Article

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

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Abstract

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.

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... Neben den beschriebenen Komplikationen klagen ungefähr 20% der Tätowierten über Lichtempfindlichkeit in sonnenexponierten Tattoos [3,68]. Relativ zur Häufigkeit der tätowierten Farbe ist auch hier Rot die auffälligste Farbe, gefolgt von Schwarz, Blau, Gelb und Orange [3,68]. ...
... Neben den beschriebenen Komplikationen klagen ungefähr 20% der Tätowierten über Lichtempfindlichkeit in sonnenexponierten Tattoos [3,68]. Relativ zur Häufigkeit der tätowierten Farbe ist auch hier Rot die auffälligste Farbe, gefolgt von Schwarz, Blau, Gelb und Orange [3,68]. Der zugrunde liegende Mechanismus ist weitgehend unklar. ...
... Eine Möglichkeit, welche häufig in der Literatur zitiert wird, ist die Produktion von "reactive oxygen species" (ROS) in Abhängigkeit von der Aggregation der Kohlenstoff-Nanopartikel in schwarzen Tätowiertinten [69,70]. In farbigen Tätowierungen können auch hier UV-induzierte Spaltprodukte von organischen (Azo-)Pigmenten eine Rolle spielen [30,68]. Insofern könnte Fotosensitivität in diesen Fällen eine milde Form der Kontaktsensibilisierung anzeigen. ...
Article
Tattoos and Permanent Make-up are two ways of everlasting beautification of the human body and these days gain rising popularity. Allergologists all over the World are confronted with increased numbers of intolerance tattoo reactions. This article comprises an overview about ingredients of tattoo inks, clinical appearances and diagnostic possibilities in non-infectious adverse reactions. Decomposition of pigments by laser or UV irradiation plays a role in allergic pathogenesis. Lichenoid reactions, hyperkeratoses, allergic contact eczemas and cutaneous lymphoid hyperplasia are contrasted with common differential diagnoses like granuloma, sarcoidosis and photosensitivity. For the time being, no official patch test recommendation exists so far. Nevertheless, this article provides assistance for the choice of test substances based on existing knowledge.
... Neben den beschriebenen Komplikationen klagen ungefähr 20% der Tätowierten über Lichtempfindlichkeit in sonnenexponierten Tattoos [3,68]. Relativ zur Häufigkeit der tätowierten Farbe ist auch hier Rot die auffälligste Farbe, gefolgt von Schwarz, Blau, Gelb und Orange [3,68]. ...
... Neben den beschriebenen Komplikationen klagen ungefähr 20% der Tätowierten über Lichtempfindlichkeit in sonnenexponierten Tattoos [3,68]. Relativ zur Häufigkeit der tätowierten Farbe ist auch hier Rot die auffälligste Farbe, gefolgt von Schwarz, Blau, Gelb und Orange [3,68]. Der zugrunde liegende Mechanismus ist weitgehend unklar. ...
... Eine Möglichkeit, welche häufig in der Literatur zitiert wird, ist die Produktion von "reactive oxygen species" (ROS) in Abhängigkeit von der Aggregation der Kohlenstoff-Nanopartikel in schwarzen Tätowiertinten [69,70]. In farbigen Tätowierungen können auch hier UV-induzierte Spaltprodukte von organischen (Azo-)Pigmenten eine Rolle spielen [30,68]. Insofern könnte Fotosensitivität in diesen Fällen eine milde Form der Kontaktsensibilisierung anzeigen. ...
Article
Tattoos and Permanent Make-up are two ways of everlasting beautification of the human body and these days gain rising popularity. Allergologists all over the World are confronted with increased numbers of intolerance tattoo reactions. This article comprises an overview about ingredients of tattoo inks, clinical appearances and diagnostic possibilities in non-infectious adverse reactions. Decomposition of pigments by laser or UV irradiation plays a role in allergic pathogenesis. Lichenoid reactions, hyperkerato-ses, allergic contact eczemas and cutaneous lymphoid hyperplasia are contrasted with common differential diagnoses like granu-loma, sarcoidosis and photosensitivity. For the time being, no official patch test recommendation exists so far. Nevertheless, this article provides assistance for the choice of test substances based on existing knowledge.
... About 11-31.5 % of citizens in Western societies have at least one tattoo (Borkenhagen et al., 2019;Kluger, 2015) and one in five tattooed individuals experiences tattoo associated side effects . Light exposure of tattooed skin accounts for up to 60 % of all reported side effects (Hutton Carlsen and Serup, 2014) and outnumbers tattoo associated infections, allergies and foreign body granuloma formation (Serup et al., 2016. ...
... Phototoxic effects are reported for the entire color range of tattoo pigments (Hutton Carlsen and Serup, 2014), but the molecular mechanisms of tattoo associated side effects are not yet fully understood. The white pigment TiO 2 is widely applied in its crystal structure anatase but generates reactive oxygen species (ROS) upon UVA irradiation (Wamer and Yin, 2011). ...
Article
The increasing number of tattooed persons urges the development of reliable test systems to assess tattoo associated risks. The alarming prevalence of 60% phototoxic reactions in tattoos ask for a more comprehensive investigation of phototoxic reactions in tattooed skin. Here, we aimed to compare the cellular responses of human skin cells to ultraviolet (UV)A and UVB irradiation in doses of short to intermitted sun exposure (3 – 48 J/cm² and 0.05 – 5 J/cm², respectively) in the presence of tattoo pigments. Therefore, we used fibroblast monolayer-culture (2D), our recently developed three dimensional full-thickness skin model with dermal-located tattoo pigments (TatSFT) and its dermal equivalents (TatSDE) that lack keratinocytes. We tested the most frequently used tattoo pigments carbon black, titanium dioxide (TiO2) anatase and rutile as well as Pigment Orange (P.O.)13 in ranges from 0.067 – 2.7 ng/cell in 2D. For TatSDE and TatSFT, concentrations were 1.3 ng/cell for TiO2, 0.67 ng/cell for P.O.13 and 0.067 ng/cell for carbon black. We assessed cell viability and cytokine release in all systems, and cyclobutane pyrimidine dimer (CPD) formation in TatSFT. Phototoxicity of tattoo pigments was exclusively observed in 2D, where especially TiO2 anatase induced phototoxic effects in all concentrations (0.067 – 2.7 ng/cell). Contrary, fibroblasts were protected from UV irradiation in TatSDE by TiO2 and carbon black. Neither toxic nor protective effects were recorded in TatSFT. P.O.13 showed altered cytokine secretion in 2D (0.067 – 1.3 ng/cell) and TatSDE, despite the absence of significant effects on viability in all systems. All pigments reduced the number of CPDs in TatSFT compared to the pigment-free controls. In conclusion, our study shows that within a 3D arrangement, intradermal tattoo pigments may act photoprotective despite intrinsic phototoxic properties in 2D. Thus, dermal 3D equivalents should be considered to evaluate acute tattoo pigment toxicology.
... Mainly mild and transient complications have been reported herein, as, in fact, in the literature. [5][6][7][8][9][10] ...
... Mainly mild and transient complications have been reported herein, as, in fact, in the literature. [5][6][7][8][9][10] Tattooing has become a widespread phenomenon among young people. Psoriatic patients may also be interested in getting tattooed, but some may fear a risk of complications due to their disease and/or treatments. ...
Article
The blockade of immunological targets by biological agents can induce paradoxical inflammatory conditions as a result of a cytokine imbalance. Paradoxical eczema‐like reactions have infrequently been reported in patients with psoriasis treated with anti‐TNF agents and ustekinumab.¹ We report an eczematous eruption with Staphylococcus aureus infection in a patient receiving ixekizumab. This article is protected by copyright. All rights reserved.
... Nowadays, the frequency of tattoos has been growing, especially among young people. Demographic studies show that in Germany, 8.5% of the population with ages between 14 and 90 has a tattoo, in France, the percentage is 10% and among young people, in many countries, more than 25% of them are tattooed. Most of them see it as a form of body art. ...
... A study was conducted in Denmark, in 2014, which included 144 tattooed subjects with history of sun exposure. Sixty of them complained about cutaneous reactions after sun exposure, which included edema (58%), pruritus/pain/burn (52%) and erythema (26%) (8). ...
Article
Full-text available
Tattoos have been used for over 2000 years. Nowadays, the frequency of tattoos has been growing, especially among young people. In many countries, more than 25% of the population has a tattoo. Lately, the medical world is trying to increase the awareness concerning tattoos and the multiple risks they carry, like allergic reactions, lichenoid reactions, sarcoidosis, scleroderma-like reactions, viral, bacterial and fungal infections, benign tumors, pseudolymphomas, chronic lymphoid hyperplasia. Rarely, malignant tumor can develop on the tattoo surface. Clinical case: A 25 year old male has been admitted in our clinic presenting infi ltrative, erythematous, scaly plaques, with yellow crusts on the surface, placed on the left arm and right leg, on the surface of two tattoos, only on the areas with red pigment. The patient had these symptoms for over one year. The tattoos were made two years before coming to the hospital. The cutaneous lesions were surgically removed and a histopathological exam was performed, revealing chronic granulomatous infl ammatory infi ltrate, with giant cells and eosinophilic necrosis areas. Discussions: In order to make a tattoo, body artists use multiple pigments, by themselves or in different combinations. The red pigment used in tattoos can be organic (santal wood, Caesalpinia echinata-both vegetal dyes) or inorganic (cadmium, mercury, selenium, sienna, the last one is an iron hydrate). There are several cutaneous reactions to the pigments found in tattoos: infl ammatory reactions, allergic reactions, granulomatous reactions, lichenoid reactions and pseudolymphomatous reactions. Conclusions: 1) The granulomatous reaction is a complication that occurs frequently after red pigment tattoos; and 2) The patients need to be thoroughly investigated in order to rule out a foreign body reaction, sarcoidosis, an infectious disease (tuberculosis, mycobacteria infections, leprosy, leishmaniasis, and fungal infections), granuloma annulare, and iatrogenic granulomatous disease after the use of ribavirin, interferon, anti-TNF  medication, ipilimumab.
... As briefly mentioned in the introduction, biological phenomena underlying tattooinduced changes are still largely unexplored. Nevertheless, oxidative stress has been proposed as the most important pathophysiological mediator responsible for tattoo-related health complaints such as swelling, itching, and redness following solar radiation exposure in the famous "Beach study" [25]. Interestingly, the association of reactive oxygen species (ROS) and tattoo ink in humans has so far only been supported by indirect findings from in vitro toxicological studies [26,27] and theoretical assumptions based on the fact that mechanisms of photoactivation underlying the biological effects of photodynamic therapy were also shown for some chemicals that are often present in tattoo inks such as polycyclic aromatic hydrocarbons [25,28]. ...
... Nevertheless, oxidative stress has been proposed as the most important pathophysiological mediator responsible for tattoo-related health complaints such as swelling, itching, and redness following solar radiation exposure in the famous "Beach study" [25]. Interestingly, the association of reactive oxygen species (ROS) and tattoo ink in humans has so far only been supported by indirect findings from in vitro toxicological studies [26,27] and theoretical assumptions based on the fact that mechanisms of photoactivation underlying the biological effects of photodynamic therapy were also shown for some chemicals that are often present in tattoo inks such as polycyclic aromatic hydrocarbons [25,28]. Nevertheless, PubMed search for "tattoo" AND "oxidative stress" and "tattoo" AND "ROS" only yields 7 and 8 hits respectively, and none of the results provide any evidence for direct oxidative stress effects of tattooing in humans. ...
Article
Biomedical aspects of tattooing have been extensively discussed in the literature, however pathophysiological effects of tattoo inks in the human body are still unexplored. Oxidative stress is considered responsible for the adverse effects of tattooing, however, no experimental evidence for tattoo ink-related oxidative stress in the human body currently exists. The aim was to examine the effect of a blue tattoo on skin redox regulatory network (RRN) parameters in a single human subject. Skin surface oxidation-reduction potential (ORP) was analyzed with a PH60F flat probe. Interstitial and intracellular fluid enriched capillary blood from the tattoo and the control area was extracted and analyzed with I2/KI-stabilized microORP, nitrocellulose redox permanganometry (NRP), carbonato-cobaltate (III) formation-derived H2O2 dissociation rate assay, 1,2,3-trihydroxybenzene autoxidation assay, thiobarbituric reactive substances (TBARS) assay and 5,5,’-dithio-bis-(2-nitrobenzoic acid) (DTNB)-based determination of free thiol content in low molecular weight and protein precipitate fractions. Surface ORP analysis revealed a greater antioxidant capacity of tattooed skin in comparison with the control (CTR). Capillary blood analysis confirmed greater reductive capacity in the tattoo sample both by microORP (-4.33mV vs CTR) and NRP (+10.8%). Hydrogen peroxide dissociation rate (+11.8%), and protein sulfhydryl content (+8.5%) were increased, and lipid peroxidation (-15%) was reduced in the tattoo sample in comparison with the CTR. In this N-of-1 study, RRN of tattooed skin was shifted towards a more reductive state with all parameters indicating reduced levels of oxidative stress in comparison with nontattooed skin. The local antioxidant effect of copper(II) phthalocyanine provides one possible explanation of the observed effects.
... Furthermore, allergic reactions without generalized rashes can be initialized by laser treatment, and putatively by sun exposure, due to the release of sensitizers [65][66][67]. This so-called photoallergy should not be confused with phototoxicity which involves transient reactions during exposure of the tattoo to sunlight [68]. ...
... This indicates that at least some allergens may already be present in the ink. For tattoo hypersensitivity reactions with a late onset, external factors, especially light inducing photochemical cleavage of tattoo pigments in situ in the skin, may contribute to allergen formation from pre-haptens or pro-haptens [27,68,71,79]. ...
Article
Full-text available
During tattooing, a high amount of ink is injected into the skin. Tattoo inks contain numerous substances such as the coloring pigments, impurities, solvents, emulsifiers, and preservatives. Black amorphous carbon particles (carbon black), white titanium dioxide, azo or polycyclic pigments create all varieties of color shades in the visible spectrum. Some ingredients of tattoo inks might be hazardous and allergenic chemicals of unknown potential. In Germany, about 20 % of the general population is tattooed and related adverse reactions are increasingly reported. Since tattoo needles inevitably harm the skin, microorganisms can enter the wound and may cause infections. Non‐allergic inflammatory reactions (for example cutaneous granuloma and pseudolymphoma) as well as allergic reactions may emerge during or after wound healing. Especially with allergies occurring after weeks, months or years, it remains difficult to identify the specific ingredient(s) that trigger the reaction. This review summarizes possible adverse effects related to tattooing with a focus on the development of tattoo‐mediated allergies. To date, relevant allergens were only identified in rare cases. Here we present established methods and discuss current experimental approaches to identify culprit allergens in tattoo inks – via testing of the patient and in vitro approaches.
... Allergische Reaktionen ohne generalisierten Hautausschlag können auch durch Laserbehandlung und vermutlich auch durch Sonnenexposition aufgrund der Freisetzung von Sensibilisatoren angestoßen werden [65][66][67]. Diese sogenannte Photoallergie ist nicht zu verwechseln mit der Phototoxizität, bei der es sich um kurzzeitige Reaktionen während der Einwirkung von Sonnenlicht auf die Tätowierung handelt [68]. In einigen seltenen Fällen können vermeintliche allergische Reaktionen, die in Zusammenhang mit einer Tätowierung beobachtet wurden, auch durch Implantatmaterialien ausgelöst werden [69,70]. ...
... Das lässt darauf schließen, dass zumindest einige Allergene bereits in der Tinte vorhanden sein können. Bei den späten Reaktionen auf Tätowierungen können äußere Faktoren wie Licht, welches die photochemische Spaltung von Tätowierungspigmenten in situ in der Haut induziert, zur Allergenbildung aus Prä-oder Pro-Haptenen beitragen [27,68,71,79]. Der Nachteil des Epikutantests ist, dass er nur eine Assoziation zwischen der Sensibilisierung und einer Einzelsubstanz, mit der der Patient Kontakt hatte, herstellen kann; zum Beispiel eine Nickelsensibilisierung, die mit Nickel in einer Tätowiertinte korreliert. ...
Article
Full-text available
Zusammenfassung Beim Tätowieren wird eine erhebliche Menge an Tinte in die Haut eingestochen. Tätowiertinten enthalten zahlreiche Inhaltsstoffe, dazu zählen Farbpigmente, Verunreinigungen, Lösungsmittel, Emulgatoren und Konservierungsmittel. Schwarze amorphe Kohlenstoffpartikel (Carbon Black), weißes Titandioxid, Azo‐ oder polyzyklische Pigmente lassen alle möglichen Farbnuancen im sichtbaren Spektrum entstehen. Einige Inhaltsstoffe von Tätowiertinten können gefährliche und allergieauslösende Chemikalien mit unbekanntem Gefahrenpotenzial sein. In Deutschland sind etwa 20 % der Bevölkerung tätowiert und es wird zunehmend über die damit einhergehenden unerwünschten Wirkungen berichtet. Da Tätowiernadeln unweigerlich die Haut verletzen, können Mikroorganismen in die Wunde eindringen und Infektionen verursachen. Während oder nach der Wundheilung kann es sowohl zu nichtallergischen Entzündungsreaktionen (zum Beispiel kutanen Granulomen und Pseudolymphomen) als auch zu allergischen Reaktionen kommen. Besonders bei den Allergien, die nach Wochen, Monaten oder sogar Jahren auftreten können, bleibt es schwierig, den oder die auslösenden Substanzen zu identifizieren. Diese Übersichtsarbeit fasst mögliche unerwünschte Wirkungen im Zusammenhang mit dem Tätowieren zusammen, wobei der Schwerpunkt auf der Allergieentstehung liegt. Bislang wurden relevante Allergene nur selten identifiziert. Im Folgenden stellen wir etablierte Methoden vor und diskutieren aktuelle experimentelle Ansätze zur Identifizierung von Allergenen in Tätowiertinten – über Tests am Patienten und in vitro.
... As reações de fotossensibilidade são aquelas em que o pigmento contido em determinada tinta reage com a radiação solar levando a uma inflamação, com presença de edema, ardor e, principalmente, prurido, sendo restritos ao local da tinta específica. São descritas principalmente nas tatuagens vermelhas, pretas e azuis 8 . ...
... O mecanismo envolvido é a hipersensibilidade mediada por células (tardia ou do tipo IV), sendo a radiação solar necessária para converter o pigmento da tatuagem num composto imunopatologicamente ativo (fotoproduto) que vai induzir a resposta imunológica, gerando sintomatologia 8,9 . Os sintomas podem se manifestar num intervalo de minutos até semanas após a exposição solar, e permanecer por semanas a meses 3 . ...
Article
Full-text available
Tattooing is a very old practice that has become extremely popular in recent years; however, it carries risks that cannot be ignored. The inks used in tattoos are an important factor for the appearance of adverse reactions. Hypersensitivity reactions to the pigments in the inks are some of the most common. These include allergic reactions such as contact dermatitis or photosensitivity reactions, the latter being the reason for this report. The recommended treatment is the use of corticosteroids and photoprotection. In this article, we will specifically discuss the photosensitivity reaction to the blue pigment with a case report and a brief literature review.
... Europe across the Baltic Sea. In Scandinavia, only our colleagues from Copenhagen University Hospital, in Denmark are currently active on this topic (4,5). Other studies have been performed mainly in Germany (6) and in the United States (7-9). ...
... Tattooed individuals are often reluctant to take part to such studies because of the negative connotations that are often associated with tattooing. To achieve an acceptable response rate, studies usually are based on phone interviews (7), Internet survey (6) or direct interview of randomly selected tattooed (5,8,9). Because of lack of funding in our study, we designed a short survey inspired from previous studies (7,9) and choose the setting of a small new tattoo convention. ...
Article
Full-text available
Objectives. Tattoos are increasingly popular in Northern Europe. There are currently very limited data about the features of tattoos and complications in Finland. We aimed to assess the demographic of tattooed individuals and the rate of complications on tattoos in a tattoo convention in Finland. Study design. An observational anonymous self-reported 15-question survey was performed among the visitors of a tattoo convention in Hämeenlinna, Finland. Results. Of the 46 tattooed respondents, 61% were women and the mean age was 33 years old. The mean number of tattoos was 4,8; for a tattooed body surface of 14%. The tattoos were multicoloured in 56% of the cases (mean number of colour 2.8). Twenty percent reported at least one amateur tattoo and 6.5% only home-tattoos and 28% were still minor (< 18 years) when receiving their first tattoo. An acute local adverse “tattoo reaction” was reported 8.6% that necessitated a medical consultation and treatment in 75% of the cases, but without any severe consequences. No chronic reaction or other complication was here reported. Conclusion. Despite limitations due to a small sample size and the selection bias, the profile of the “tattooed Finn” is similar to other studies in Europe or in the USA.
... 11 local metabolism of these unknown azo dyes into porphyrins may have photo-sensitizing effects on the skin. 19 Phototoxicity describes the tissue reactions caused by light and it is the toxic response of the skin that develops due to the light exposure of a substance that is applied to the organism systemically or subcutaneously. 13 The phototoxic reactions are characterized by skin irritation or exaggerated sunburn-like symptoms such as erythema, tenderness, pruritus and edema in patients. ...
... It has been reported that red, blue, and black tattoos cause more sun-related complaints than other colors. 19 A clear relationship between having tattoos and skin cancer development has not established today. There are case reports of the development of cancer types such as melanoma, basal cell carcinomas, squamous cell carcinomas, and keratoacanthomas in persons with tattoos. ...
Article
Objectives: Tattooing is an ancient practice and its popularity has been increasing in the recent years. After tattooing, complications may occur related to compose tattoo inks. In this study, the phototoxicity potential of the blue, red and black colors of the most commonly used three different commercially-available tattoo ink brands have been examined by performing in vitro 3T3-neutral red uptake (NRU) phototoxicity test. Materials and methods: In the study, the phototoxicity of serial diluted concentrations of tattoo inks were evaluated with in vitro 3T3-NRU phototoxicity test method according to OECD guide 432. The data obtained from the NRU test result were uploaded to Phototox software (version 2.0) and the phototoxicity potentials of tattoo inks were determined via the calculation of the mean photo effect (MPE) and photo irritation factor (PIF) values. Results: The red, black and blue colors of three different commercially available tattoo inks did not cause a cytotoxic activity on BALB/c 3T3 cells with 3T3-NRU test. The IC50 values could not be determined +ultraviolet (UV) and -UV conditions. PIF values could not be calculated and MPE values were <0.1, which predicts the absence of phototoxic effect for all of the tested tattoo inks. Conclusion: All tested inks were evaluated as non-phototoxic according to the results of MPE values calculated using Phototox software. However, test results should be verified by other phototoxicity test methods to obtain a comprehensive evaluation of phototoxic complications of different tattoo inks.
... The cleavage of Pigment red 57:1 by acid-catalysis also has been reported. Moreover, aromatic compounds may be photo-decomposed leading to the formation of photoproducts of which some are reported to be known or suspected carcinogens to human beings (De Cuyper, 2008;Hutton Carlsen and Serup, 2014). Photolysis of Pigment Orange 13 to substances such as 3,3ʹ-dichloro-4-aminobiphenyl or 3,3ʹ-dichlorobenzidine (Cul et al., 2004) and Pigment Red 22 to various by-products has been reported (Hutton Carlsen and Serup, 2014;Vasold et al., 2004Vasold et al., , 2008Vasold et al., 2008). ...
... Moreover, aromatic compounds may be photo-decomposed leading to the formation of photoproducts of which some are reported to be known or suspected carcinogens to human beings (De Cuyper, 2008;Hutton Carlsen and Serup, 2014). Photolysis of Pigment Orange 13 to substances such as 3,3ʹ-dichloro-4-aminobiphenyl or 3,3ʹ-dichlorobenzidine (Cul et al., 2004) and Pigment Red 22 to various by-products has been reported (Hutton Carlsen and Serup, 2014;Vasold et al., 2004Vasold et al., , 2008Vasold et al., 2008). The skin keeps out the outside world, but it can also break down chemicals that get into the body through absorption. ...
Article
Today, tattooing has become very popular among people all over the world. Tattooists, with the help of tiny needles, place tattoo ink inside the skin surface and unintentionally introduce a large number of unknown ingredients. These ingredients include polycyclic aromatic hydrocarbons (PAHs), heavy metals, and primary aromatic amines (PAAs), which are either unintentionally introduced along with the ink or produced inside the skin by different types of processes for example cleavage, metabolism and photodecomposition. These could pose toxicological risks to human health, if present beyond permissible limits. PAH such as Benzo(a)pyrene is present in carbon black ink. PAAs could be formed inside the skin as a result of reductive cleavage of organic azo dyes. They are reported to be highly carcinogenic by environmental protection agencies. Heavy metals, namely, cadmium, lead, mercury, antimony, beryllium, and arsenic are responsible for cancer, neurodegenerative diseases, cardiovascular, gastrointestinal, lungs, kidneys, liver, endocrine, and bone diseases. Mercury, cobalt sulphate, other soluble cobalt salts, and carbon black are in Group 2B, which means they may cause cancer in humans. Cadmium and compounds of cadmium, on the other hand, are in Group 1 (carcinogenic to humans). The present article addresses the various ingredients of tattoo inks, their metabolic fate inside human skin and unintentionally added impurities that could pose toxicological risk to human health. Public awareness and regulations that are warranted to be implemented globally for improving the safety of tattooing.
... Photosensitive reactions are frequently reported. 46 However, in our study, we found a relatively low number of patients with (non-allergic) photosensitive reactions (1.3%). The symptoms are generally acute and mild and this could explain this low number, since patient is not expected to be referred to a dermatologist with only mild complaints. ...
Article
Full-text available
Background Worldwide 10–20% of the population is tattooed. However, tattoo complications can occur, such as allergic tattoo reactions, infections, and manifestations of autoimmune dermatoses. Despite the growing popularity of tattoos and changes in tattoo ink composition over the last decades, little is known about these complications, its clinical aspects, pathomechanism, and relative occurrence. Objective The aim of this article is to describe the types and clinical aspects of dermatological tattoo complications, its relative occurrence and underlying conditions. Methods We performed a retrospective cohort study enrolling all patients with tattoo complications from the Tattoo Clinic. Tattoo complications were categorized into infections, inflammatory tattoo reactions, neoplasms, or miscellaneous reactions and correlated to clinical data. Results Of the total of 326 patients, 301 patients were included with 308 complications. The majority of the complications were chronic: 91.9%. Allergic red tattoo reactions and chronic inflammatory black tattoo reactions (CIBTR) accounted for 50.2% and 18.2%, respectively, of all tattoo complications. Of these CIBTR reactions, extracutaneous involvement was found in 21.4%, including tattoo-associated uveitis (7.1%) and systemic sarcoidosis (14.2%). Of all black tattoo reactions, systemic sarcoidosis was found in 7.8%. Conclusion Tattoos can cause a wide range in complications that may start years after getting the tattoo. The most frequent tattoo reactions are allergic red tattoo reactions and chronic inflammatory black tattoo reactions, making these the most relevant for the dermatologist. CIBTR have a high percentage of multi-organ involvement, and therefore, screening for sarcoidosis, including ocular involvement, is advised.
... Im Jahr 2010 führte unsere Arbeitsgruppe eine Online-Befragung von 3 411 Probanden aus deutschsprachigen Ländern zum Thema gesundheitliche Probleme bei tätowierter Haut durch. 67 % der Befragten berichteten von Hautproblemen und 7 % schilderten Allgemeinsymptome, die in erster Linie einige Wochen nach dem Tätowieren auftraten (10) Zusammen mit 2 weiteren, dänischen Studien (11,12) konnte gezeigt werden, dass Beschwerden wie Juckreiz und Schwellung relativ häufig nach einer Tätowierung auftreten und nahezu ein Drittel der Tätowierten davon betroffen ist. Etwa ein Fünftel hatte UV-Licht-assoziierte Beschwerden (9). ...
... As shown in Table 1 reported, such as papular and nodular reactions and phototoxic reactions, allergic reactions to black tattoo ink rarely occur. 1,2,33,34 One possible explanation for this may be that the PAHs are removed from the skin with time, in contrast to the encapsulated ink pigments. 35,36 Also, whereas a substantial increase in IL-18 secretion was observed in the RHS after exposure to Intenze Sculpting Black, our RHS IL-18 assay represents only keratinocyte activation (key event 2 of the sensitization AOP), and further downstream key events, such as dendritic cell activation and T cell priming, may possibly not occur. ...
Article
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Background During the last decade, the number of people with ≥1 tattoo has increased noticeably within the European population. Despite this, limited safety information is available for tattoo inks. Objectives To test the skin sensitization potential of 5 tattoo inks in vitro by using reconstructed human skin (RHS) and the contact sensitization biomarker interleukin (IL)‐18. Methods Two red and 3 black tattoo inks, 1 additive (Hamamelis virginiana extract) and 1 irritant control (lactic acid) were tested. The culture medium of RHS (reconstructed epidermis on a fibroblast‐populated collagen hydrogel) was supplemented with test substances in a dose‐dependent manner for 24 hours, after which cytotoxicity (histology; thiazolyl blue tetrazolium bromide assay) and skin sensitization potential (IL‐18 secretion; enzyme‐linked immunosorbent assay) were assessed. Results All but 1 ink showed cytotoxicity. Notably, 1 red ink and 1 black ink were able to cause an inflammatory response, indicated by substantial release of IL‐18, suggesting that these inks may be contact sensitizers. Conclusions The in vitro RHS model showed that 4 tattoo inks were cytotoxic and 2 were able to cause an inflammatory IL‐18 response, indicating that an individual may develop allergic contact dermatitis when exposed to these tattoo inks, as they contain contact sensitizers.
... As shown in Table 1 reported, such as papular and nodular reactions and phototoxic reactions, allergic reactions to black tattoo ink rarely occur. 1,2,33,34 One possible explanation for this may be that the PAHs are removed from the skin with time, in contrast to the encapsulated ink pigments. 35,36 Also, whereas a substantial increase in IL-18 secretion was observed in the RHS after exposure to Intenze Sculpting Black, our RHS IL-18 assay represents only keratinocyte activation (key event 2 of the sensitization AOP), and further downstream key events, such as dendritic cell activation and T cell priming, may possibly not occur. ...
Article
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BACKGROUND: During the last decade, the number of people with ≥1 tattoo has increased noticeably within the European population. Despite this, limited safety information is available for tattoo inks. OBJECTIVES: To test the skin sensitization potential of 5 tattoo inks in vitro by using reconstructed human skin (RHS) and the contact sensitization biomarker interleukin (IL)-18. METHODS: Two red and 3 black tattoo inks, 1 additive (Hamamelis virginiana extract) and 1 irritant control (lactic acid) were tested. The culture medium of RHS (reconstructed epidermis on a fibroblast-populated collagen hydrogel) was supplemented with test substances in a dose-dependent manner for 24 hours, after which cytotoxicity (histology; thiazolyl blue tetrazolium bromide assay) and skin sensitization potential (IL-18 secretion; enzyme-linked immunosorbent assay) were assessed. RESULTS: All but 1 ink showed cytotoxicity. Notably, 1 red ink and 1 black ink were able to cause an inflammatory response, indicated by substantial release of IL-18, suggesting that these inks may be contact sensitizers. CONCLUSIONS: The in vitro RHS model showed that 4 tattoo inks were cytotoxic and 2 were able to cause an inflammatory IL-18 response, indicating that an individual may develop allergic contact dermatitis when exposed to these tattoo inks, as they contain contact sensitizers.
... However, they have been tested in 3 patients, with negative results [23]. Some researchers have postulated that sunlight could induce a process of photochemical cleavage of the tattoo pigments, particularly the azo pigments, which would enable chemical substances to act as haptens [27,28]. This observation could explain numerous phenomena of solar intolerance that have been described in tattooed areas and opens up new possibilities in how to approach these patients, whether through photopatch testing or patch testing with substances processed with ultraviolet light. ...
Article
The last few decades have seen a notable increase in the number of people who have a tattoo. This practice is not free from complications. Most adverse effects appear early and are temporary, although they can occasionally develop later and be permanent and serious. Recent research has generated new knowledge on the composition of inks, their degradation over time, the immune activity that is stimulated, and the various clinical disorders that can arise. This information enables better approaches to diagnosis and management when complications arise. Diagnosing allergic reactions to permanent tattoo ink can be very challenging. This review aims to identify clinical and histological clues to help practitioners differentiate allergic reactions from other complications. We discuss the yield and appropriateness of skin tests and biopsies and propose an algorithm to guide the diagnostic process.
... The components (colorants and additives) or even the impurities that are present in tattoo inks may generate singlet oxygen in presence of UV light [26], while in absence of light the aggregation of tattoo ink particles may induce the production of reactive oxygen species (ROS) [27]. Antioxidants such as phenolic compounds have an effect on the protection of the tattooed skin area skin during the decolorization process from ROS [28]. ...
Article
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Permanent make-up (PMU) has become a very popular application over the last few years. The ingredients of PMU inks, used over the face area, are organic and inorganic substances very close to the chemical composition of tattoo inks. As the application rates increase, the demand for PMU removal rises. The aim of this study is to assess the decolorization of PMU inks using preparations originating from different plant sources. The leaves of Pelargonium zonale (PE) were extracted with water for 48 h. The Total Phenolic Content (TPC) of the extract was determined using the Folin–Ciocalteu technique reaching 201.34 ± 4.57 μg Gallic Acid Equivalents (GAE)/mL of extract. The antioxidant activity of the extract was 20.87 ± 0.36 μg of Trolox equivalents (TE)/mL and 3.56 ± 0.43 mg FeSO4×7H2O mL of extract when assessed by 2,2-diphenyl-1-picrylhydrazyl (DPPH) or ferric reducing antioxidant power (FRAP) assay respectively. The decolorization potential of PE leaf extract on five commercially available PMU inks of different hues was assessed by UV-Vis spectrophotometry in comparison to polyphenol oxidases enzyme (PPO). The results demonstrated higher absorption reduction that indicates decolorization potential for the inks that have mainly ferrous oxides as colorants.
... Black, red and blue tattoos were dominantly responsible for sunrelated complications. 37 Another study done by FDA, according to which there is negative effects on health due to tattoos ink, according to the FDA the sources of pigments like heavy metals, hydrocarbons and phthalates can act as cancer causing agents 38,39,40 . ...
Article
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Background:The trend of tattoos increases day-by-day in many of the countries but unfortunately there is no evaluation of this practice in Pakistan.The term “tattoo” is the art of making colourful designs beneath the skin. There are different types of tattoos with different colour of inks. This practice is done for many reasons including fashion, beauty, to hide skin marks, addiction to pain, to memorize something or due to any personal reasons. Some people hide their tattoos due to some restrictions. Tattooed people may face restriction in jobs. They may cause different type of skin infections and other medical conditions. Objective:Our motive of research is to evaluate the relation of tattoos with disease conditions and reasons for adaptation of tattoos in Pakistan. Methodology:The data was collected by online interviews and face-to-face interactions with participants and tattoo artists. All the participants (N=181) with permanent tattoos were asked about different questions regarding age, gender, motivations for being tattooed, opinions and side effects following tattooing etc. Results: In Pakistan, tattooing is more common among males (74.03%) than females (25.96%). The highest motivation of being tattooed was found to be fashion (31.57%) and beauty (36.31%). Greater number of participants considered tattooing as harmless (66%) and less considered it as harmful (28%), while few (N=6%) have mixed opinions. Common side effect experienced by participants was inflammation (23.36%) and then allergy (11.41%) but majority of the participants did not experience any severe side effects. People belonging to any occupation were equally influenced by tattooing but it is more common in teenagers. Conclusion:In Pakistan, tattoos trend seems to be increasing day-by-day. Most people regardless of age, occupation, religion and side effects got tattoos because of fashion and beauty and there were no severe side effects of tattooing in Pakistan. Bangladesh Journal of Medical Science Vol. 21 No. 03 July’22 Page: 730-740
... 4 However, intermittent sun-induced complaints are common in tattoos and occur at a similarly high rate. 16 These complaints might be induced partly by titanium dioxide, a white pigment used for color blending in tattoo inks. Titanium dioxide is used in the crystal structures rutile and anatase, of which the latter is known to cause formation of reactive oxygen species upon UV irradiation and that also occurs in tattoo and permanent makeup inks. ...
Article
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Background: Red tattoos are prone to allergic reactions. The identity of the allergen(s) is mostly unknown. Objectives: Chemical analysis of human skin biopsies from chronic allergic reactions in red tattoos to identify culprit pigment(s) and metals. Material and methods: 104 dermatome biopsies were analysed by matrix assisted laser desorption/ionization tandem mass spectrometry (MALDI-MS/MS) for identification of commonly used organic pigments. Metal concentrations were assessed by inductively coupled plasma (ICP)-MS and X-ray fluorescence (XRF). Fourteen patients had cross-reactions in other red tattoos. Results: In total, the identified pigments were mainly azo Pigment Red (P.R.) 22 (35%), P.R. 210 (24%), P.R. 170 (12%), P.R. 5 (0.9%), P.R. 112 (0.9%) and Pigment Orange (P.O.) 13 (11%). P.R. 122 (0.9%) and Pigment Violet (P.V.) 23 (8%) were also common. P.R. 22, P.R. 170, and P.R. 210 also dominated in patients with cross-reactions. In 22% of the biopsies, no red pigment was detected. Element analysis indicated the presence of the sensitizers nickel and chromium. Conclusions: P.R. 22, P.R. 170 and P.R. 210 were identified as the prevailing pigments behind chronic allergic reactions in red tattoos. The epitope causing the reaction might be a pigment degradation product. Metal contamination may derive from different sources and its role in red tattoo allergy cannot be ascertained. This article is protected by copyright. All rights reserved.
... Protein sulfhydryl content and low molecular weight thiol determination Protein thiols and low molecular weight thiols (LMWT) were determined by reacting the samples with 5,5'-dithio-bis(2-nitrobenzoic acid) (DTNB) with subsequent quantification of 5-thio-2-nitrobenzoic acid (TNB)[15,16]. Briefly, samples(10 μl) were mixed with 15 μl of ddH2O and 25 μl of sulfosalicylic acid (4% w/v) was added to the mixture. ...
Preprint
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Biomedical aspects of tattooing have been extensively discussed in literature, however pathophysiological effects of tattoo inks in the human body are still unexplored. Oxidative stress is considered responsible for the adverse effects of tattooing, however no experimental evidence for tattoo ink-related oxidative stress in the human body currently exists. The aim was to examine the effect of a blue tattoo on skin redox regulatory network (RRN) parameters in a single human subject. Skin surface oxidation-reduction potential (ORP) was analyzed with a PH60F flat probe. Interstitial and intracellular fluid enriched capillary blood from the tattoo and the control area was extracted and analyzed with I2/KI-stabilized microORP, nitrocellulose redox permanganometry (NRP), carbonato-cobaltate (III) formation-derived H2O2 dissociation rate assay, 1,2,3-trihydroxybenzene autoxidation assay, thiobarbituric reactive substances (TBARS) assay and 5,5,’-dithio-bis-(2-nitrobenzoic acid) (DTNB)-based determination of free thiol content in low molecular weight and protein precipitate fractions. Surface ORP analysis revealed a greater antioxidant capacity of tattooed skin in comparison with the control (CTR). Capillary blood analysis confirmed greater reductive capacity in the tattoo sample both by microORP (-4.33mV vs CTR) and NRP (+10.8%). Hydrogen peroxide dissociation rate (+11.8%), and protein sulfhydryl content (+8.5%) were increased, and lipid peroxidation (-15%) was reduced in the tattoo sample in comparison with the CTR. In this N-of-1 study, RRN of tattooed skin was shifted towards a more reductive state with all parameters indicating reduced levels of oxidative stress in comparison with nontattooed skin. The local antioxidant effect of copper(II) phthalocyanine provides one possible explanation of the observed effects.
... With an increasing frequency of tattooing, the overall number of observed tattoo-associated side effects also increased. Besides phototoxicity, which represents 60% of side effects (Hutton Carlsen and Serup 2014), the contamination and release of potential carcinogens and other toxic substances are possible risks related to tattooing (Hauri and Hohl 2015;Hering et al. 2018;Schreiver et al. 2016). In addition, infections, allergies and foreign body granulomas are also common (Serup et al. 2016). ...
Article
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Reports of tattoo-associated risks boosted the interest in tattoo pigment toxicity over the last decades. Nonetheless, the influence of tattoo pigments on skin homeostasis remains largely unknown. In vitro systems are not available to investigate the interactions between pigments and skin. Here, we established TatS, a reconstructed human full-thickness skin model with tattoo pigments incorporated into the dermis. We mixed the most frequently used tattoo pigments carbon black (0.02 mg/ml) and titanium dioxide (TiO2, 0.4 mg/ml) as well as the organic diazo compound Pigment Orange 13 (0.2 mg/ml) into the dermis. Tissue viability, morphology as well as cytokine release were used to characterize TatS. Effects of tattoo pigments were compared to monolayer cultures of human fibroblasts. The tissue architecture of TatS was comparable to native human skin. The epidermal layer was fully differentiated and the keratinocytes expressed occludin, filaggrin and e-cadherin. Staining of collagen IV confirmed the formation of the basement membrane. Tenascin C was expressed in the dermal layer of fibroblasts. Although transmission electron microscopy revealed the uptake of the tattoo pigments into fibroblasts, neither viability nor cytokine secretion was altered in TatS. In contrast, TiO2 significantly decreased cell viability and increased interleukin-8 release in fibroblast monolayers. In conclusion, TatS emulates healed tattooed human skin and underlines the advantages of 3D systems over traditional 2D cell culture in tattoo pigment research. TatS is the first skin model that enables to test the effects of pigments in the dermis upon tattooing.
... Fotosensitive reaksjoner i huden er relativt hyppig forekommende og kan opptre ved flere ulike tatoveringsfarger (12). Lichenoide dermatitter, granulomatøse betennelser (inkludert sarkoidose), forverring av psoriasis eller eksem og utvikling av keloid er andre hudreaksjoner som har vaert rapportert etter tatovering (13). ...
... Tattoos, light, complaints, and complications constitute an unspecified number of facets. In the general population of people with tattoos, as many as 1 in 5 report sensitivity of their tattoo to sunlight, and photosensitivity ranks as the most frequent complaint [23,24] . In our material of tattoo complications, photosensitivity with some immediate swelling of tattoos occurred in a significant number of cases. ...
Article
Background/aims: Tattooing is a global trend. Clinical knowledge of complications is based on case reports collected over a century. Larger cohorts reflecting complications associated with contemporary trends are lacking. Methods: The study was a retrospective review of a consecutive cohort of patients with tattoo complications diagnosed in the "Tattoo Clinic" of Bispebjerg University Hospital in Copenhagen, Denmark, from 2008 to 2015, based on patient history and systematic clinical examination. Results: A total of 493 tattoo complications in 405 patients were studied. Overall, 184 (37%) presented allergic reactions with plaque elevation in 32.2%, excessive hyperkeratosis in 3.7%, and ulceration in 1.4%, predominantly observed in red tattoos and nuances of red; 66 (13%) presented papulo-nodular reactions, mainly observed in black tattoos (considered non-allergic) and due to pigment agglomeration; 53 (11%) had bacterial infections; 46 (9%) were psycho-social complications; 144 (30%) belonged to several specific diagnostic entities, including photosensitivity, pain syndrome, and lymphopathy. We found no cases of cutaneous or other malignancies. Sarcoidosis was primarily seen in black tattoos and was a common associated disease, found in 23 reactions (5%), compared to the background population. Conclusion: The study introduces a new concept of classification of tattoo complications based on simple tools such as patient history and objective findings supplemented with histology. The study reflects complications originating from presently used tattoo inks, often with organic pigments. The introduced classification has been submitted to the World Health Organisation (WHO) as a proposal to the 11th revision of the International Classification of Diseases.
... There is increasing evidence that adverse skin reactions to tattoos, including infections and allergies, are common. European surveys of tattooed individuals report the prevalence of immediate adverse tattoo reactions as 15-68% and that of delayed reactions as 9-27% among respondents [4][5][6] . A New York City (NYC) survey of tattooed individuals in Central Park showed that 4.3% of respondents experienced acute tattoo reactions and 6.0% suffered from chronic reactions lasting longer than 4 months [7] . ...
Article
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To understand the role that tattooists play in providing skin care advice, we conducted an online, survey-based study of 90 licensed tattooists in New York City. The survey asked tattooists about their exposure to adverse tattoo events, advising on tattoo removal/correction, behaviors regarding preexisting skin conditions and aftercare, confidence in addressing client questions about adverse events and preexisting conditions, and prior training about skin conditions related to tattoos. Most tattooists (92.8%) reported being asked by clients to evaluate adverse tattoo reactions, 85% were asked about tattoo removal, and 90% were asked about the safety of getting a tattoo with a preexisting skin condition. About half (56.1%) had received training about skin conditions related to tattoos. Tattooists with prior training reported higher rates of optimal skin care behaviors and higher confidence with tattoo-related skin conditions; 91.4% reported interest in skin care education. Tattooists play a major role in the skin health of their clients. Providing education for tattooists may improve skin care in populations less likely to see a dermatologist.
... Some pigments and dye also produce free oxygen radicals after sun exposure and cause reactions as most tattoos are created on arms, neck, and forearms. 8 Tattoo reactions may be seen in the form of allergic reactions, infections, lichenoid dermatoses, granulomatous dermatitis, sarcoidosis, pseudo lymphomas, and skin malignancies such as melanoma and keratoacanthoma. 9,10 This study was undertaken to do a clinicopathological correlation of the various types of cutaneous reactions to the cosmetical tattoos as there is a paucity of such studies in the Indian literature. ...
Article
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Background: Tattooing has been around for many years and is becoming an increasingly common fashion trend. As there are no regulatory laws regarding the practice, an increase in the incidence of cutaneous reactions to tattoo inks is noted. These include allergic reactions, granulomatous dermatitis, infections, lichenoid dermatoses, and sometimes malignancy. Aim: To study the histopathological changes seen in patients with cutaneous reactions to tattoo ink. Method: A prospective observational study was conducted over 18 months in the dermatology clinic of a tertiary care center in western India. The study population included 22 patients with cutaneous reactions over the tattoos. Punch biopsy specimens were sent to study the pattern of histological response. Results: All 22 patients studied were between the ages of 17-35 years. The mean duration of development of reaction was 8.1 months. Most of the reactions were seen in black ink tattoos performed by amateurs. Perivascular and spongiotic dermatitis suggestive of allergic response was the most common feature on histopathology. Granulomatous response and lichenoid response were seen in five and three biopsies respectively. Conclusion: Legalization is needed for this practice to prevent tattoo reactions. Histopathological evaluation is important as tattoo reactions may be associated with skin infections and malignancies. This article is protected by copyright. All rights reserved.
... 15 Phototherapy may trigger photosensitive tattoo reactions, as well as a premature fading of the ink. 7,16 Immunosuppressive treatments increase the risk of local and systemic infections, especially when a tattoo is performed in uncertain hygienic conditions. There are only a few cases of serious tattoo-related infectious complications caused by immunosuppression described in the literature, however, this risk should not be ignored. ...
Article
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Purpose: Among populations of Western countries, tattoos have become an accepted form of skin ornamenting. With tattoos growing in popularity, also patients suffering from chronic dermatoses may more often be willing to get tattooed. Psoriasis is not considered as a strict contraindication for tattooing; however, it is not advised to get a tattoo while undergoing immunosuppressive treatment and during an active stage of the disease. We attempted to assess the knowledge level of tattooed psoriatic patients about the potential risks connected with tattooing, as well as to explore their attitudes and tendencies towards this procedure. Moreover, we analyzed the frequency and type of tattoo complications in this study group. Patients and methods: An anonymous, online questionnaire was performed among online communities dedicated to psoriasis. Data from 150 tattooed psoriatic patients have been scrutinized. Results: Eight percent of the surveyed psoriatic patients sought medical advice before getting a tattoo. While undergoing the tattooing procedure, 23 (15.3%) of the respondents received systemic psoriasis treatment: 8 (5.3%) being treated with methotrexate, 5 (3.3%) with cyclosporine A, one (0.7%) acitretin, and 9 (6%) patients were under biological treatment. Thirteen (8.7%) of the participants experienced complications associated with their tattoos, among which, the insurgence of the Koebner phenomenon on the tattoo, was the most frequent one (8 cases- 5.3%). Getting tattooed improved patients' self-esteem in 76 (50.7%) of the cases. Conclusion: An increased level of education among patients, medical practitioners, and tattooists concerning general precautions of tattooing in psoriasis is advisable.
Article
With tattoos becoming increasingly mainstream, dermatologists are more and more often consulted by patients who are considering getting an ornamental, cosmetic, or even a medical tattoo, and who subsequently ask for advice. This includes not only patients with chronic skin diseases such as psoriasis or atopic dermatitis but also patients with other medical conditions. This review first explores the reasons why patients may want to get a tattoo and aims to offer some key information to dermatologists on what they should know about tattooing and the main risks associated with this procedure. Second, the risks and recommendations of tattooing in patients with specific skin diseases are described more in detail, and the relative and strict contraindications discussed, including the necessity to discontinue certain treatments that could influence the outcome of the procedure and the final result. Our aim was to provide dermatologists with the current knowledge they need to help their patients make adequate and informed choices on skin art, focusing specifically on considerations in patients with chronic skin conditions. Finally, other aspects regarding some general systemic conditions and concomitant diseases that the patient could present are also addressed. In particular, the risks of tattooing in patients with diabetes, coagulation disorders, heart conditions, immunosuppressive treatments, and pregnancy are discussed.
Chapter
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In this chapter allergic reactions related to body art procedures will be discussed.
Article
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.
Article
Key points Tattooing can result in a wide variety of complications, whose prevalence and incidence remain still unclear. Hypersensitivity reactions (or allergies) to tattoo pigments are currently the most common complication on a tattoo, however they are not predictable. Infections are nowadays directly related to the lack of asepsis and hygiene during the tattooing procedure or during the healing phase. Patients with a known cutaneous disease should be warned of a potential risk of localization of their disease to the tattoo. A skin eruption restricted to a tattoo may reveal sarcoidosis. Patients with chronic conditions and/or impaired immunity should discuss with their physician about the possibility and when to have a tattoo.
Chapter
Lymphocytoma cutis is a subtype of cutaneous pseudolymphoma involving the face, chest, and upper extremities. It clinically presents as skin-colored to dark-red papules, nodules, or infiltrative plaques similar in appearance to cutaneous malignant lymphoma. Histologic features help differentiate lymphocytoma cutis from cutaneous malignant lymphoma. The cause of lymphocytoma cutis is typically indeterminate. Cryosurgery is an acceptable treatment of choice for patients whose lymphocytoma cutis fails to respond to known trigger avoidance, and other topical or systemic drugs as well as radiation therapy.
Article
Introduction: Decorative tattooing involves the introduction of exogenous pigments and/or dyes into the dermis to produce a permanent design. Areas covered: This review provides an overview of the current aspects of cutaneous complications associated with permanent tattooing and permanent make-up based on the previous reviews of interest, case series and case reports of interest. References for this review were found through a search of Pubmed by use of the terms “tattoo”, “tattoos”, or “tattooing” Expert opinion: Complications include primarily infections, allergy to tattoo pigments, benign and sometimes malignant tumours arising on tattoos and the localization of various dermatoses to tattoos. Immunocompromised patients and individuals with chronic conditions should be able to discuss with their physician and ask advice before getting tattooed. Tattoo color allergy still remains an unsolved issue. The identification of current culprit failed. It is most likely a byproduct that appears in situ in the skin during the life of the tattooed bearer. Studies involving expert centers are warranted to establish the best treatments for tattoo allergy. The risk of tattoo associated cancers appears to this author as largely overstated. However, case controls studies on large on cohorts of individuals with or without tattoos could help to evaluate whether tattoos have a possible in role in cancers.
Chapter
Tattooing has become widespread in the Western cultures in recent years. The large spectrum of side effects related to tattooing will be reviewed in this chapter. The manifestations can be mild and localized, or severe and systemic, and transient, intermittent, or persistent, with an infectious or a noninfectious origin. More in particular chronic granulomatous reactions are a challenge for differential diagnosis and treatment. Tattoos can interfere with medical investigations and sports. Itch and photosensitivity are common complaints. Tattoo-related adverse events can disturb daily life, influence social behavior, and have an impact on quality of life comparable to chronic skin diseases. Black henna tattoos containing paraphenylenediamine are responsible for many allergic manifestations. Temporary tattoos with Genipa americana extracts cause allergic reactions. Other body-modifying techniques can result in permanent disfiguring scars. Customers, body art professionals, and healthcare practitioners should be aware of possible side effects and contraindications.
Article
The prevalence of tattoos is estimated at 10‐30% in Western countries, and it is increasing.1,2 This procedure is associated with potential complications such as pruritus, swelling, photosensitivity, infections, Koebner phenomenon, and allergy3,4. These complications are most often transient and easily treatable. Patients with chronic dermatosis such as psoriasis may want to get tattooed. This article is protected by copyright. All rights reserved.
Article
In der gynäkologischen Klinik und Praxis sehen wir immer mehr Patientinnen mit Tätowierungen in der Intim- und Unterbauchregion sowie im Bereich der Mamma und der Axillen. Durch Migration von Tattoosubstanzen kann es sowohl in der Nähe als auch fern der Tätowierungsstellen zu gesundheitlichen Problemen kommen.
Article
Background: Tattooist-related technical failures of tattooing were hitherto unstudied and related to clinical complications. Tattooing requires talent, training and experience. Amateurism is a challenge in popular tattoo industry with no formal education and certification of the tattooists. Objective: To study technical tattoo failures causing disease in a consecutive hospital material of tattoo complications. Material: 574 patients with 702 tattoo complications referred to the "Tattoo Clinic" (a subspecialised dermatological clinic) were enrolled. Patients were examined clinically and classified with respect to the cause of complication. Results: 147 (21%) tattooist and tattoo studio-related complications were recorded, i.e. excessive pigment installed in the dermis with "pigment overload" in 64 (9%), tattoo "needle trauma" with "overworked tattoos" in 43 (6%), contaminated ink causing infection in 20 (3%), and other sources of infections related to tattooing in 20 (3%). Pain and discomfort were particularly common as well as long-term complications including scarring induced by "needle trauma." "Pigment overload" with black pigment carried a special risk of granulomatous inflammation and sarcoid granuloma and was observed in 12/35 (34%) of punch biopsies taken from tattoos with "pigment overload." Keratoacanthoma associated with trauma was observed in 1 case. 82% of complications were related to professional tattooists working in a tattoo studio and 18% to amateurs. Conclusion: Technical failures of tattooing are associated with medical tattoo complications. "Needle trauma" with major skin damage, e.g. "overworked tattoo," and installation of excessive pigment, e.g. "pigment overload," and (re)use of contaminated tattoo ink bottles are identified failures calling for preventive intervention.
Article
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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 is 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 if 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.
Article
Tattoo colourants decompose under solar radiation and when exposed to laser light for their removal, leading to the accumulation in the dermis of toxic products. Aim of this study was to develop lipid microparticles (LMs) loaded with the colourant, Acid Red 87 (C.I. 45380) used in tattoo inks, and to investigate the effect of this system on the photostability of the colourant under simulated sunlight or laser irradiation. LMs loaded with C.I. 45380 were prepared by melt emulsification using tristearin and phosphatidylcholine as excipients. They were characterized by optical microscopy, laser diffraction, X‐ray diffraction and release studies. Free C.I. 45380 and the colourant‐loaded LMs were irradiated with a solar simulator or a Q‐switched laser. Irradiation with a solar simulator demonstrated that photodecomposition of C.I. 45380 was markedly reduced by incorporation of the dye in the LMs, from 20.5 ± 4.6% to 1.3 ± 1.8%. Conversely, the laser‐induced degradation of the colourant (30.1 ± 6.6%) was not significantly influenced by encapsulation in the LMs (the encapsulated C.I. 45380 loss was 27.4 ± 5.5%). Incorporation of C.I. 45380 in lipid microparticles enhances the photostability under sunlight of tattoo inks containing this colourant, without affecting its laser‐induced degradation and hence laser removal efficiency.
Article
Allergic reactions in tattoos and permanent make-up are rare but they could be problematic. The clinical presentation and the histopathology are diverse and often confusing. Symptomatic treatment is frequently unsuccessful and invasive techniques can be required. Patch testing to identify the causative allergen is disappointing. The composition of the inks is complex; organic and inorganic colorants, auxiliary components and by-products must be considered. Physical factors such as ultraviolet and laser irradiation could play a role in haptenization of colorants in the skin. Clinical observation and advanced diagnostic methods can be helpful in the diagnosis. Preventive systematic skin testing with tattoo inks, apart from being time-consuming and expensive, is useless.
Article
Tattooing and permanent make-up have become mainstream procedures. Many factors play a role in the final outcome of a tattoo and the satisfaction of the customer. The technical and artistic skills of the tattooist will determine the esthetic result and will help to guide the customers in their decision and choice of the tattoo. Although tattooing is by many considered as safe one should be are aware of the risks of complications related to this body modification technique. Some customers have a medical problem and some doubt about the safety of the procedure. People with increased risk of adverse events often seek medical advice prior to decide to get a tattoo or PMU. Physicians should not only be informed about the medical history of their patients but also have some basic knowledge of the practice of tattooing and the effects this procedure can exert on the skin and on the health condition of the patient.
Article
Tattooing is creating a permanent design by placing exogenous pigment particles and additives into the dermis. An adverse reaction may occur due to the act of tattooing and subsequent application of aftercare products. Numerous articles report the wide spectrum of adverse reactions related to tattooing, ranging from superficial infections and vasculitis to Koebner triggered autoimmune diseases. These reactions have different time of onset of symptoms, appearing immediately after placement of the tattoo until several years later. In this article we will give an overview of cutaneous non-allergic adverse reactions of tattoos.
Article
Background: With the increasing diffusion of tattooing, the photolability of tattoo inks has become a critical issue, as available data indicated that several tattoo colorants are unstable under sunlight, generating potentially toxic photodegradation products. Therefore, it is desirable to enhance the photostability of coloring agents contained in tattoo inks. Aims: Lipid microparticles (LMs) highly loaded with Acid Red 87 (C.I. 45380), a colorant used in tattoo inks, were evaluated for their effect on the colorant photoinstability. In addition, the capacity of the LMs to retain the incorporated C.I. 45380 colorant after their intradermal administration in excised porcine skin was investigated. Methods: LMs loaded with C.I. 45380 were prepared using glyceryl tristearate as the lipidic material and phosphatidylcholine as the surfactant. Non-encapsulated C.I. 45380 or the colorant-loaded LMs were irradiated with a solar simulator for photodecomposition studies or introduced in the excised porcine skin mounted in Franz diffusion cells for stability evaluation in the dermal tissue. Results and conclusion: The colorant content of the microparticles was 17.7%, and their size ranged from 25 to 170 μm. The light-induced degradation of C.I. 45380 was significantly decreased by its incorporation in the LMs from 20.2 ± 5.8% to 1.9 ± 2.1%. Moreover, after intradermal injection of free or microencapsulated C.I. 45380 in the excised pig skin, the LMs reduced by 93.7% (from 24.6 to 1.5%) the quantity of the colorant diffused and hence lost in the Franz cell receptor fluid. Hence, the LM carrier efficiently retained the entrapped C.I. 45380 following incubation in the dermal region of the isolated porcine skin, which is in favor of a long-lasting tattoo. Based on these data, the incorporation of C.I. 45380 in the LMs could represent a potentially useful strategy to reduce the photodecomposition of the tattoo colorant and its harmful interactions with the skin tissue.
Article
Tattoos are characterized by the introduction of exogenous pigments into the dermis. Tattoos usually serve cosmetic purposes, although they may have other causes, such as traumatic pigment implants in accidents or medical-related tattoos in the context of radiotherapy. Dermatologic adverse reactions are relatively uncommon, and they include infections, immune-mediated reactions, cutaneous lesions secondary to the Koebner phenomenon, exacerbation of preexisting dermatosis, benign and malignant neoplasms, and a miscellaneous group of dermatologic conditions that may appear in a preexisting tattoo. The aim of this study is to review the types of histopathologic reactions that may appear in a preexisting permanent tattoo.
Article
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.
Article
Full-text available
The pathogenicity of skin disorders involves a complexity of physiological, immunological, environmental, and genetic phenomena. This review focuses on cross-talks between two main agents, the oxidants and cytokines network, which have recently been found to play important roles in the pathophysiology of a large variety of skin disorders, including carcinogenesis, UVB irradiation damages, inflammatory processes, and a series of diseases such as, psoriasis, pyoderma gangrenosum, atopic dermatitis, irritant contact dermatitis, and bacterial skin infections. In particular the review discusses the question how an interplay between oxidants and cytokines might be beneficial in wound-healing and in therapeutic strategies in clinical settings. These involve topical applications and oral administration of antioxidant and inflammatory-cytokines-neutralizing antibodies. Monitoring cytokine expression in skin disorders (inflammatory versus anti-inflammatory, or Th1 versus Th2 types of cytokines) will definitely help to evaluate the severity of injury, its type, and its role in therapy. Furthermore, it is expected that future studies should explore the possible roles of the synergistic interactions between antioxidants and cytokines and their impact on the Th1/Th2 cytokine networks balances.
Article
Tattooing has become a popular recreational practice among younger adults over the past decade. Although some of the pigments used in tattooing have been described, very little is known concerning the toxicology, phototoxicology or photochemistry of these pigments. Seven yellow tattoo inks were obtained from commercial sources and their pigments extracted, identified and quantitatively analyzed. The monoazo compound Pigment Yellow 74 (PY74; CI 11741) was found to be the major pigment in several of the tattoo inks. Solutions of commercial PY74 in tetrahydrofuran (THF) were deoxygenated using argon gas, and the photochemical reaction products were determined after exposure to simulated solar light generated by a filtered 6.5 kW xenon arc lamp. Spectrophotometric and high-pressure liquid chromatography (HPLC) analyses indicated that PY74 photodecomposed to multiple products that were isolated using a combination of silica chromatography and reversed-phase HPLC. Three of the major photodecomposition products were identified by nuclear magnetic resonance and mass spectrometry as N-(2methoxyphenyl)-3-oxobutanamide (o-acetoacetanisidide), 2-(hydroxyimine)-N-(2-methoxyphenyl)-3-oxobutanamide and N,N"-bis(2-methoxyphenyl)urea. These results demonstrate that PY74 is not photostable in THF and that photochemical lysis occurs at several sites in PY74 including the hydrazone and amide groups. The data also suggest that the use of PY74 in tattoo inks could potentially result in the formation of photolysis products, resulting in toxicity at the tattoo site after irradiation with sunlight or more intense light sources.
Book
Body piercings, tattoos, and permanent make-up have become very popular as a fashion statement in recent decades. This book guides the reader through the world of body art. An overview is first provided of the history and epidemiology of tattoos and piercings. Subsequent chapters go on to examine in detail the materials and devices used in various forms of body art, and the techniques employed. All relevant risks and potential complications are clearly described with the aid of color illustrations. Special attention is paid to allergic reactions and the management of complications. The closing chapter examines the techniques and devices used for tattoo removal, with a particular focus on the use of different lasers. © Springer-Verlag Berlin Heidelberg 2010. All rights are reserved.
Chapter
There are two tetrapyrroles of extraordinary biologic importance. One is chlorophyll which is responsible for photosynthesis in plants and thus is crucial for life on earth. In animals, the porphyrin derivative heme is required for the transport and metabolism of oxygen. The porphyrias are uncommon. They are primarily hereditary disturbances in the synthesis of heme, involving well-defined enzymatic defects. Figure 44.1 shows the process of heme synthesis involving multiple intermediates and at least eight enzymes. Defects in each of these enzymes can lead to a clinical disease. Thus porphyrin metabolism provides a fascinating interplay which has interested biochemists, hematologists, geneticists and dermatologists.
Chapter
Tattooing and body piercing date back to early civilizations. In the past, they were used during initiation rites or as an indication of social status. Tattooing has been used to identify criminals, prisoners, and slaves, and for punishment. Body modification has become more common and more sophisticated over the last 30 years. Body art may be associated with risky behavior. Body piercing may be associated with depression. Regulation in the United States of America is variable from state to state.
Chapter
› The treatment of choice for tattoo removal nowadays is a specific treatment with Q-switched lasers; however, multiple treatments are normally required and may vary between 5 and 20 or more. › Excellent results can be obtained with Q-switched lasers but complete clearance of tattoos is rare and there is no guarantee that any treatment will restore the skin to its original condition. Side effects and complications can occur. › In some indications, adjunctive topical therapy and nonspecific treatment with surgery or ablative lasers can be necessary, more particularly, tattoo granulomas or tattoos with an allergic response. Other indications are resistant tattoos after multiple Q-switched laser treatment sessions and some cosmetic tattoos.
Article
Body art is increasingly popular, resulting in the raising occurrence of complications and adverse reactions, some of them related to the substances used. To identify the causative agent, it is essential to know the exact composition and nature of the materials applied. Nickel allergy is the most common complication of body piercing and can easily be avoided by the use of ornaments made of high-grade stainless steel or inert plastic material. Tattoo compounds in comparison to cosmetics are in general not officially controlled. Moreover, the origins as well as the chemical and toxicological specifications of these colouring agents are hardly known by the producers, the performers and by the consumers. From the medical perspective, uniform worldwide regulation would certainly offer opportunities to reduce the risks and complications involved in the use of chemical components that might be potentially hazardous and may threaten the health of the tattooed individual with special concern for heavy metals and carcinogenic aromatic amines. Recent studies have demonstrated that sunlight exposure and laser treatment of tattoos can induce decomposition products with carcino-genic properties. The clinical implications of these findings have not yet been identified. Recommendations on the hygienic conditions of piercing and of the application of tattoos and permanent make up (PMU) are available. Respecting these guidelines could minimise the risk of transmission of infectious diseases. The occurrence of contact allergy to temporary (henna) tattoos is linked to the presence of PPD in high concentration.
Article
Black tattoo inks are composed of carbon nanoparticles, additives and water and may contain polycyclic aromatic hydrocarbons (PAHs). We aimed to clarify whether reactive oxygen species (ROS) induced by black inks in vitro is related to pigment chemistry, physico-chemical properties of the ink particles and the content of chemical additives and contaminants including PAHs. The study included nine brands of tattoo inks of six colours each (black, red, yellow, blue, green and white) and two additional black inks of different brands (n = 56). The ROS formation potential was determined by the dichlorofluorescein (DCFH) assay. A semiquantitative method was developed for screening extractable organic compounds in tattoo ink based on gas chromatography-mass spectrometry (GC-MS) and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS). Two black inks produced high amounts of ROS. Peroxyl radicals accounted for up to 72% of the free radicals generated, whereas hydroxyl radicals and H2 O2 accounted for <14% and 16%, respectively. The same two inks aggregated strongly in water in contrast to the other black inks. They did not exhibit any shared pattern in PAHs and other organic substances. Aggregation was exclusively shared by all ink colours belonging to the same two brands. Ten of 11 black inks had PAH concentrations exceeding the European Council's recommended level, and all 11 exceeded the recommended level for benzo(a)pyrene. It is a new finding that aggregation of tattoo pigment particles correlates with ROS production and brand, independently of chemical composition including PAHs. ROS is hypothesized to be implicated in minor clinical symptoms.
Article
Tattooing has become a popular recreational practice among younger adults over the past decade. Although some of the pigments used in tattooing have been described, very little is known concerning the toxicology, phototoxicology or photochemistry of these pigments. Seven yellow tattoo inks were obtained from commercial sources and their pigments extracted, identified and quantitatively analyzed. The monoazo compound Pigment Yellow 74 (PY74; CI 11741) was found to be the major pigment in several of the tattoo inks. Solutions of commercial PY74 in tetrahydrofuran (THF) were deoxygenated using argon gas, and the photochemical reaction products were determined after exposure to simulated solar light generated by a filtered 6.5 kW xenon arc lamp. Spectrophotometric and high-pressure liquid chromatography (HPLC) analyses indicated that PY74 photodecomposed to multiple products that were isolated using a combination of silica chromatography and reversed-phase HPLC. Three of the major photodecomposition products were identified by nuclear magnetic resonance and mass spectrometry as N(2-methoxyphenyl)-3-oxobutanamide (o-acetoacetanisidide), 2-(hydroxyimine)-N-(2-methoxyphenyl)-3-oxobutanamide and N,N″-bis(2-methoxyphenyl)urea. These results demonstrate that PY74 is not photostable in THF and that photochemical lysis occurs at several sites in PY74 including the hydrazone and amide groups. The data also suggest that the use of PY74 in tattoo inks could potentially result in the formation of photolysis products, resulting in toxicity at the tattoo site after irradiation with sunlight or more intense light sources.
Article
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.
Chapter
Q-switched lasers (alexandrite, Nd:YAG and ruby lasers) can successfully remove tattoos with few adverse effects. Removing professional tattoos usually entails 20–25 treatment sessions at intervals of 4–6 weeks. Residual pigment may remain, especially when multi-coloured tattoos are involved. Amateur tattoos and traumatic tattoos are usually easier to treat (5–10 sessions). Drug-induced hyperpigmentation is fairly common and tends to respond well to treatment with Q-switched laser (the exception here is chrysiasis). Frequent adverse effects are changes in pigmentation (particularly hypopigmentation), shifts in tattoo colour and changes in skin texture; the latter two are usually temporary. Scarring is possible but rare when treatment is performed correctly.
Article
Background European Council resolutions on tattoo ink introduce sterility and preservation of inks to protect customers. Inks used in Denmark are typically purchased over the internet from international suppliers and manufacturers from the US and the UK. In Denmark tattoo inks are regulated and labelled according to REACH as if they were plain chemicals. Objective The objective of this study was to check the microbial product safety of unopened and opened tattoo ink stock bottles. Packaging, labelling, preservation, sterility and contamination with micro-organisms were studied. Methods Physical inspection and culture of bacteria and fungi. Results Six of 58 unopened stock bottles (10%) were contaminated with bacteria and one of six samples (17%) of previously used stock bottles was contaminated. The bacterial species represented bacteria considered pathogenic in humans as well as non-pathogenic environmental bacteria. Yeast or moulds were detected in none of the samples. A total of 31% of the manufacturers informed only about the brand name. No information about content, sterility, risks or expiry date was indicated on the label. A total of 42% claimed sterility of their inks. A total of 54% labelled a maximum period of durability of typically 2–3 years. The physical sealing was leaking in 28% of the products. Conclusions The European Council resolutions regarding safety of tattoo inks are not effective. Stock bottles of tattoo ink may contain bacteria pathogenic to humans and environmental bacteria, and packaging, labelling and preservation of inks are of inadequate quality. Claim of sterility can be erroneous.
Article
To our knowledge tattooing has never been thought of as a method of introducing nanoparticles (NPs) into the human body by the intradermal route, and as such it has never been a topic of research in nanotoxicology. The content of NPs in tattoo inks is unknown. To classify the particle sizes in tattoo inks in general usage. The particle size was measured by laser diffraction, electron microscopy and X-ray diffraction. The size of the pigments could be divided into three main classes. The black pigments were the smallest, the white pigments the largest and the coloured pigments had a size in between the two. The vast majority of the tested tattoo inks contained significant amounts of NPs except for the white pigments. The black pigments were almost pure NPs, i.e. particles with at least one dimension <100 nm. The finding of NPs in tattoo inks in general usage is new and may contribute to the understanding of tattoo ink kinetics. How the body responds to NP tattoo pigments should be examined further.
Article
Please cite this paper as: Tattoo inks contain polycyclic aromatic hydrocarbons that additionally generate deleterious singlet oxygen. Experimental Dermatology 2010; 19: e275–e281. Abstract: In the past years, tattoos have become very popular worldwide, and millions of people have tattoos with mainly black colours. Black tattoo inks are usually based on soot, are not regulated and may contain hazardous polycyclic aromatic hydrocarbons (PAHs). Part of PAHs possibly stay lifelong in skin, absorb UV radiation and generate singlet oxygen, which may affect skin integrity. Therefore, we analysed 19 commercially available tattoo inks using HPLC and mass spectrometry. The total concentrations of PAHs in the different inks ranged from 0.14 to 201 μg/g tattoo ink. Benz(a)pyrene was found in four ink samples at a mean concentration of 0.3 ± 0.2 μg/g. We also found high concentrations of phenol ranging from 0.2 to 385 μg/g tattoo ink. PAHs partly show high quantum yields of singlet oxygen (ΦΔ) in the range from 0.18 to 0.85. We incubated keratinocytes with extracts of different inks. Subsequent UVA irradiation decreased the mitochondrial activity of cells when the extracts contained PAHs, which sufficiently absorb UVA and show simultaneously high ΦΔ value. Tattooing with black inks entails an injection of substantial amounts of phenol and PAHs into skin. Most of these PAHs are carcinogenic and may additionally generate deleterious singlet oxygen inside the dermis when skin is exposed to UVA (e.g. solar radiation).
Article
Millions of people are tattooed. However, the frequency of health problems is unknown. We performed an Internet survey in German-speaking countries. Results: The provenance of tattooed participants (n = 3,411) was evenly distributed in Germany. The participants had many (28%; >4) and large tattoos (36%; >or=900 cm(2)). After tattooing, the people described skin problems (67.5%) or systemic reactions (6.6%). Four weeks after tattooing, 9% still had health problems. Six percent reported persistent health problems due to the tattoo, of which females (7.3%) were more frequently concerned than males (4.2%). Colored tattoos provoked more short-term skin (p = 0.003) or systemic (p = 0.0001) reactions than black tattoos. Also the size of tattoos and the age at the time of tattooing play a significant role in many health problems. Our results show that millions of people in the Western world supposedly have transient or persisting health problems after tattooing. Owing to the large number and size of the tattoos, tattooists inject several grams of tattoo colorants into the skin, which partly spread in the human body and stay for a lifetime. The latter might cause additional health problems in the long term.
Article
Millions of people are tattooed with inks that contain azo pigments. The pigments contained in tattoo inks are manufactured for other uses with no established history of safe use in humans and are injected into the skin at high densities (2.5 mg/cm(2)). Tattoo pigments disseminate after tattooing throughout the human body and although some may photodecompose at the injection site by solar or laser light exposure, the extent of transport or photodecomposition under in vivo conditions remains currently unknown. We investigated the transport and photodecomposition of the widely used tattoo Pigment Red 22 (PR 22) following tattooing into SKH-1 mice. The pigment was extracted quantitatively at different times after tattooing. One day after tattooing, the pigment concentration was 186 microg/cm(2) skin. After 42 days, the amount of PR 22 in the skin has decreased by about 32% of the initial value. Exposure of the tattooed skin, 42 days after tattooing, to laser light reduced the amount of PR 22 by about 51% as compared to skin not exposed to laser light. A part of this reduction is as a result of photodecomposition of PR 22 as shown by the detection of corresponding hazardous aromatic amines. Irradiation with solar radiation simulator for 32 days caused a pigment reduction of about 60% and we again assume pigment decomposition in the skin. This study is the first quantitative estimate of the amount of tattoo pigments transported from the skin into the body or decomposed by solar or laser radiation.
Article
In the Western world, there are at least 20-30 million people with tattoos. Improved self-image and social stigmatization are the main reasons for removing tattoos from skin. Q-switched lasers are applied to destroy the tattoo compounds in the skin. The treatment of tattoos containing ink often gives excellent results, whereas the results of treatments for coloured tattoos are not predictable and usually are worse. The chemical structure and the absorption spectra of the tattoo pigments are usually unknown. However, the efficacy of the treatment by using light of different Q-switched lasers (wavelengths 510, 532, 694, 755, 1064 nm) is correlated to both the chemical structure of the tattooed compounds yielding specific absorption spectra and the laser wavelength used. A structural and spectroscopic analysis of 41 coloured pigments was performed. The 41 substances were identified, and they consist of 16 individual chemicals of different structured well-known industrial organic pigments. The absorption spectra of the 16 pigments were measured quantitatively. The results of the present analysis explain to some extent the outcome of clinical studies regarding laser therapy of coloured tattoos. Because the laser energy used produces a high temperature in the azo or polycyclic pigments, it is necessary to investigate whether that change causes possibly toxic or cancerogenic compounds.
Article
Of 24 patients with yellow tattoos, 18 observed a swelling reaction in them when they were exposed to sunlight.Four of these patients also observed a similar type of reaction in the red tattoos.Tattoos done experimentally with cadmium sulfide were shown to give a swelling reaction when exposed to the wavelengths 3,800, 4,000, and 4,500 Angstroms (A).Photopatch testing with cadmium sulfide was negative.Cadmium sulfide is a compound with marked photoconducting properties. The swelling reaction provoked by light in tattoos of cadmium sulfide seems to be phototoxic in nature.
Article
In the western world, more than 80 million people decorate their skin with tattoos. Tattoo colorants are injected into the skin, like medical drugs. Most tattoo colorants are industrial pigments, and chemical industries have never produced them for human use but only to stain consumer goods. Up to 10% of tattooed people request removal of their tattoos because of an improved self-image or social stigmatization. In contrast to tattooing, physicians usually perform the tattoo removal. For that purpose laser light at very high intensities irradiates the skin to destroy the tattoo pigments. Based on a recent analysis of tattoo pigments, two widely used azo compounds were irradiated in suspension with laser and subsequently analyzed by using quantitative high-performance liquid chromatography and mass spectrometry. The high laser intensities cleaved the azo compounds, leading to an increase of decomposition products such as 2-methyl-5-nitroaniline, 2-5-dichloraniline and 4-nitro-toluene, which are toxic or even carcinogenic compounds. Moreover, the results of the chemical analysis show that the tattoo colorants already contain such compounds before laser irradiation. Because of a high number of patients undergoing laser treatment of tattoos and based on the results of our findings in vitro, it is an important goal to perform a risk assessment in humans regarding laser-induced decomposition products.
Article
Tattooing has become a popular recreational practice among younger adults over the past decade. Although some of the pigments used in tattooing have been described, very little is known concerning the toxicology, phototoxicology or photochemistry of these pigments. Seven yellow tattoo inks were obtained from commercial sources and their pigments extracted, identified and quantitatively analyzed. The monoazo compound Pigment Yellow 74 (PY74; CI 11741) was found to be the major pigment in several of the tattoo inks. Solutions of commercial PY74 in tetrahydrofuran (THF) were deoxygenated using argon gas, and the photochemical reaction products were determined after exposure to simulated solar light generated by a filtered 6.5 kW xenon arc lamp. Spectrophotometric and high-pressure liquid chromatography (HPLC) analyses indicated that PY74 photodecomposed to multiple products that were isolated using a combination of silica chromatography and reversed-phase HPLC. Three of the major photodecomposition products were identified by nuclear magnetic resonance and mass spectrometry as N-(2-methoxyphenyl)-3-oxobutanamide (o-acetoacetanisidide), 2-(hydroxyimine)-N-(2-methoxyphenyl)-3-oxobutanamide and N,N''-bis(2-methoxyphenyl)urea. These results demonstrate that PY74 is not photostable in THF and that photochemical lysis occurs at several sites in PY74 including the hydrazone and amide groups. The data also suggest that the use of PY74 in tattoo inks could potentially result in the formation of photolysis products, resulting in toxicity at the tattoo site after irradiation with sunlight or more intense light sources.
Article
From the Eskimo in Greenland to the tribes in Polynesia-the whole world knows the art of tattoo. Despite their wide popularity the relation between the skin diseases and the tattooed pictures aren't studied in depth. With the appearance of professional tattoo studios, the risk of infectious complications was reduced. Simultaneously, on a global scale there has been an increase in pseudolymphoma and allergic reactions caused by the introduction of an exogenous pigment into the dermis. The results of our clinical and therapeutic research and review of literature on the subject outline the major problems related to tattoos, i.e. clinical complications. The summarized data showed infectious diseases transmitted through the process of tattooing and many allergic reactions, granulomas and tumors as complications of a tattoo.
Ueber die Wirkung der photodynamischen (fluo-rescierenden) Stoffe auf Protozoen und Enzyme
  • Von Tappeiner
23 Von Tappeiner H. Ueber die Wirkung der photodynamischen (fluo-rescierenden) Stoffe auf Protozoen und Enzyme. Arch Klin Med 1904; 80: 427–487.
Permanent-Make-up, Piercing und verwandte Praktiken. A summary of a campaign of the Federal Office of
  • Bag Tattoo
High prevalence of minor symptoms in tattoos among a young population tattooed with carbon black and organic pigments
  • Høegsberg
Tattoo pigments are cleaved by laser light - the chemical analysis in vitro provide evidence for hazardous compounds
  • Vasold
Ueber die Wirkung fluorescirender Stoffe auf Infusorien
  • Raab