Sequels to tattoo removal by caustic products.

BACKGROUND: Caustic products are used as affordable alternatives to laser removal of tattoos. OBJECTIVE: Describe a series of patients with sequels after tattoo removal by caustic products. METHODS: 11 patients with complications referred from 2013 to 2017 were studied. Objective findings, sequels, corrective treatments, cost and psychological aspects were obtained. Numeric Rating Scale (NRS, score 10 extremely dissatisfied) was used to describe patient satisfaction with tattoos before and after removal. RESULTS: Scarring and residual tattoo pigments were detected in all patients. Chronic itching (73%), redness (73%) and swelling (64%) were frequent. Patients were less satisfied with their tattoo after removal attempts; Average NRS prior to removal was 7.5 (range 5-10), and afterwards 8.9 (range 4.5-10), t test non-significant. Removal was performed by medical professionals (82%) and cosmetologists (18%), involving the marketed injection brands Tatt2Away and Rejuvi. Ten patients had corrections eg. laser, plastic surgery or cover-up tattoos. Private expense for corrections was mean 1.953 EUR, not including consultations provided by the Hospital. CONCLUSION: Tattoo removal by caustic products can cause severe and chronic sequels with dissatisfaction despite therapeutic interventions to correct disfiguring changes. Removal by caustic products is freely permitted. Products are obscured and liability and consumer protection is unacceptable; limitation is needed.

Tattoo removal by Q-switched yttrium aluminium garnet laser: client satisfaction.

BACKGROUND: Tattoo removal by Q-switched yttrium aluminium garnet (YAG) lasers is golden standard; however, clients' satisfaction with treatment is little known. OBJECTIVE: To determine clients' satisfaction with tattoo removal. METHODS: One hundred and fifty-four tattoo removal clients who had attended the private clinic 'Centre for Laser Surgery', Hellerup, Denmark, from 2001 to 2013 completed a questionnaire concerning outcome expectations, level of pain experiences and satisfaction with tattoo removal. The laser surgeon and his team were blinded from data handling. The study design included a minimum 2-year postlaser treatment observation period from 2013 to 2015. RESULTS: Overall, clients were satisfied with their laser treatment; 85% assessed their treatment and results to be acceptable to superb, while 15% assessed their treatment and results to be inferior to unacceptable. Effectiveness relative to colour of tattoo on a scale from 0 (no effect) to 10 (complete removal) scored a mean of blue 9.5, black 9.4, yellow 8.9, red 8.8 and green 6.5. Clients were dissatisfied with green pigment remnants, which could mimic bruising. One hundred and twenty-nine clients (84%) experienced moderate to extreme pain during treatment. Twenty-eight (20%) developed minor scarring. There were many reasons for tattoo removal; e.g. stigmatisation (33%), conspicuousness (29%) and poor artistic quality (22%). One hundred and two clients had expected complete removal of tattoos without a blemish, expectations that were only partly fulfilled. During the treatment period, clients adjusted expectations and adapted more realistic views of outcomes. CONCLUSION: The majority of clients were satisfied with Q-switched YAG laser removal of tattoos despite high pretreatment expectations which were only partly met. The study supports YAG lasers for tattoo removal as acceptable therapy of today, with room for new approaches.

Allergic reactions in red tattoos: Raman spectroscopy for 'fingerprint' detection of chemical risk spectra in tattooed skin and culprit tattoo inks.

AIM: The aim of this study was to assess the feasibility of Raman spectroscopy as a screening technique for chemical characterisation of tattoo pigments in pathologic reacting tattoos and tattoo ink stock products to depict unsafe pigments and metabolites of pigments. MATERIALS/METHODS: Twelve dermatome shave biopsies from allergic reactions in red tattoos were analysed with Raman spectroscopy (A 785-nm 300 mW diode laser). These were referenced to samples of 10 different standard tattoo ink stock products, three of these identified as the culprit inks used by the tattooist and thus by history the source of the allergy. Three primary aromatic amine (PAA) laboratory standards (aniline, o-anisidine and 3,3'-dichlorobenzidine) were also studied. RESULTS: Application of Raman spectroscopy to the shave biopsies was technically feasible. In addition, all ten inks and the three PAA standards could be discriminated. 10/12 shave biopsies provided clear fingerprint Raman signals which differed significantly from background skin, and Raman spectra from 8/12 biopsies perfectly matched spectra from the three culprit ink products. The spectrum of one red ink (a low cost product named 'Tattoo', claimed to originate from Taiwan, no other info on label) was identified in 5/12 biopsies. Strong indications of the inks 'Bright Red' and 'Crimson Red' were seen in three biopsies. The three PAA's could not be unambiguously identified. CONCLUSION: This study, although on a small-scale, demonstrated Raman spectroscopy to be feasible for chemical analysis of red pigments in allergic reactions. Raman spectroscopy has a major potential for fingerprint screening of problematic tattoo pigments in situ in skin, ex vivo in skin biopsies and in tattoo ink stock products, thus, to eliminate unsafe ink products from markets.

Patients with tattoo reactions have reduced quality of life and suffer from itch: Dermatology Life Quality Index and Itch Severity Score measurements.

BACKGROUND: Tattoos are a trend with increasing side-effects. The burden of local reaction with swelling, itching and discomfort may impel sufferers to consult medical assistance. OBJECTIVES: To assess tattoo reactions and their influence on quality of life and itching by utilizing the Dermatology Life Quality Index (DLQI) scoring system and Itch Severity Scale (ISS). METHODS: Patients attending the 'Tattoo Clinic' at Bispebjerg University Hospital, Denmark with tattoo problems spanning more than 3 months were invited. Forty patients participated during September-November 2012. Patients attending their routine consultations completed the ISS and DLQI questionnaires. RESULTS: Patients with tattoo reactions experienced reduced quality of life, DLQI score 7.4 and were burdened by itch, ISS score 7.2. Both DLQI and ISS results attained the level of discomfort of known skin diseases such as psoriasis, pruritus and eczema albeit the typical tattooed affected areas are smaller. CONCLUSION/DISCUSSION: Sufferers of tattoo reactions have reduced quality of life and are often burdened by itching attaining the level of other cumbersome afflictions recognized as dermatological diseases associated with itch. Tattoo reactions warrant diagnosis and treatment with same professional intent shared with other skin diseases.

Photosensitivity and photodynamic events in black, red and blue tattoos are common: A 'Beach Study'.

OBJECTIVES: To find the prevalence of complaints in people having tattoos, with emphasis on chronic complaints, photosensitivity and photodynamic events. METHODS: Individuals sunbathing from June to September 2011 at the beaches of Denmark were invited to participate as they are prone to report tattoos and sun habits reliably. Sun-related and non-sun-related problems in tattoos were determined along with participants' use of sunscreen. Skin type was categorized, as were motifs and colours associated with problems. RESULTS: Of 467 sunbathers, 146 (31.3%) had tattoos. A total of 144 sunbathers with 301 tattoos accepted inclusion. Complaints were experienced in 60/144 (42%), of which 31/60 (52%) were sun related, such as swelling (58%), itching/stinging/pain (52%) and redness (26%). Reactions independent of sun were 29/60 (48%), such as reactions to heat 12/29 (41%) and cold 1/29 (4%). Red, blue and black tattoos predominantly caused sun-related complaints followed by the remaining colours. By number, problems in black tattoos dominated as black was far more frequent. DISCUSSION/CONCLUSION: Complaints such as swelling, itching, stinging, pain and redness are common, predominantly in black and red tattoos, but also frequent in blue tattoos, thus, not confined to one specific colour or chemical entity or class of pigment. Symptoms may switch on and off in seconds, typically not of the weal-and-flare type. Photochemical reactions to pigment or pigment-breakdown products in situ in the skin with induction of reactive oxygen species (ROS) is presumed to be one causative mechanism. Another possible mechanism especially relevant in black may be induction of ROS due to effects of aggregation of carbon black nanoparticles.

High prevalence of minor symptoms in tattoos among a young population tattooed with carbon black and organic pigments.

BACKGROUND: The prevalence of mild adverse reactions, i.e. complaints, in tattoos is sparsely described. OBJECTIVE: The demography of tattoos in a young population representing an index population of the recent trend was studied. The prevalence of complaints related to tattoos, and tattoos by number, size, localization and colour were registered. METHODS: The data were collected through personal interviews and examinations of consecutive individuals who spontaneously attended a clinic of venereology. RESULTS: Of 154 participants with 342 tattoos, 27% reported complaints in a tattoo beyond 3 months after tattooing. The complaints were predominantly related to black and red pigments. The participants reported complaints in 16% of their tattoos. Fifty-eight per cent of those complaints were sun induced. The complaints varied in intensity but were mainly minor. Skin elevation and itching were most frequent. The responders stated overall satisfaction with 80% of all tattoos. Eight per cent of tattoos were situated on anatomical sites prohibited by Danish law. CONCLUSION: We found a remarkably high prevalence of tattoo complaints, including photosensitivity, among young individuals tattooed with carbon black and organic pigments especially red.