the differential diagnosis to be considered in this cases. Around one third of the spanish population wears a tattoo, and series of autopsies show an elevated incidence of the presence of pigment in nodes adjacent to tattoos. The correct differential diagnosis with melanoma and other etiologies in tattooed patients is necessary to establish an adequate surgical indication (AU)

[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.

"Pokemonitis": los peligros de los tatuajes con henna negra / "Pokemonitis": the dangers of black henna tattoos

Los llamados tatuajes temporales realizados con henna negra son cada vez más frecuentes durante los meses de verano, especialmente en niños y jóvenes. La henna es un colorante natural que se utiliza mezclado con otras sustancias, como la parafenilendiamina, que pueden tener capacidad sensibilizante. Se describe el caso de un niño de cuatro años que presentó en ambos antebrazos lesiones residuales hipopigmentadas un mes después de la realización de estos tatuajes. Queremos aprovechar estas imágenes curiosas para llamar la atención sobre los peligros de la henna negra (AU)

The so-called temporary tattoos made with black henna are increasingly common during the summer months, especially in children and youth. Henna is a natural dye that is used mixed with other substances, such as phenylenediamine, which may have sensitizing capacity. We describe the case of a four year old boy who presented residual hypopigmented lesions on both forearms a month after the completion of these tattoos. We want to bring these curious images to draw attention to the dangers of black henna (AU)

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.