ArticleLiterature Review

A medical-toxicological view of tattooing

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A medical-toxicological view of tattooing

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Abstract

Long perceived as a form of exotic self-expression in some social fringe groups, tattoos have left their maverick image behind and become mainstream, particularly for young people. Historically, tattoo-related health and safety regulations have focused on rules of hygiene and prevention of infections. Meanwhile, the increasing popularity of tattooing has led to the development of many new colours, allowing tattoos to be more spectacular than ever before. However, little is known about the toxicological risks of the ingredients used. For risk assessment, safe intradermal application of these pigments needs data for toxicity and biokinetics and increased knowledge about the removal of tattoos. Other concerns are the potential for phototoxicity, substance migration, and the possible metabolic conversion of tattoo ink ingredients into toxic substances. Similar considerations apply to cleavage products that are formed during laser-assisted tattoo removal. In this Review, we summarise the issues of concern, putting them into context, and provide perspectives for the assessment of the acute and chronic health effects associated with tattooing. Copyright © 2015 Elsevier Ltd. All rights reserved.

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... Adverse effects of tattooing have been reported, with incidence as high as 31% (Antoszewski et al., 2006) and 68% (Klü gl et al., 2010) describing skin complications after receiving a tattoo, most commonly pruritus and/or bleeding (Paola et al., 2016). There is also a risk of infection, which is primarily bacterial and localized to the skin, with an incidence of up to 5% of tattoo recipients (Klü gl et al., 2010;Laux et al., 2016). Infection is believed to be due largely to contaminated ink or needles due to poor manufacturing or unsafe practices during tattoo application (e.g., use of saliva as a needle lubricant or tap water as an ink diluent) (Laux et al., 2016;Paola et al., 2016). ...
... There is also a risk of infection, which is primarily bacterial and localized to the skin, with an incidence of up to 5% of tattoo recipients (Klü gl et al., 2010;Laux et al., 2016). Infection is believed to be due largely to contaminated ink or needles due to poor manufacturing or unsafe practices during tattoo application (e.g., use of saliva as a needle lubricant or tap water as an ink diluent) (Laux et al., 2016;Paola et al., 2016). ...
... In current practice, administering a tattoo requires a person with specific technical, and in some cases artistic, skill. The process of administering a tattoo is time-consuming, painful, and risks causing infection (Klü gl et al., 2010;Laux et al., 2016;Liszewski et al., 2015;Paola et al., 2016). As an alternative to current tattooing practice, MN patch tattoos could for some applications facilitate increased access to tattoos, reduce their cost, and increase their safety. ...
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Medical tattoos provide medical information, guide radiotherapy, and improve cosmetic outcomes of medical interventions. These tattoos are administered by repeated needle injection that causes pain, bleeding, and risk of infection, which limit more widespread use. Here, we developed single-use microneedle (MN) patches to deposit tattoos in the skin in a simple, rapid, painless, and bloodless way without biohazardous sharps waste. MN patch tattoos were designed with numbers, letters, symbols, environmentally responsive inks, and QR codes. Colored tattoos, and tattoos only visible with ultraviolet illumination for increased privacy, were developed and retained in the skin for at least one year. These MN patch tattoos recorded medical conditions such as diabetic medical alerts and vaccination status, responded to biophysical cues for possible physiological monitoring, and encoded complex personal health information. MN patches may increase safety and access to medical tattoos for improved fiducial marking, medical information storage, physiological monitoring, and cosmetic outcomes.
... The mixture that is introduced into the dermis, in addition to containing the pigments that give the color, also contains other substances such as vehicles (water, glycerin, and other alcoholic derivatives) and additives (surfactants, polycyclic aromatic hydrocarbons, nanoparticles, and polymers) [1,2]. The latest generation of tattoo inks mainly contain organic pigments (polycyclic compounds with or without the azo group) and metals such as nickel, cobalt, chromium, or lead [3][4][5][6], such as chromophores, unspecified additives, and contaminants of various types [2,7]. The composition of these elements varies according to the manufacturer and the color [2,7]. ...
... The latest generation of tattoo inks mainly contain organic pigments (polycyclic compounds with or without the azo group) and metals such as nickel, cobalt, chromium, or lead [3][4][5][6], such as chromophores, unspecified additives, and contaminants of various types [2,7]. The composition of these elements varies according to the manufacturer and the color [2,7]. Colored tattoo pigments such as PR. ...
... Modern tattoo inks mainly contain organic pigments, metals, unspecified additives, and contaminants of various types [2,6,7]mixed in various way. Use of model organisms to study their possible toxic effects is certainly of great help. ...
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Tattooing is a technique that introduces colored substances under the skin in order to color it permanently. Decomposition products of tattoo pigments produce numerous damages for the skin and other organs. We studied the effects of a commercial red ink tattoo, PR170, on Xenopus laevis embryos and Daphnia magna nauplii using concentrations of 10, 20, and 40 mg/L. For Xenopus, we applied the FETAX protocol analyzing survival, malformations, growth, heart rate, and the expression of genes involved in the development. In D. magna, we evaluated the toxicity with an immobilization test. Moreover, we investigated the production of ROS, antioxidant enzymes, and the expression of the ATP-binding cassette in both models. Our results indicate that PR170 pigment has nanoparticle dimensions, modifies the survival and the ATP-binding cassette activity, and induces oxidative stress that probably produces the observed effects in both models. Deformed embryos were observed in Xenopus, probably due to the modification of expression of genes involved in development. The expression of pro-inflammatory cytokines was also modified in this amphibian. We think that these effects are due to the accumulation of PR170 and, in particular, to the presence of the azoic group in the chemical structure of this pigment. Further studies needed to better understand the effects of commercial tattoo inks.
... Although organic pigments have been replacing inorganic pigments in commercial inks, tattoo inks still contain heavy metals either as additives, chromophores or contaminants 22 . Titanium, barium and aluminium were found as common colourants while antimony, arsenic, cadmium, lead, chromium and nickel were identified as contaminants after chemical analysis of commercially available inks 22,23 . ...
... Although organic pigments have been replacing inorganic pigments in commercial inks, tattoo inks still contain heavy metals either as additives, chromophores or contaminants 22 . Titanium, barium and aluminium were found as common colourants while antimony, arsenic, cadmium, lead, chromium and nickel were identified as contaminants after chemical analysis of commercially available inks 22,23 . ...
... While all of these metals possess toxic properties, some extremely toxic metals like chromium, nickel and lead have also been found to be highly concentrated in some tattoo inks 22,24 . Taken together with their sensitization capacity, these findings have led to concern about the additional health hazards tattoos impose and urge for thorough safety assessment of tattoo inks. ...
Article
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Background The number of people within the European population having at least 1 tattoo has increased notably, and with it the number of tattoo-associated clinical complications. Despite this, safety information and testing regarding tattoo inks remains limited. Objective To assess cytotoxicity and sensitization potential of 16 tattoo inks after intradermal injection into reconstructed human skin (RHS). Methods Commercially available tattoo inks were injected intradermally into RHS (reconstructed epidermis on a fibroblast-populated collagen hydrogel) using a permanent make-up device. RHS biopsies, tissue sections and culture medium were assessed for cytotoxicity (MTT assay), detrimental histological changes (H&E) and for the presence of inflammatory and sensitization cytokines (IL-1α, IL-8, IL-18; ELISA), respectively. Results Varying degrees of reduced metabolic activity and histopathological cytotoxic effects were observed in RHS after ink injection. Five inks showed significantly reduced metabolic activity and enhanced sensitization potential compared to negative controls. Discussion Using the RHS model system, four tattoo inks were identified as highly cytotoxic and classified as potential sensitizers, suggesting that allergic contact dermatitis could emerge in individuals carrying these inks. These results indicate that RHS-based assessment of cytotoxicity and sensitization potential by intradermal tattoo ink injection is a useful analytical tool to determine ink-induced deleterious effects. This article is protected by copyright. All rights reserved.
... Most tattoo inks consist not only of insoluble pigments but also additives, dispersants and preservatives. The toxicological risk of some of the used compounds is relatively unknown [81]. The predominantly used ink color is black (carbon black), often containing compounds such as potential genotoxic polyaromatic hydrocarbons (PAHs) [82]. ...
... Although today's ink compounds are assumed to contain less genotoxic compounds, they still consist mainly of pigments that were developed for other purposes (e.g., plastics, printing, textiles, cosmetics and even automotive coatings) and safety assessments/risk assessment are lacking [83]. Nevertheless, heavy metals still have a large proportion of tattoo ink [81]. An analysis of commercially used inks revealed that the most used colorants were titanium, barium, aluminum and copper [84,85]. ...
... An analysis of commercially used inks revealed that the most used colorants were titanium, barium, aluminum and copper [84,85]. However, it became clear that more harmful compounds such as antimony, arsenic, cadmium, chromium, cobalt, lead, and nickel were mostly present as contaminants [81,84,85]. The amounts of metals in the composition of tattoo inks seems highly variable between brands and colors, even in pigments with the same base color [86]. ...
Article
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Background: A variety of side effects following the tattooing of the skin were reported over the years. Analytical studies showed that some tattoo inks contain harmful compounds. Methods: We presented six patient cases with cutaneous malignancies in tattooed skin and performed an extensive literature research. Results: Two patients with black ink tattoos that were diagnosed with malignant melanoma raises the number of described cases to 36 patients. One of the patients developed an immunologic reaction limited to the tattoo area after treatment with a targeted immune therapy. In the other patient, the malignancy (malignant melanoma) was fatal. Basal cell carcinoma was seen in four patients with tattoos containing varying ink colors (black, green, red). This increased the number of described patient cases to 18. Although some ink components and their cleavage products have carcinogenic properties, epidemiological evidence for a causative correlation fails. Further epidemiologic studies on tattoos and malignancies, as well as on the appearance of naevi in tattoos, are necessary. Determining the type of mutation might be helpful to separate sun-induced tumors from skin cancers due to other pathogenic mechanisms.
... Piercing is made by creating openings through the skin or cartilage to insert decorative ornaments, such as rings, studs, or pins generally fabricated of stainless steel, titanium, gold, niobium, or acrylic [5]. Therefore, both these procedures require that sharpened tools pass through the skin/mucous barrier, which may lead to the penetration of infectious agents coming from skin, pigments, or instruments in the underlying tissues [1,3,[6][7][8][9]. Bacterial local (e.g., abscesses, necrotizing fasciitis) and systemic infections (e.g., endocarditis, septic shock), so as the transmission of cutaneous and bloodborne viruses (human papillomavirus, herpes simplex virus, hepatitis B, hepatitis C, and human immunodeficiency viruses) were associated with tattooing [10,11]. ...
... In addition, hypersensitivity and allergic reactions to metals, inks, local anesthetic, and antiseptic creams employed during tattooing and piercing are common [7][8][9]13]. Nonallergic inflammatory reactions (for example, cutaneous granuloma and pseudolymphoma) as well as allergic reactions occurring during or after wound healing were associated with tattooing [13], and allergic contact dermatitis caused by metal allergens is a usual reaction to body piercing [14]. ...
... The risk of developing a subsequent infection or immune reaction is related to the body site involved, the immune status of the customer, the adoption of hygienic rules during and after the procedure, and the experience of the tattooist/piercer [7][8][9]. Licensed operators, in fact, should have adequate education on possible health risks of these procedures and must follow strict control measures, such as the use of single use inks and sterile needles and jewels. Furthermore, they should identify among their customers those presenting possible contraindications or needing special precautions, inform their clients of possible consequences of tattoos and piercings, and recommend aftercare procedures to prevent complications [15]. ...
Article
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Background: tattooing and piercing are increasingly common, especially among youths. However, several health complications may be associated with these practices if basic hygiene rules are not respected. This multicenter study was aimed at exploring tattoo and piercing experiences reported by a large sample of Italian undergraduate students through a public health perspective. Methods: tattooed and/or pierced students attending 12 Italian universities were asked to complete a web-based questionnaire regarding their body art experience. Results: out of 1472 respondents, 833 (56.6%) were tattooed and 1009 (68.5%) were pierced. The greatest proportion of tattooed students (93.9%) got her/his first tattoo in a tattoo studio, while most of the pierced were serviced in a jewelry store (48.0%). The pierced ones were less informed on health issues related to the procedure (56.0% versus 77.8% of tattooed p < 0.001), and tattooists were reportedly more attentive to hygiene rules (instrument sterilization 91.5% versus 79.1% of piercers, p < 0.001; use of disposable gloves 98.2% versus 71% of piercers, p < 0.001). Conclusions: educational interventions for both professionals and communities are needed to improve the awareness and the control of health risks related to body art throughout the Italian territory.
... 4 e inks anteriorly used in tattoos were suspensions of insoluble pigments composed of organic and inorganic elements dispersed in water or glycerin, together with other additives such as dispersants and preservatives. [5][6][7] Currently, inks contain mainly organic components, initially designed as automotive paint components or inks for printing, 5,6 and metals such as manganese, lead, vanadium, cadmium, and antimony diluted in water, alcohol, or glycerin. 8 Other types of decorating tattoos are the temporary ones, usually made with henna, an organic compound (2-hydroxy-1,4-naphthoquinone). ...
... 4 e inks anteriorly used in tattoos were suspensions of insoluble pigments composed of organic and inorganic elements dispersed in water or glycerin, together with other additives such as dispersants and preservatives. [5][6][7] Currently, inks contain mainly organic components, initially designed as automotive paint components or inks for printing, 5,6 and metals such as manganese, lead, vanadium, cadmium, and antimony diluted in water, alcohol, or glycerin. 8 Other types of decorating tattoos are the temporary ones, usually made with henna, an organic compound (2-hydroxy-1,4-naphthoquinone). ...
... 12 Black ink, the most frequently used (50%), presents carcinogenic components such as carbon black, a substance that induces the inflammatory response with mutagenic effects due to the formation of reactive oxygen species, polycyclic aromatic hydrocarbons, and phenols. [5][6][7][8]13 Red ink, second in use (14%), is most frequently related to allergic reactions, possibly linked with the photosensitization of cadmium. 6,14 White ink is composed mainly of titanium dioxide, a large molecule related to a low number of allergic reactions. ...
Article
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Purpose: The purpose of this work was to review the scientific evidence about dermatological and ophthalmological inflammatory, infectious, and tumoral tattoo-related reactions published in the literature. Methods: We conducted a literature search from January 1, 2000 to July 15, 2020 in MEDLINE, COCHRANE, EMBASE, and LILACS. Limits regarding the language and period of publication were used. A data collection form was designed in Excel. Four reviewers independently extracted relevant details about the design and the results of each study. Results: One hundred four studies were included, most of them were conducted in Europe and North America. The remaining studies were conducted in Asia, South America, Africa, and Oceania. We included 52 case reports, 21 cross-sectional studies, 20 case series, 10 case-control studies, and 1 cohort study. Eighty-six studies described skin tattoos, of which 7 were publications of eyebrow tattoos and 6 of eyelid tattoos, and 5 articles included cases of subconjunctival tissue tattoos (eyeball). Fifty-seven studies described local reactions related to tattoos and 47 studies reported systemic reactions or reactions in different locations from the tattoo site. The types of reactions described in the studies were: infections in 45 studies, inflammatory reactions in 53 studies, neoplasia in 4 studies, and hypertrichosis in 2 studies. Conclusion: This literature review evidenced a close relationship between the application of tattoos on dermatological and ophthalmological tissues, and the possible immunological complications, neoplasms, and infectious complications. Dermatologists and ophthalmologists should be aware of the consequences caused by even small amounts of ink applied on skin and eyes, generating the need for strict regulations for its use.
... Moreover, there is no current register in Italy to record complications due to tattooing, and there is a need for harmonized supervision in other EU countries. In one study, >50% of the people who were tattooed reported dissatisfaction with their tattoos [4]. Poorly considered decisions often result in attempts to remove a tattoo, AND adverse events and complications have been reported involving tattoo removal procedures [2]. ...
... One study found that in approximately 20% of the packaging used to contain tattoo ink that had been marked as sterile, contamination occurred because of microbiological pathogens. Package containing ink has been shown to be contaminated when it is stored for a long time after opening, or when the package had been stored in suboptimal conditions, which can cause the proliferation of pathogens or the spread of pathogens into the sterile content of the container [4,20]. Medically, tattooing involves other risks [12,[21][22][23][24][25]. ...
... In a composition analysis of the dyes used in tattooing, some dyes contained mutagenic and carcinogenic compounds [26,27]. Some dyes cause local and distant reactions, and microorganisms may spread or remain localized at the site of the "injections" [4,28]. There have also been reports of sepsis and endocarditis with the transmission of infection as a consequence of tattooing [29][30][31]. ...
Article
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Across cultures and generations, people have tattooed their bodies. Although blood-borne infections from tattooing have been reduced, certain service aspects remain improperly managed. We assessed the infection risks associated with tattooing by conducting a cross-sectional study (2013-2014) in Poland using an anonymous questionnaire survey. Scoring procedures for blood-borne infection risks for tattooists and their clients were used. Overall, 255 tattooists were interviewed. A quasi-random selection of tattoo parlors was based on a service register. Knowledge, attitudes, and behavior regarding blood-borne infection risks were assessed using a questionnaire. Simultaneously, tattoo centers were audited. Tattooing had a higher infection risk for tattooists than for clients. Approximately 50% of respondents underwent training on postexposure procedures, which constituted almost one in five of the reported needlestick/cut injuries sustained while working. Furthermore, 25.8% had no knowledge regarding risk from reliable sources, and 2.1% had not broadened their knowledge. Tattooists and their clients are at a risk of infection, and knowledge concerning infection risks remains an underestimated preventative factor. Service quality surveillance and creation of a register for tattoo-related complications may help assess the scale of this public health issue. However, a lack of these records implies the challenges in developing effective organizational and legal protections.
... Большинство красок, используемых для татуировок, состоит из плохо растворимых пигментов, диспергированных в воде, в комплексе с различными добавками, такими как формулянты, диспергаторы и консерванты. В качестве красителей используют соли и оксиды металлов: титан, алюминий, медь, барий, тогда как сурьма, мышьяк, кадмий, хром, кобальт, свинец и никель, иногда определяемые в коммерческих красках, являются загрязняющими веществами [3]. Кроме того, применяются органические красители -полиароматические соединения, биокинетика и токсичность которых редко тестируются при использовании внутрикожно [4]. ...
... Гранулематозные воспалительные реакции на инородный материал являются одними из основных неинфекционных побочных эффектов, возникающих после нанесения татуировки [9,10]. Другие проблемы связаны с потенциальной фототоксичностью и возможными метаболическими превращениями ингредиентов чернил татуировки в токсичные вещества, в том числе при лазерном удалении [3]. Например, анатаза (одна из структурных форм диоксида титана) под действием солнечных лучей способствует образованию активных форм кислорода, что, в свою очередь, приводит к воспалению с клиникой гиперемии, высыпаний и зуда кожи, и, как следствие, замедленному заживлению повреждений кожи после татуировки [11]. ...
... In the last two decades, the prevalence of tattoos has increased significantly [2], ranging from 5 to 40% in adults [3]. Many individuals will have their first tattoo at the age of 16-20 years [4]. Throughout history, tattoos have been performed for various purposes, representing simple decorative elements, a marker of social rank, or the sign of belonging to a certain group [5]. ...
... Tattooing represents an important aggression of the skin that leads to the disruption of the epidermal basement membrane and even cell necrosis [1]. Between 1-5% of those who get a tattoo experience tattoo-related skin infections [4]. Infections after tattooing can be caused by endogenous microorganisms, i.e., microorganisms that are part of the normal flora, as a result of altered skin barrier or exogenous microorganisms that enter the skin by inoculation during tattooing [14]. ...
Article
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Since ancient times, people have tattooed their skin for various reasons. In the past, tattoos were associated with low social status; nowadays, tattoos are very popular and are considered a form of art. However, tattoos are associated with various clinical problems, including immune reactions, inflammatory disorders, infections, and even skin cancer. Epidemiological and clinical data of infections on tattoos are scarce. Tattoo-related infections are mostly bacterial; only a few localized viral infections have been reported so far and are caused by molluscum contagiosum virus (MCV), human papillomavirus (HPV), and herpes simplex virus (HSV). In most cases, the lesions were strictly confined to the area of the tattoo. In this review, we have analysed reported cases of viral infections localized on tattoos and discussed the possible mechanisms involved in the occurrence of these infections.
... Puncture depth may vary between 1 and 4 mm [6]. Approximately 1 mg/cm 2 of pigment will remain on the skin [7]. Once ink particles enter the dermis, they are ingested by macrophages [8,9]. ...
... Some dyes contain a large number of organic pigments, which are used in association with metals to obtain the ink composition. Some pigments have not been toxicologically tested for use on humans [7]. ...
Article
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Tattoos are a current trend, but their impact on skin homeostasis and epidermal barrier function is not well known. So, the aims of this study are (1) to investigate epidermal barrier function and skin homeostasis in skin with permanent tattoos, adhesive temporary tattoos and non-tattooed skin, and (2) to analyze the effect of petrolatum on skin with permanent and adhesive tattoos. In total, 67 tattoos were enrolled (34 permanent tattoos and 33 adhesive tattoos). Temperature, transepidermal water loss (TEWL), stratum corneum hydration (SCH), erythema and total antioxidant capacity (TAC) were measured in skin with permanent tattoos, adhesive tattoos and non-tattooed skin before and after petrolatum application. The temperature was lower (30.47 °C vs. 31.01 °C; p = 0.001) on skin with permanent tattoos than non-tattooed skin, while SCH (48.24 Arbitrary Units (AU) vs. 44.15 AU; p = 0.008) was higher. Skin with adhesive tattoos showed lower temperature, SCH (21.19 AU vs. 41.31 AU; p < 0.001) and TAC (1.27 microcoulombs (uC) vs. 3.48 uC; p < 0.001), and higher TEWL (8.65 g/h/m2 vs. 6.99 g/h/m2; p = 0.003), than non-tattooed skin. After petrolatum application, the temperature decreased on skin with permanent tattoos, and TEWL and SCH decreased on skin with adhesive tattoos. Adhesive tattoos may affect skin barrier function, while permanent tattoos may have a lower impact. Tattooed and non-tattooed skin responds in different ways to moisturizers.
... A cursory look at the chemical constituents of tattoo inks reveals a great chemical variability with an equally enormous list of possible biological effects of different chemicals and their combinations. The composition and toxicological effects of tattoo inks have been reviewed in detail in the literature and interested readers are pointed to informative articles by Arl et al. [1] and Laux et al. [2]. The main components of tattoo inks are usually vehicles (e.g. ...
... titanium, barium, aluminum, and copper) or contaminants (e.g. arsenic, cadmium, chromium, cobalt, lead, or nickel) [1][2][3][4][5]. Black and colored inks differ greatly in their chemical composition. ...
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.
... Molecules remaining in the dermis may have different physical and biological characteristics. Metal-containing pigment could theoretically transform into toxic chemicals after light exposure, and cleavage of azo dyes may result in carcinogenic amines [13,15]. ...
... Furthermore, many colorants may contain problematic substances such as primary aromatic amines, nitrosamines, metal pigments, phenols, formaldehyde, or phthalates. Some inks, such as red biolip, have been proved to have solid cytotoxic potential [13][14][15]. ...
Article
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Tattoo removal is a well-established procedure in dermatology. Lasers represent the gold standard in the management of this condition nowadays. In this study, we report our experience on the use of a Q-switched nanosecond source. A total of 52 patients were consecutively enrolled in performing tattoo removal at Magna Graecia University of Catanzaro and Tor Vergata University of Rome. Black and blue tattoos were treated with a 1064 nm laser, with a pulse duration of 6 ns and a fluence up to 10 J/cm2, while colored tattoos were treated with sessions of 532 nm laser, with a pulse duration of 6 ns and a fluence up to 5 J/cm2. Up to nine treatments with a minimum interval of 8 weeks between each session were performed. A six-month follow-up visit assessed patient satisfaction (Visual Analogue Scale). Overall clinical result was assessed with a clinical evaluation by two blinded dermatologists using a 5-point scale, comparing pictures before treatment and at follow up. A total of 52 patients were included and analyzed: 30 females (57.7%) and 22 males (42.3%). Mean age was 43.7 ± 12.7 years. According to Fitzpatrick’s skin classification, 16 individuals (30.8%) were type II, 15 (28.8%) were type III, and 21 (40.4%) were type IV. Most of the treated tattoos were carried out by professionals. The mean number of sessions required to obtain a result was 4.6 ± 2.5, and the final tattoo removal rate was 60% or higher, with 51.9% of the patients reporting highest satisfaction scores Q-Switched 1064/532 nm laser may be considered today as the gold-standard treatment for tattoo removal. Our results confirm literature findings of the safety and effectiveness of these devices.
... Additionally, there is no regulation on their use in tattoo inks for organic/inorganic pigments, carbon black, and different chemicals used as coloring agents in tattoo inks. 3 Dermatological severe complications may occur during tattooing and there is a serious increase in the number of patients who apply to the dermatology doctor due to skin conditions caused by a tattoo. Allergic skin reactions caused by tattoos are the most common skin problem. ...
... 6 Despite the increasing number of tattooed individuals, there are not sufficient toxicological and pharmacokinetic evaluations of the intradermal use of inks and colorants used for tattooing. 3 Tattoo inks mainly contain pigments, dyes, water, solvent additives such as glycerin, alcohol, and ethylene glycol, preservatives, stabilizers, and pH regulators. 15 The coloring agents that are used in the inks can vary depending on the brand and the color. 2 The tattoo ink manufacturers not must disclose the chemical composition and exact ingredients in their inks that cause potential uncertainty in the evaluation of the toxic effects of the pigments, solvents, and binders that are used in the tattoo inks. 1 The black tattoo inks mainly contain carbon. ...
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.
... However, tattoo inks may still contain other pigments such as heavy metals. 23 Therefore, the role of heavy metals is still disputed. 24 It may be a delayed-type hypersensitivity reaction or a manifestation of lo- ...
Article
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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.
... 10 Furthermore, information is lacking regarding inactive ingredients in US tattoo inks including preservatives, which may potentially be allergenic. 11 In Europe, there has been increasing concerns about sensitization to preservatives in tattooed individuals. Recently, the German Contact Dermatitis Research Group has developed a screen tattoo series patch that consisted of 82 substances including dyes, preservatives and biocides, and other tattoo ink constitutes. ...
Article
Background: Allergic contact dermatitis to tattoo ink may last from weeks to years. Formaldehyde is a strong sensitizer that may be present in predispersed tattoo inks. Objectives: The aim of this study was to evaluate the presence of formaldehyde in predispersed tattoo inks using the chromotropic acid method. Methods: Tattoo inks from 39 companies were evaluated. Inclusion criteria included availability to purchase inks online through US tattoo product wholesalers or individual Web sites. Brands were grouped based on prevalence of use: common, uncommon, or rare. For common brands, 8 colors (primary colors, secondary colors, black, and white) were purchased. For uncommon and rare brands, 5 colors (primary colors, black, and white) were purchased. Each ink was tested with standard chromotropic acid method procedures; concentration of formaldehyde released was quantified using spectrophotometry. Results: In total, 127 tattoo inks were purchased and tested. Ninety-three (73%) tested positive for formaldehyde release; 34 (27%) tested negative. Formaldehyde release did not correlate with color or brand. At least 1 ink from all brands (except 1) was positive for formaldehyde release. Conclusion: Approximately three-quarters of selected US tattoo inks tested positive for formaldehyde release. Clinicians should be aware of tattoo ink as a potential source of formaldehyde.
... Die Tränenmeniskushöhe und die bulbäre Rötung zeigten keine signifikanten Unterschiede in den beiden Gruppen. Dies ist durchaus in Einklang zu bringen mit vorangegangenen dermatologischen Studien als auch ophthalmologischen Fallberichten, dass Tattoos nicht nur zu lokalen Infektionen, toxischen Prozessen und Allergien sondern auch zu einem Eindringen der Tinte in die Tiefe führen können [30][31][32][33][34][35]. Dies ist ein Vorgang, der häufig als "Ausbleichen" verstanden wird und zu einer weiteren kosmetischen Anwendung führt. ...
Article
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Zusammenfassung Hintergrund Ziel dieser Studie war es, Veränderungen hinsichtlich der Meibomdrüsen, der Augenoberfläche und des Tränenfilms durch Lidrandtätowierungen zu ermitteln. Methodik Querschnittsstudie: 100 Augen mit Permanent-Make-up von 50 Patientinnen wurden 100 Augen ohne Permanent-Make-up von 50 Patientinnen gegenübergestellt. Die subjektive Symptomabfrage erfolgte mittels OSDI-Fragebogen und wurde mit den objektiven Testergebnissen – erhoben durch die klinische Untersuchung an der Spaltlampe sowie am Keratographen 5M (Oculus, Germany) – verglichen. Resultate Es zeigte sich ein statistisch signifikanter Unterschied zwischen den beiden Gruppen hinsichtlich des OSD-Index, der NIK-BUT, der Meibomdrüsen und der LIPKO-Falten. Keinen Unterschied zeigte sich in der bulbären Injektion und der Tränenmeniskushöhe. Schlussfolgerungen In der durchgeführten Studie zeigte sich, dass Permanent-Make-up an den Lidrändern zu anatomischen und funktionellen Veränderungen der Meibomdrüsen und des Tränenfilms führt. Diese Ergebnisse korrelieren auch stark mit einem subjektiven okulären Dyskomfort der Patientinnen.
... Tattooing is a common practice of intradermal pigment application with increased prevalence. Some dyes are potentially carcinogenic, such as primary aromatic amines and cleavage products of organic azo colorants [2]. 2-anisidin in red dyes acts as a co-carcinogen especially in combination with sunlight [3]. ...
Article
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We report on a 39-year-old man who presented with seven skin lesions on the right thigh 3 weeks after receiving a large tattoo which included red and black pigments. Initially, the lesions grew fast, later their growth stabilized. Histopathology showed well-circumscribed symmetric tumors with a central keratin-filled crater along with further trademarks of a keratoacanthoma. The patient had previously had multiple tattoos with no history of similar lesions. PCR analysis of one of the lesions revealed the presence of human papillomavirus 6. All lesions were excised with a safety margin. A 3-month follow-up revealed no further lesions.
... Azo or polycyclic compounds from colored tattoos express the same characteristics. These kinds of pigments are designed mainly for industrial use and not to be injected into human skin [14]. Due to adverse reactions, pigment compositions of certain ink colors have changed through the years [15]. ...
Article
Full-text available
The art of tattooing is a popular decorative approach for body decoration and has a corrective value for the face. The tattooing procedure is characterized by placing exogenous pigments into the dermis with a number of needles. The process of creating traditional and cosmetic tattoos is the same. Colorants are deposited in the dermis by piercing the skin with needles of specific shape and thickness, which are moistened with the colorant. Colorants (pigments or dyes) most of the time include impurities which may cause adverse reactions. It is commonly known that tattoo inks remain in the skin for lifetime. It is also a fact that the chemicals that are used in permanent makeup (PMU) colorants may stay in the body for a long time so there is a significant long-term risk for harmful ingredients being placed in the body. Tattoo and PMU colorants contain various substances and their main ingredients and decomposition components may cause health risks and unwanted side effects to skin.
... Besides, wound healing after tattooing or piercing depends on many factors, e.g., tissue characteristics (blood supply, cohesiveness), location and size of the puncture area, following aseptic procedures, reactivity of the human body to substances applied on/in the skin and deeper tissues [8]. In addition, allergic reactions to metals, inks, local anesthetic, and antiseptic cream employed during these procedures and other toxicity aspects of colorants have been reported in the literature [7][8][9][10][11]. ...
Article
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Tattooing and piercing may lead to health complications. The present multicenter cross-sectional study aimed to assess awareness and knowledge of health risks related to body art and to identify their possible determinants among a large sample of undergraduates in Italy. A web-based questionnaire collecting information on socio-demographic characteristics, awareness, knowledge, and some potential predictors was administered to undergraduates attending twelve Italian universities. The level of knowledge was expressed as the number of correct answers (0–11 for tattooing, 0–14 for piercing). A total of 2985 participants (mean age 23.15 ± 3.99, 73.9% F) participated in the study. Although 95.4% of the respondents were aware of possible health consequences of body art, a low level of specific knowledge was registered for both tattooing (mean number of correct answers 5.38 ± 2.39) and piercing (5.93 ± 3.12) consequences. Lower knowledge was associated with the attendance of non-life science course and with lower duration of academic education for both tattoo and piercing. Lower knowledge of tattooing risks was related with commuter status, while lower knowledge of piercing risks was associated with lower father’s education. These findings highlight the need to enhance information campaigns targeted to youths to increase their awareness of possible health risk of body art.
... This is why tattoos are currently not limited to black ink (carbon black), and the use of different inks, even though it has increased recently, go back a long way (9). Thus, tattoos are generally based on a wide range of colored substances in suspension and these mixtures of substances have evolved over time to improve the range of colors or because of national and international regulations (10,11). However, mixtures of substances are still not well documented due to the persistent inadequacy of (4,12) and clandestine tattoos (up to one quarter of all tattoos) (4). ...
Article
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Pigments are among the oldest nanoparticulate products known to mankind, and their use in tattoos is also very old. Nowadays, 25% of American people aged 18 to 50 are tattooed, which poses the question of the delayed effects of tattoos. In this article, we investigated three cobalt [Pigment Violet 14 (purple color)] or cobalt alloy pigments [Pigment Blue 28 (blue color), Pigment Green 14 (green color)], and one zinc pigment [Pigment White 4 (white color)] which constitute a wide range of colors found in tattoos. These pigments contain microparticles and a significant proportion of submicroparticles or nanoparticles (in either aggregate or free form). Because of the key role of macrophages in the scavenging of particulate materials, we tested the effects of cobalt- and zinc-based pigments on the J774A.1 macrophage cell line. In order to detect delayed effects, we compared two exposure schemes: acute exposure for 24 hours and an exposure for 24 hours followed by a 3-day post-exposure recovery period. The conjunction of these two schemes allowed for the investigation of the delayed or sustained effects of pigments. All pigments induced functional effects on macrophages, most of which were pigment-dependent. For example, Pigment Green 19, Pigment Blue 28, and Pigment White 4 showed a delayed alteration of the phagocytic capacity of cells. Moreover, all the pigments tested induced a slight but significant increase in tumor necrosis factor secretion. This effect, however, was transitory. Conversely, only Pigment Blue 28 induced both a short and sustained increase in interleukin 6 secretion. Results showed that in response to bacterial stimuli (LPS), the secretion of tumor necrosis factor and interleukin 6 declined after exposure to pigments followed by a recovery period. For chemoattractant cytokines (MCP-1 or MIP-1α), delayed effects were observed with a secretion decreased in presence of Pigment Blue 28 and Pigment violet 14, both with or without LPS stimuli. The pigments also induced persisting changes in some important macrophage membrane markers such as CD11b, an integrin contributing to cell adhesion and immunological tolerance. In conclusion, the pigments induced functional disorders in macrophages, which, in some cases, persist long after exposure, even at non-toxic doses.
... Darüber hinaus findet sich in der Literatur ein Fallbericht über eine perforierende Verletzung mit intraokulärer Pigmentinjektion sowie resultierender Panuveitis, initialer und Renetzhautablösung nach dem Versuch einer episkleralen Tätowierung bei einem 49-jährigen Mann [11]. Insbesondere in Tätowierfarbe enthaltenes Kupfer (blaue, grüne Farbe) [23] kann schwere Entzündungsreaktionen hervorrufen [11,17], wohingegen Cobalt (meist als Verunreinigung) [16] sogar retinatoxisch wirkt [13]. Die bei episkleralen Tätowierungen verwendeten Pigmente sind solche, diefür Hauttätowierungenzugelassen, jedoch nicht an der Bindehaut getestet wurden. ...
Article
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Zusammenfassung Einführung Augapfeltätowierungen („eyeball tattoos“, syn. episklerale Tätowierungen) sind ein neuer Trend extremer „body modification“, bei dem mit einer Nadel Tätowierfarbe unter die Bindehaut injiziert wird und zu einer irreversiblen Färbung der Sklera führt. In der medizinischen Fachliteratur werden vermehrt Fallberichte vorgestellt, bei denen teils schwerwiegende Komplikationen aufgetreten sind. Material und Methoden Neben einer aktuellen Literaturreche zum Thema wurde eine Anfrage an 120 zufällig ausgewählte Tattoo-Studios in 6 europäischen Ländern gerichtet, ob sie Eyeball-Tätowierungen anbieten. Die Kommunikation wurde bei den Studios, die diese Frage positiv beantworteten, gezielt vertieft. Ziel war es, einen Eindruck zu Angebot und Nachfrage, der Aufklärung über Risiken, Häufigkeit und Art beobachteter Komplikationen, den Vorerfahrungen und ggf. zur medizinischen Ausbildung der Tätowierenden sowie zum organisatorischen und zum technischen Ablauf der eigentlichen Prozedur der episkleralen Tätowierung im jeweiligen Studio zu gewinnen. Auf Tattoo Conventions und über Foren in sozialen Medien wurden 6 Personen mit max. 7 Jahre alten Eyeball tattoos ausführlich zu ihren Erfahrungen vor, während und nach der Augapfeltätowierung befragt. Resultate Neun Studios teilten mit, Augapfeltätowierungen anzubieten bzw. durch Gasttätowierer organisieren zu können. Die restlichen 49 Studios lehnten diese Prozedur ab. Insgesamt 4 Studios schätzten die Häufigkeit der Prozedur auf 10- bis 20-mal/Jahr; die restlichen Studios gaben an, lediglich sporadische Anfragen zu erhalten. Durch ein Studio wurde der Fall einer schweren Komplikation in Form einer persistierenden anhaltenden Infektion mit initial reduziertem, später gebessertem Visus berichtet. Ein Tätowierer gab an, in ca. jedem 20. Fall Pigmentwanderungen in die periorbitalen Gewebe zu beobachten. Postprozedural wurden bis zu 2 Wochen andauernde Kopfschmerzen, anhaltendes Fremdkörpergefühl und Lichtempfindlichkeit beschrieben. Keine der interviewten Personen mit Eyeball tattoos habe eine bleibende Visusminderung bemerkt, eine beklagte Lichtscheu, eine weitere negative soziale Folgen. Ablehnungserfahrungen seien jedoch seltener als Zuspruch. Schlussfolgerung Episklerale Tätowierungen sind noch selten, nehmen aber stetig zu. Sie werden von Personen durchgeführt, die keine hinreichende medizinische Ausbildung besitzen und eintretende Komplikationen nicht ausreichend einschätzen können. Die im Interview berichtete Seltenheit schwerwiegender Komplikationen kontrastiert mit der Darstellung desaströser Folgen in den sozialen Medien, deren breite Präsenz jedoch auf redundanten Darstellungen einzelner Fälle beruhen kann. Andererseits sind die Angaben der Befürworter zu hinterfragen, weil sie womöglich aus geschäftlichen Überlegungen heraus oder aus Angst vor rechtlichen Konsequenzen Problemfälle unterschlagen oder deren Verläufe beschönigen. Die Diskussion, ob solche risikoreichen irreversiblen Body modifications verboten werden sollten, muss von anderer Stelle geführt werden.
... Eine genaue Zahl ist nicht bekannt, aber es wird geschätzt, dass etwa 1-5 % der Tätowierten eine tattooassoziierte Hautinfektion entwickelt (13,14). Im Allgemeinen werden diese durch Staphylococcus aureus und Streptococcus pyogenes verursacht. ...
... Some azo pigments in tattoo dyes may be responsible for these adverse skin reactions, as they may strongly absorb some radiation and thus photosensitize (12). (16). In addition, all tattoo artists should be properly trained in identifying harmful components written on the product packaging (26). ...
Article
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The tattooing process relates to the introduction of exogenous pigments that color the dermis in order to obtain a permanent, desired pattern. The complications associated with the tattooing process have been reported since the end of the 19th Century. Despite the prevalence of tattoos, public awareness of possible related complications and health risks is low. The exact pathogenesis of adverse tattoo reactions on functioning and microstructure of skin, still remains unknown. Potential local and systemic adverse reactions of the tattoos, as well as the reactions to the tattoo pigments used during this process, are inaccurately understood and poorly described. The aim of this study was to review the literature regarding skin complications after having a tattoo. This review of literature will allow the authors of this publication, to specify the aim of future studies, which will allow to precisely determine occurance of potential complications after having a tattoo.
... The most important component in semi-permanent cosmetic ink is a colorant, which is an insoluble pigment. Most tattoo inks consist of carbon black, colorants such as titanium dioxide and iron oxide, and auxiliary substances (Laux et al. 2016). ...
Article
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Our purpose in this study is to analyze the microstructural characteristics and constituent elements of inorganic substances added to the yellow ink and red ink pigments used in permanent makeup. We observed the microstructural properties of inorganic pigments added to the ink using a scanning electron microscopy (SEM) and analyzed the constituent elements of the inorganic pigment particles using an energy dispersive X-ray spectroscopy (EDX). In red wine-colored ink, cubic titanium dioxide with a diameter of 110 to 200 nm was the major component, and rod-shaped iron oxide was rarely observed. Most of the ingredients of taupe yellow ink were rod-shaped yellow iron oxide, and a small amount of cubic titanium dioxide was observed. Red wine-colored ink and taupe yellow ink contained lumps composed of titanium dioxide particles. In red wine-colored ink, lumps were formed by agglomeration. However, we observed that the surface of the lump composed of titanium dioxide in the taupe yellow ink had a smooth surface caused by external physical compression. The titanium dioxide particle mass which found in taupe yellow ink in this study is an artificial product. When this mass accumulates in the dermis, it may cause a color mismatch. Therefore, permanent makeup using fine pigments should be free of foreign substances that may cause trouble in the skin. In addition, there is a need to improve the quality of the ink so that the required color can be safe and long lasting in the dermis.
... We report 2 cases of anaphylaxis, with the presence of potentially life-threatening symptoms, which had occurred after tattooing; however, objective accessory investigations were not performed. Identification of the provocative factor can be challenging as manufacturers are not required to reveal the full composition of inks [31]. Preservatives, such as formaldehyde, added to tattoo inks in order to stabilize them after opening, can be considered as potential triggers [32]. ...
Article
Background: The frequency of tattoos varies from 10% to 30% across the population worldwide. The growing popularity of tattooing increases the number of cutaneous reactions connected with this procedure. As we have not found any previous studies in the literature concerning tattoo complications in Poland and other Eastern European countries, we believe this to be the first study of this kind. Objective: The primary objective of this study was to evaluate the clinical spectrum of complications associated with the procedure of permanent tattooing among patients from Northern Poland. Methods: Medical data of 53 patients who developed tattoo-related cutaneous conditions were analyzed. All of the patients were consulted in the Dermatology, Venereology and Allergology Clinic in Gdańsk in the years 2018-2021. Medical history, dermatological assessment, and photographic documentation of skin lesions were performed in each case. Dermoscopic examination was carried out in 16 cases and 20 skin biopsies of the tattoo reactions were performed. Results: Twenty-one patients (40%) presented tattoo ink hypersensitivity reactions, out of which 18 were triggered by the red ink. In 11 cases (21%), contact dermatitis has developed after tattooing, while 9 of the patients (17%) presented tattoo infectious complications, including local bacterial infections, common warts, molluscum contagiosum, and demodicosis. We collected 8 cases (15%) of papulonodular reactions in black tattoos, and in 6 of them, histology showed granuloma formation. In 2 cases (4%), symptoms of anaphylaxis were observed after the tattooing procedure, and in another 2 cases (4%), Koebner phenomenon in the tattoo was diagnosed. Dermoscopy was the clue to the diagnosis in 4 cases. Conclusions: This is the first report presenting multiple cases of tattoo complications from Eastern Europe. The results of the study are consistent with other researches, showing a similar distribution of tattoo complications and that across the different pigments used, the red ink is most frequently responsible for tattoo reactions. We emphasize the usefulness of dermoscopic examination in the diagnosis of tattoo-related infections and draw the reader's attention to the rare, yet hazardous complications connected with peri-tattooing anaphylaxis.
Article
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Objective: Tattoos and piercings are types of body art, which are gaining popularity over the last decades. An increasing number of adolescents and adults with congenital heart disease (CHD) have piercings or tattoos. This review will provide prudent information on the subject for affected patients and health care professionals caring for them. Background: Amongst others, local infections are a common complication in up to 20% of all piercings and isolated cases of systemic infections like endocarditis have been reported. Individuals with congenital heart disease are especially susceptible to endocarditis and prone to suffer severe health consequences from it. In terms of tattooing endocarditis is less common but the localization must be well considered as it might interfere with cardiovascular magnetic resonance imaging (CMR), which constitutes an important part of follow up investigations in these patients. Methods: This article is written as a commentary narrative review and will provide an update on the current literature and available data on common forms of body modification and the potential risks for patients with CHD. Conclusions: In order to best advise patients and their families, health care professionals must be aware of potential risks accompanying the implementation of body art. Neither the European nor the American guidelines for endocarditis prophylaxis address piercings and tattoos. To our knowledge, there are no clear recommendations concerning piercings and tattoos for adolescents and adults with CHD.
Article
If you don’t need the laser, should you still use it? George Winter investigates.
Article
Background Nipple-areolar tattooing is well accepted as part of breast reconstruction, but the clinical data on its safety and patient satisfaction after the procedure are insufficient. We aimed to evaluate the complications of and patient satisfaction after nipple-areola tattooing in Japanese post-mastectomy breast reconstruction patients.Methods Patients who visited our center after undergoing nipple-areola tattooing from January 2017 to March 2020 were given an unmarked questionnaire with questions about complications related to their nipple-areola tattoo. Patients’ registered their subjective evaluation responses regarding nipple-areola appearance using visual analog scale and that regarding overall satisfaction using 5-point Likert scale and free-text responses. Patients who were followed up within 6 months after tattooing or those with incomplete data were excluded.ResultsSixty-two patients (average age: 49.7 ± 9.8 years), with an average post-tattooing period of 21.2 ± 10.5 months, were included. No patient had infections or allergic reactions. The average VAS score for nipple-areola appearance was high (8.5), and 59 patients (95.3%) answered that they were satisfied. In the free-text patient responses, 25 patients answered that they now felt comfortable going to the hot spring or taking a bath with their children, and 19 patients reported improved mental health after the procedure.Conclusion Post-breast reconstruction nipple-areola tattooing with sterilized inorganic pigments could achieve high esthetics and patient satisfaction, without serious complications. It is recommended for Japanese individuals with a culture of visiting hot springs and public baths.Level of Evidence IVThis journal requires that authors assign a level of evidence to each submission to which evidence-based medicine rankings are applicable. This excludes review articles, book reviews, and manuscripts that concern basic science, animal studies, cadaver studies, and experimental studies. For a full description of these evidence-based medicine ratings, please refer to the table of contents or the online instructions to authors www.springer.com/00266.
Article
Tattoos are a common practice in the 21st century. Although most modern pigments are organic and made of vegetable or plastic compounds, they still sometimes elicit an adverse reaction in the skin. Identifying the tattoo pigment in such biopsies is not always an easy task. To study how tattoo inks appear in the skin, we injected 14 different colors of commercial tattoo ink into normal skin obtained from a mastectomy specimen. One unstained section was obtained from each case, as well as one section stained with hematoxylin-eosin from each case. All sections were observed under the microscope. Stained and unstained sections were also examined under polarized light. We did not observe any modification of the ink color with the staining process with hematoxylin-eosin. However, some pigments appeared differently in stained and unstained sections than in the vial. Pink was the most difficult color to identify from the eosinophilic tissue. None of the colors showed any birefringent particles. However, in some unstained slides under polarized light, the color of the pigment appeared more similar to the one in the vial than in the stained slide.
Article
Tattoos are increasingly gathering attention in the young population, especially in second to fourth decade of life. With such trends, rate of its removal also has been on the rise. Treatment options for tattoo removal besides lasers are surgery, radiofrequency, infrared light, cryotherapy, dermabrasion and salabrasion. Unfortunately, none of these procedures are associated with satisfactory cosmetic results due to adverse effects such as scarring and dyspigmention. Although laser treatment has become the gold standard for tattoo removal, it is also associated with some limitations. Some tattoos inks are resistant to laser and multiple sessions and multiple wavelengths may be required for its complete removal. Considering these limitations, other treatment modalities for tattoo removal must be explored. This article highlights the non‐laser treatment options for tattoo removal. We reviewed all published literature identified from electronic databases (MEDLINE and PubMed) till August 2021 to highlight the non‐laser treatment options for tattoo removal.
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
Puncturing the skin with a tattoo needle damages the immunological and physical barrier. This facilitates the entry of pathogenic microorganisms and the risk of suffering infectious complications. The circumstances around the procedure, sanitary conditions and biosecurity standards are determinants of this risk; however, it is a practice with surveillance and control challenges due to the existing regulatory gap. Because of the significant rise in decorative tattoos among contemporary society, there has been an increase in complications, some are mild and usually resolve on their own, but there are others that leave sequelae and put the health of tattooed patient at risk. This review article includes main local tattooing regulations and epidemiological aspects, as well as dermatological manifestations of infections, their etiological classification, diagnostic and therapeutic approach.
Article
Background Tattooing is increasingly common among adolescents and young adults. This study explores the clinical efficacy of picosecond laser for the correction of tattoos. Literature suggests that 25–47% of the population have had a tattoo at some point in their life (1). The incidence is slightly higher in adults 18–35 years (22–47%) compared to college students (18–25 years of age(1, 2). Recent surveys report 25% of tattooed adults expressing regret, while 4% of tattooed students had already undergone some form of tattoo-removal procedure (3). A common request for tattoo removal includes poorly executed tattoos, avoidance of stigmatization, trauma, socially inappropriate, and employment. Several procedures have been proposed to remove tattoos including cryosurgery, thermal cautery, or surgical resection (4). A major disadvantage of these methods is that they are all highly operator dependent, and carry a very high risk of residual scarring, residual pigment being left behind “ghosting” (3). In addition, some opt to cover the unwanted tattoo with another design, which results in layered tattoos that are substantially harder to manage. Laser surgery, in skilled hands, is an effective method for tattoo removal and traditionally, this is performed with Quality-Switched Laser, where energy liberatred in the nanosecond range results in a selective photothermal effect (5). Picosecond laser is a more recent innovation that results in energy released in a picosecond timescale (a time interval 1000 times shorter). One potential disavantage of laser therapy for the effacement of cutaneous tattoos is the length of treatment and associated cost, which might dissuade the patient from following through to completion of treatment, limiting potential benefits whilst still being exposed to risk of harm. (5, 6). Recent studies suggest that picosecond laser result in substantially reduced treatment times, whilst achieving an identical or more effective end result (7–9). However, these studies are limited by very small sample size and follow-up.
Article
High-density foci within axillary lymph nodes are associated with a number of potential diagnoses. In this case series, we present four tattooed patients who had mammographic findings that demonstrated high-density material in axillary lymph nodes, indicative of tattoo pigment migration. The aim of presenting these cases is to highlight the importance of recognizing such pigment migration in order to help breast radiologists form an appropriate differential diagnosis that might include this entity.
Conference Paper
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Introduction: Cases of pneumothorax have been reported by various authors in patients with COVID-19. The association between these two diseases, as well as its frequency, have not yet been well studied. Aim: To present the first three cases of spontaneous pneumothorax associated with COVID-19 registered in the University Hospital “Sveti Georgi” Plovdiv. Clinical cases: Three cases of pneumothorax associated with COVID-19 were presented in two men aged 76 and 33 years and one woman aged 72 years. All three patients were on mechanical ventilation. They underwent thoracentesis with the placement of a chest drain. Due to the worsening of the underlying disease, all three patients died. Discussion: Pneumothorax associated with COVID-19 has been reported in 1% of patients requiring hospitalization. Association between barotrauma and pneumothorax is observed in the intubated patients in ICU. Another pathogenetic mechanism is the diffuse alveolar damage caused by the virus with the formation of interstitial emphysema and pneumatocele. The surgical method of choice is thoracentesis. The outcome in patients with COVID-19 and pneumothorax depends on the severity of the underlying lung injury. Conclusion: Pneumothorax is a rare but serious complication of COVID-19. It is often associated with poor outcome, especially in patients on mechanical ventilation.
Article
With increased popularity of decorative tattoos, awareness of tattoo‐based dermatological complications has been raised. Health issues include a broad spectrum dominated by allergies and infections. To examine the etiopathology and prognose the outcome of an appropriate therapy, a non‐invasive intravital diagnostic approach is indicated. The present pilot study introduces multiphoton tomography equipped with fluorescence lifetime imaging as a diagnostic technique to examine the morphological and metabolic status of tattooed human skin at patient’s bedside. The distributing course of tattoo particles can be visualized over time. By providing optical biopsies, inflammation‐based alterations in freshly tattooed skin and tattoo complications can be analyzed. The study concludes that multiphoton tomography combined with fluorescence lifetime imaging is a suitable technique for in vivo visualization of tattoo pigments as well as for the assessment of quantitative and qualitative skin changes after injection of tattoo ink into human skin.
Article
The popularity of tattooing has increased significantly over recent years. This has raised concerns about the safety of tattoo inks and their metabolites/degradation products. The photolytic and metabolic degradation of tattoo pigments may result in the formation of toxic compounds, with unforeseen health risks. A systematic literature review was undertaken to determine the current state of knowledge of tattoo pigments’ degradation products when irradiated with sunlight, laser light or metabolised. The review demonstrates that there is a lack of knowledge regarding tattoo pigment degradation/metabolism, with only eleven articles found pertaining to the photolysis of tattoo pigments and two articles on the metabolism of tattoo pigments. The limited research indicates that the photolysis of tattoo pigments could result in many toxic degradation products, including hydrogen cyanide and carcinogenic aromatic amines.
Article
Importance: Reactions to tattoo may simulate common dermatosis or skin neoplasms. Histopathology allows diagnosis and helps determining the level and degree of inflammation associated, consequently orientating treatment. Objective: To describe the histological features found in biopsies of cutaneous reactions to tattoo. Design: This study was designed as a multicenter case series. Setting: All consecutive histopathological samples of tattoos referred from 1992 to 2019 to the Hospital General de Catalunya, Hospital Germans Trias i Pujol, and a private practice, all in Barcelona, Spain, and from the Kempf und Pfaltz Histologische Diagnostik in Zurich, Switzerland were retrieved from the files. Participants and exposure: The inclusion criteria were all cosmetic/permanent makeup, artistic/professional, and traumatic tattoos associated with either inflammatory reactions alone and/or with tumors and/or infections. Exclusion criteria were cases without any associated pathologic finding in the place of the ink, amalgam tattoos, and medical or temporary tattoos. Main outcomes and measures: In all patients, clinical features (age, sex, location, tattoo color, and presentation) were recorded. Histological features evaluated included ink color, associated tumors or infections, and inflammatory reaction pattern. Inflammation was graded in low to moderate or severe. Results: From 477 biopsies diagnosed as tattoos, 230 cases from 226 patients met the inclusion criteria. Samples corresponded to 107 male and 120 female subjects and 3 of unknown gender. Median age was 39 years (ranging from 9 to 84 years). Fifty-three samples were referred from centers in Spain and 177 from the center in Switzerland. The series was analyzed in 2 parts: tattoos associated only with inflammatory reactions (117/230) and tattoos associated with tumors or infections (113/230). The most common form of inflammatory pattern associated with tattoo was the fibrosing reaction (79/117, 68%), followed by granulomatous reaction (56/117, 48%), lichenoid reaction (33/117, 28%), epithelial hyperplasia (28/117, 24%), pseudolymphoma (27/117, 23%) and spongiotic reaction (27/117, 23%). Combined features of 2 or more types of inflammatory patterns were seen in 64% cases. Conclusions and relevance: Our series confirms that cutaneous reactions to tattoos are polymorphous. Inflammation tends to present with combined patterns. Infections are tending to decline, and pathologic findings are not specific to ink color or clinical features.
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Context: The treatment of allergic reactions to red tattoo dye is challenging in most cases, as local therapy often does not offer long-term improvement and laser therapy is considered relatively contraindicated by many authors owing to the risk of generalized side effects. Therefore, surgical removal of these tattoos is favored; shave excision is the method of choice, particularly for the removal of the entire dye. Aims: The aim of this article was to retrospectively analyze the best post-operative outcome after surgical removal of allergic tattoo reactions using different excision techniques. Materials and methods: We compared the different surgical procedures performed on seven patients with single and multiple allergic tattoo reactions treated between 2013 and 2018. Results: The best aesthetic results were achieved by superficial ablation of the inflammatory reaction, partially leaving tattoo remains in the skin. Conclusion: Based on our experience with this small number of patients, a superficial removal of the tattoo without complete removal of the dye is, in most cases, sufficient to achieve healing. The remaining dye residues seem to be better tolerated by the immune system afterwards. Furthermore, the tattoo is often preserved in large parts.
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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.
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The persistence of traditional tattoo inks presents an advantage for continuous and long‐term health monitoring in point of care devices. The replacement of tattoo pigments with optical biosensors aims a promising alternative for monitoring blood biomarkers. Tattoo inks functionalization enables the control of interstitial biomarkers with correlated concentrations in plasma, to diagnose diseases, evaluate progression, and prevent complications associated with physio pathological disorders or medication mismatches. The specific biomarkers in interstitial fluid provide a new source of information, especially for skin diseases. The study of tattoo inks displays insufficient regulation in their composition, a lack of reports of the related complications, and a need for further studies on their degradation kinetics. This review focuses on tattoo optical biosensors for monitoring dermal interstitial biomarkers and discusses the clinical advantages and main challenges for in vivo implantation. Tattoo functionalization provides a minimally invasive, reversible, biocompatible, real‐time sensing with long‐term permanence and multiplexing capabilities for the control, diagnosis, and prevention of illness; it enables self‐controlling management by the patient, but also the possibility of sending the records to the doctor. The replacement of tattoo pigments with optical biosensors enables a minimally invasive, reversible, biocompatible, and real‐time platform with long‐term permanence and multiplexing capabilities for the control, diagnosis, and prevention of illness by monitoring interstitial biomarkers with correlated concentrations in plasma. The interaction of the biomarker with the biosensor produces a signal proportional to the biomarker concentration in the interstitial fluid.
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Tattoos are used as world‐wide cosmetic practice and an exotic self‐expression form in some social groups. In the black henna tattoo, to darken the color, it occasionally contains hair dyes, as represented by paraphenylenediamine (PPD)8–10, which is well known as contact allergen. We report an erythematous indurated eruption congruous with a dermally injected permanent tattoo in a patient who had contact dermatitis to PPD.
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XANES spectroscopy, which uses synchrotron radiation as a probe, offers substantial information about the local structure of biological samples, encompassing those without long range order such as Pt anticancer molecules, and nanometre scale or amorphous particles of calcium phosphate. Its subcellular spatial resolution, as well as its capacity to operate at room temperatures and pressures represent major advantages for medical research. Moreover, paraffin embedded biopsy samples can be analysed without any further preparation, Key publications which illustrate these capacities are presented.
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This contribution tries to indicate to the clinician what kind of information can be investigated through X-ray fluorescence, what kind of information can be extracted from this spectroscopy and finally how it competes with other tools described in previous publications such as Fourier Transform Infrared or Raman spectroscopy, X-ray Absorption Near Edge Structure spectroscopy and X-ray diffraction. To attain this goal, several examples based on X-ray fluorescence experiments performed on biological samples namely concretions, medical devices, biological fluids as well as tissues are presented.
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Für die Herstellung und Anwendung von Tätowier- und Permanent-Make-up-Farben gelten seit dem 1. Januar 2008 Vorschriften zur Zusammensetzung, mikrobiologischen Sicherheit und Etikettierung dieser Produkte. Ziel der vorliegenden Kampagne war es, anhand einer grösseren Stichprobenzahl überprüfen zu lassen, wie es im Markt um die Einhaltung dieser Vorschriften steht. In 16 Kantonen sowie im Fürstentum Lichtenstein wurden Proben erhoben und im Kantonalen Laboratorium Basel-Stadt mikrobiologisch und chemisch untersucht. Von 152 Proben waren nur 32 (21%) ohne jeglichen Beanstandungsgrund, 62 (41%) mussten wegen gesundheitsgefährdender Mängel sofort von der weiteren Verwendung ausgeschlossen werden. Die aktuelle Situation ist unbefriedigend und die Hersteller stehen in der Verantwortung, nur konforme Produkte herzustellen und weiter zu geben sowie die bestehenden Vorschriften strikte mzusetzen.
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The objective of this systematic review and meta-analysis is to assess the association between tattooing and the risk of transmission of hepatitis B virus. A systematic search of MEDLINE, EMBASE, PubMed, Database of Abstracts of Reviews of Effects, ACP Journal Club and BIOSIS Previews was performed up to March 2011. Forty-two observational studies were included in this systematic review, of which 31 were included in the meta-analysis. Pooled odds ratios (95% confidence intervals) of the association of tattooing and hepatitis B infection was 1.48 (1.30-1.68) when all studies were included in the analysis. Subgroup analysis shows the strongest association between tattooing and risk of hepatitis B among populations involved in high-risk behaviours (OR = 1.64, 95% CI: 1.32-2.03). Findings of the current systematic review and meta-analysis indicate that tattooing is associated with hepatitis B transmission in all subgroups. A population health approach that emphasizes universal hepatitis B immunization, education of young adults who are more likely to get tattoos, and education of prison inmates (who have the highest background rate of hepatitis B infection), along with enforcement of guidelines and safer tattooing practices in prison, are fundamental in prevention of transmission of hepatitis B.
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Hundreds of millions of people worldwide have tattoos, which predominantly contain black inks consisting of soot products like Carbon Black or polycyclic aromatic hydrocarbons (PAH). We recently found up to 200 μg/g of PAH in commercial black inks. After skin tattooing, a substantial part of the ink and PAH should be transported to other anatomical sites like the regional lymph nodes. To allow a first estimation of health risk, we aimed to extract and quantify the amount of PAH in black tattooed skin and the regional lymph nodes of pre-existing tattoos. Firstly, we established an extraction method by using HPLC - DAD technology that enables the quantification of PAH concentrations in human tissue. After that, 16 specimens of human tattooed skin and corresponding regional lymph nodes were included in the study. All skin specimen and lymph nodes appeared deep black. The specimens were digested and tested for 20 different PAH at the same time.PAH were found in twelve of the 16 tattooed skin specimens and in eleven regional lymph nodes. The PAH concentration ranged from 0.1-0.6 μg/cm2 in the tattooed skin and 0.1-11.8 μg/g in the lymph nodes. Two major conclusions can be drawn from the present results. Firstly, PAH in black inks stay partially in skin or can be found in the regional lymph nodes. Secondly, the major part of tattooed PAH had disappeared from skin or might be found in other organs than skin and lymph nodes. Thus, beside inhalation and ingestion, tattooing has proven to be an additional, direct and effective route of PAH uptake into the human body.
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Recently, it has been demonstrated that particulate substances penetrate preferentially into the hair follicles and that the penetration depth depends on the particle size. In the present study, the influence of the vehicle of the particulate substances on the penetration depth was investigated. Four different formulations (ethanolic suspension, aqueous suspension, ethanolic gel and aqueous gel) containing peptide-loaded particles of 1 µm in diameter were prepared and applied on porcine ear skin. After penetration, punch biopsies were taken and the penetration depths of the particles were investigated by laser scanning microscopy. The deepest penetration was achieved with the gel formulations demonstrating an influence of the vehicle on the penetration depth of particulate substances.
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DESCRIPTION We present a case with images of a 50-year-old woman who was initially presented with Paget’s disease of the right breast. She then underwent a wide local excision and nipple removal of the affected breast followed by transverse rectus abdominis myocutaneous flap surgery with nipple areolar complex (NAC) reconstruction and tattooing. The 6-month postoperative follow-up revealed an irregular lump at the retroareolar region of the same breast associated with mild pain. On further enquiry, she claimed that the lump first appeared after the tattooing and it grew slightly larger and became discrete months later. On examination there was a non-tender, firm and irregular mass at the retroareolar region of the right breast. Part of the tattoo pigmentation at the reconstructed NAC region has faded with ill-defined margin (figure 1). Mammogram in craniocaudal and mediolateral-oblique views of the right breast showed irregular high-density mass at the region of the NAC, extending to the overlying skin (figure 2). Ultrasound of the left breast showed an ill-defined mass (3.0 cm×2.5 cm) with heterogeneous internal echo and posterior acoustic shadowing at the right reconstructed NAC region (figure 3). Doppler study showed minimal vascularity.
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Despite the widespread use of laser therapy in the removal of tattoos, comparatively little is known about its mechanism of action. There is a need for an improved understanding of the composition and thermal properties of the tattoo ink in order that simulations of laser therapy may be better informed and treatment parameters optimised. Scanning electron microscopy and time-of-flight secondary ion mass spectrometry identified that the relative proportions of the constituent compounds of the ink likely to exist in vivo are the following: carbon black pigment (89 %), carvacrol (5 %), eugenol (2 %), hexenol (3 %) and propylene glycol (1 %). Chemical compound property tables identify that changes in phase of these compounds lead to a considerable reduction in the density and thermal conductivity of the ink and an increase in its specific heat as temperature increases. These temperature-dependent values of density, thermal conductivity and specific heat are substantially different to the constant values, derived from water or graphite at a fixed temperature, which have been applied in the simulations of laser therapy as previously described in the literature. Accordingly, the thermal properties of black tattoo ink described in this study provide valuable information that may be used to improve simulations of tattoo laser therapy.
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In January 2012, on the basis of an initial report from a dermatologist, we began to investigate an outbreak of tattoo-associated Mycobacterium chelonae skin and soft-tissue infections in Rochester, New York. The main goals were to identify the extent, cause, and form of transmission of the outbreak and to prevent further cases of infection. We analyzed data from structured interviews with the patients, histopathological testing of skin-biopsy specimens, acid-fast bacilli smears, and microbial cultures and antimicrobial susceptibility testing. We also performed DNA sequencing, pulsed-field gel electrophoresis (PFGE), cultures of the ink and ingredients used in the preparation and packaging of the ink, assessment of source water and faucets at tattoo parlors, and investigation of the ink manufacturer. Between October and December 2011, a persistent, raised, erythematous rash in the tattoo area developed in 19 persons (13 men and 6 women) within 3 weeks after they received a tattoo from a single artist who used premixed gray ink; the highest occurrence of tattooing and rash onset was in November (accounting for 15 and 12 patients, respectively). The average age of the patients was 35 years (range, 18 to 48). Skin-biopsy specimens, obtained from 17 patients, showed abnormalities in all 17, with M. chelonae isolated from 14 and confirmed by means of DNA sequencing. PFGE analysis showed indistinguishable patterns in 11 clinical isolates and one of three unopened bottles of premixed ink. Eighteen of the 19 patients were treated with appropriate antibiotics, and their condition improved. The premixed ink was the common source of infection in this outbreak. These findings led to a recall by the manufacturer.
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Allergic reactions to metals and metal salts used in pigments for tattoos are surprisingly frequent. The objective of this study was to quantify the metal content of tattoo inks using the sector field inductively coupled plasma mass spec-trometry analysis (SF-ICP-MS). The inks were subjected to a robust microwave digestion in a mixture of nitric and fluoridric acids, and hydrogen-peroxide. A total of 13 tattoo inks including various colors, as black, blue, brown, green, red, violet, white and yellow, were examined for the content of Cd, Co, Cr, Hg and Ni. The limits of detection and quanti-fication were as follows (ng/ml): Cd, 0.02 and 0.07; Co, 0.06 and 0.20; Cr, 0.80 and 2.64; Hg, 0.50 and 1.65; and Ni, 0.40 and 1.32. The method was accurate reporting the following mean recoveries (%): Cd, 92; Co, 94; Cr, 96; Hg, 105; and Ni, 103. The precision of the method was calculated as intra-day (%) and inter-day repeatability (%) and results were: Cd, 2.09 and 5.20; Co, 1.58 and 2.67; Cr, 2.07 and 2.99; Hg, 3.88 and 4.55; and Ni, 4.05 and 5.11. All the tested metals were present in the tattoo pigments, but the relative contribution of elements to the tattoo ink compositions was highly variable between samples and even among like-colored pigments. The highest element was Cr in all the pigments (315-4720 ng/g) followed by Ni (37.5-2318 ng/g) and Cd (6.67-1150 ng/g); the lower elements were Co (2.78-125 ng/g) and Hg (<limit of quantification-179 ng/g). Since no rules regulate tattoo inks, this research can be a starting point for chemical safety as-sessment of commercial inks and for proposal of regulating legislation.
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Tattoos and piercings are increasing, especially among youths, but the risk of hepatitis C virus (HCV) infection from these practices has not been adequately assessed and there are conflicting findings in the literature. We evaluated the risk of HCV infection from tattooing and piercing using the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Studies that specified the venue of tattooing and/or piercing showed no definitive evidence for an increased risk of HCV infection when tattoos and piercings were received in professional parlors. However, the risk of HCV infection is significant, especially among high-risk groups (adjusted odds ratio, 2.0–3.6), when tattoos are applied in prison settings or by friends. Prevention interventions are needed to avoid the transmission of hepatitis C from tattooing and piercing in prisons, homes, and other potentially nonsterile settings. Youths also should be educated on the need to have tattoos and piercings performed under sterile conditions to avoid HCV infection.
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The aim of this study was to estimate the prevalence of life-style practices in adolescents and their association with nickel allergy. Upper secondary school pupils (n = 4,376; 15-23 years) were patch-tested for nickel aller-gy, follow-ing completion of a questionnaire (answered by 6,095). Almost 86% girls and 21% of boys reported piercing. More girls (6%) than boys (3%) had a tattoo. Twenty-six percent of the girls and 18% of the boys were regular smokers. Vegetarian/vegan diets were reported by 20% of girls and by 6% of boys. Piercing, female gender, and vocational programme increased the risk of nickel allergy, whereas orthodontic appliance treat-ment prior to piercing reduced the risk of nickel allergy. Pupils in vocational programmes had the highest prevalence of nickel allergy. Lifestyle behaviours are interconnected and cluster in subgroups of adolescents. Female sex, piercing and choice of educational programme are prominent lifestyle markers. A trend shift is observed, where more girls than boys report tattooing.
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Tattooing has been a part of human culture since the earliest beginnings of modern civilization. What has changed over the millennia are the myriad of colors with which we can now express our thoughts, feelings, and desires through body art. What has not changed is human nature, and our propensity to change our minds about what it is we think, feel, and wish to express on the canvas of our skin. Our fickle nature results in the desire to change what has been placed as a permanent reminder of a friend, spouse, or as a work of art. The technology used to remove tattoos began with destructive methods of removal, which wreaked havoc not only on the tattoo but more prominently on the skin containing that tattoo. The discovery of selective photothermolysis, the ability to selectively remove target structures without disrupting the surrounding skin, made it at least possible to remove tattoos without destroying the surrounding skin and leaving a scar. Theory predicted that pulse durations in the nanosecond domain would be optimal for tattoo removal, and the Q-switched neodymium:yttrium-aluminum-garnet, alexandrite, and ruby lasers operate in this range and are the key tools for modern tattoo removal. Too often, the wrong devices operating in the millisecond range, such as intense pulsed light sources, or lasers that are nonselective, such as the carbon dioxide laser, are used to treat tattoos, resulting in significant scarring without complete removal of the tattoo. Although the Q-switched lasers are capable of removing tattoos without harming the skin, removal often takes numerous treatments and still can be incomplete, especially when attempting to remove multicolored tattoos. Developments leading to removable tattoo inks, feedback systems to detect the absorbance characteristics of tattoo inks, dermal clearing agents, and perhaps even shorter pulse-duration lasers should result in improvements in tattoo removal in the near future.
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Tattooing is an ancient art and is still widely practiced all over the world. Since the biocompatibility of tattoo dyes has not been well researched, we studied the toxicity of a commercial tattoo ink, commonly used in tattoo lab and esthetic centers, on human fibroblasts. To test cell viability, MTT assays were carried out and scanning electron microscopy to visualize changes in the cell surface after the dye exposure was performed. A possible influence of the pigment on the expression of procollagen alpha1 type I protein was visualized by western blotting analysis. The results showed a reduction in cell viability, and electron microscopy demonstrated an unmodified cell surface completely covered by pigment particles. Western blotting analysis demonstrated a clear interference of the pigment on the expression of procollagen alpha1 type I protein. These data demonstrated that the commercial tattoo dye has a time-dependent effect on protein expression. A possible connection of the influence of the tattoo ink with clinical effects is discussed.
Article
Background The majority of tattoo reactions are affiliated to red pigmented areas and often suspected to be allergic in nature. A sizeable series of biopsies of such reactions has not previously been performed. The aim of this study was to type and grade epidermal and dermal changes in tattoo reactions to red/red nuances by microscopy and immunochemistry relevant for the assessment of a possible allergic pathomechanism.Methods Skin biopsies were taken from red tattoo reactions, graded by conventional microscopy and stained for T and B-lymphocytes, Langerhans cells, macrophages and tumour necrosis factor (TNF)-α.ResultsThe study included 19 biopsies from 19 patients. The culprit colours were red/pink (n = 15) and purple/bordeaux (n = 4). Interface dermatitis was clearly the lead pathology found in 78% of samples, overlapped with granulomatous (in 32%) and pseudolymphomatous reaction patterns (in 32%). Epidermal hyperkeratosis (in 89%) was common as was leakage of red pigment across the dermo-epidermal junction, with transepidermal elimination (in 28%). The dermal cellular infiltration was dominated by T-lymphocytes (in 100%), Langerhans cells (in 95%) and macrophages (in 100%). TNF-α was common.Conclusion The predominant histological pattern of chronic tattoo reactions in red/red nuances is interface dermatitis. T-lymphocytes and Langerhans cells are increased suggesting an allergic pathomechanism. TNF-α may contribute to reactions. In many cases, overlapping reactive patterns were identified.
Article
Background Tattoo reactions, especially in red tattoos, are often suggested as allergic in nature, however, systematic evaluation by patch testing has not performed in the past.Objective To report the results of patch testing in 90 patients with non-infectious chronic tattoo reactions.Materials/methodsFrom 2009 to 2013 at the ‘Tattoo Clinic’, Department of Dermatology, Bispebjerg University Hospital, 90 patients were patch tested with batteries of baseline allergens, disperse dyes/textile allergens, and a selection of tattoo ink stock products, which, according to case observations, were problematic, supplemented with individual culprit inks when accessible.ResultsPatients with reactions to the tattoo colour red, the most predominant colour associated with skin reactions, showed negative patch test results with common allergens. Outcomes were also negative in patients who had experienced concomitant reactions in another hitherto tolerated tattoo of the same colour as the problematic tattoo.Discussion/conclusionThe allergen or allergens responsible for tattoo reactions are not present directly in tattoo ink stock products. This is despite the fact that clinical histories suggest that the vast majority of clinical reactions, especially reactions to red and red nuances, are likely to be allergic events caused by the injected inks. We suggest that the responsible allergen results from a complicated and slow process of haptenization, which may even include photochemical cleavage of red azo pigment.
Article
Purpose: To describe the clinical presentation of uveitis with coincident onset of raised and indurated tattooed skin. Design: Case series. Methods: Seven consecutive patients were evaluated at a tertiary ophthalmologic facility with coincident uveitis and cutaneous tattoo induration over an 18-month period. All subjects underwent complete ophthalmic examination and a focused systemic medical evaluation including serologic testing and imaging studies. Two participants underwent biopsy of their tattoos. The patients' clinical courses and responses to treatment over a follow-up period of 1-20 months are reported (mean follow-up = 9 months). Main outcome measures included degree of intraocular inflammation, ocular complications, visual acuity, clinically observable tattooed skin changes, and biopsy results. Results: Five of 7 patients had bilateral nongranulomatous anterior uveitis: 4 with chronic and 1 with recurrent disease. The remaining 2 patients had bilateral chronic granulomatous panuveitis. Biopsies of raised and indurated tattoos were performed in 2 patients and demonstrated noncaseating granulomatous inflammation surrounding tattoo ink in the dermis. The skin changes resolved in all patients, with a faster response noted in those treated with high-dose oral prednisone for intraocular inflammation. Five patients subsequently experienced recurrent flares of intraocular inflammation in conjunction with the recurrence of raised and indurated tattoos. Conclusions: These cases represent a subset of patients in whom skin tattooing may have incited an immune response leading to simultaneous inflammation of the eyes and tattooed skin.
Article
: Although tattooing is an ancient practice, its increasing popularity and social acceptance, variability of tattoo ink composition, sporadic reports of novel tattoo reactions and advances in the field of tattoo removal techniques make it a topic of immense interest among dermatologists and pathologists alike. Since effective legislation governing the tattoo industry is largely lacking in most regions of the world, it is important to recognize the range of tattoo-related complications from a dermatopathological perspective. Using a pattern-based approach, this review details the broad spectrum of inflammatory reactions, which may be encountered in adverse reactions associated with tattooing. Awareness of the range of inflammatory tattoo reactions is crucial as some of these patterns of inflammation can be associated with systemic disorders and others may serve as important clues for an underlying infective condition.
Article
Sporadic cases and outbreaks of tattoo-associated skin infection with rapidly growing mycobacteria have been reported although they often contain few details of public health investigations and have not previously been systematically collated. We present the details of the public health investigation of a cluster of cases, which occurred in Scotland in 2010. Investigation of the cluster involved case finding, environmental investigation of the tattoo studio and pathological and microbiological investigation of possible cases and tattoo ink. Mycobacterium chelonae was isolated from one case and three probable cases were identified. M. chelonae was grown from an opened bottle of ink sourced from the studio these cases had attended. In addition, in order to identify all published cases, we conducted a systematic review of all reported cases of tattoo-associated skin infection with rapidly growing mycobacteria. A total of 25 reports were identified, describing 71 confirmed and 71 probable cases. Mycobacteria were isolated in 71 cases and M. chelonae was cultured from 48 of these. The most frequently postulated cause of infection was the dilution of black ink with tap water. Reports of tattoo-associated rapidly growing mycobacterial skin infection are increasing in frequency. Interested agencies must work with the tattoo industry to reduce the risk of contamination during tattoo ink manufacture, distribution and application.
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
The number of tattooed people has substantially increased in the past years. Surveys in different countries reveal this to be up to 24% of the population. The number of reported adverse reactions after tattooing has also increased including infections, granulomatous and allergic reactions and tumors. However, the case reports do not reflect the frequency of adverse reactions. This review compares the medically documented adverse reactions published in 1991-2011 with the findings of a nation-wide survey that recently revealed the features and health problems associated with tattoos. To compare the data with the survey, the sex of patients was reported and the location and color of tattoos were evaluated. The results show clearly that colored tattoo inks are mainly responsible for adverse skin reactions and that tattoos on the extremities are involved most.
Article
We read with great interest the recent study in this journal by Brauer et al1 and congratulate them for carrying out a well-designed pilot study of a picosecond laser for tattoo removal. In particular, we applaud the authors for demonstrating the potential of these lasers to remove multicolored tattoos, which often prove to be more challenging to remove than traditional black tattoos with current nanosecond technology.While it is exciting to read about a new commercially available device, the use of a picosecond laser for tattoo removal is not novel. Over a decade ago, several key studies that were not cited by Brauer et al1 fully set the stage for their work. The Wellman Center for Photomedicine2 at Massachusetts General Hospital and Harvard Medical School pioneered the use of picosecond lasers for tattoo treatment over 14 years ago in a landmark human pilot trial comparing picosecond and nanosecond pulsed lasers using pulse durations shorter than those used in the study reported by Brauer et al.1 Herd et al3 also reported an animal study showing superiority of a picosecond titanium:sapphire laser over the Q-switched alexandrite laser in removing tattoo pigment.
Article
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.
Article
Background and objective: Laser tattoo removal using multiple passes per session, with each pass delivered after spontaneous resolution of whitening, improves tattoo fading in a 60-minute treatment time. Our objective was to evaluate the safety and efficacy of topical perfluorodecalin (PFD) in facilitating rapid effective multiple-pass tattoo removal. Study design: In a randomized, controlled study using Q-switched ruby or Nd:YAG laser, 22 previously treated tattoos were treated with 3 passes using PFD to resolve whitening after each pass ("R0 method"). In previously untreated symmetric tattoos, seven were treated over half of the tattoo with the R20 method, and the opposite half with 4 passes using PFD (R0 method); two were treated over half with a single pass and the opposite half with 4 passes using PFD (R0 method); and six treated over half with a single pass followed by PFD and the opposite half with a single pass alone. Blinded dermatologists rated tattoo fading at 1-3 months. Optical coherence tomography (OCT) imaging of whitening was performed in two tattoos. Results: Topical PFD clinically resolved immediate whitening reactions within a mean 5 seconds (range 3-10 seconds). Tattoos treated with the R0 method demonstrated excellent fading in an average total treatment time of 5 minutes. Tattoo areas treated with the R0 method demonstrated equal fading compared to the R20 method, and improved fading compared to a single pass method. OCT imaging of whitening demonstrated epidermal and dermal hyper-reflective "bubbles" that dissipated until absent at 9-10 minutes after PFD application, and at 20 minutes without intervention. Conclusions: Multiple-pass tattoo removal using PFD to deliver rapid sequential passes (R0 method) appears equally effective as the R20 method, in a total treatment time averaging 5 minutes, and more effective than single pass treatment. OCT-visualized whitening-associated "bubbles," upon treatment with PFD, resolve twice as rapidly as spontaneous resolution.
Article
Abstract A series of 14 cosmetic colors were submitted to dermal toxicity testing in accordance with a protocol designed by the Food and Drug Administration and agreed upon with the Cosmetic, Toiletry and Fragrance Association (formerly the Toilet Goods Association). Dosage levels were based on lipstick use determinations made in a group of human female volunteers. The groups of lipstick colors were divided into three treatment series and painted on twice weekly to an area approximately 6 cm2. A total of 1400 mice were used comprising groups of 100 mice (50 per sex) plus additional positive control group of the same size and a vehicle control group of 300 mice (150 per sex). All colors were prepared at 1.0% suspensions in water. The positive control received 3.4–benzpyrene dissolved in acetone. Survival was approximately equivalent in all experimental groups except the positive controls who died earlier consistent with survival recorded by others for 3.4–benzpyrene treated mice. Extramedullary hematopoesis was found in all treated groups, equivalent to the findings in the controls. The repeated application of 0.1 ml containing 1.0% dye did not increase the incidence of neoplasia when compared to controls in any of the groups receiving application of the 14 dyes.
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.
Article
Eighteen patients who developed cutaneous reactions to red tattoos were studied to identify the chemicals responsible for the reactions to modern red tattoo pigments. Biopsies from the tattoos were examined histologically and the chemical composition of the red pigments was analysed by X-ray microanalysis. A variety of metallic elements including aluminium, iron, calcium, titanium, silicon, mercury and cadmium were detected. Patch tests were performed to the relevant chemicals in nine cases, and only one patient reacted to mercury. This study demonstrates that although reactions to mercury still occur, other red dyes containing a variety of inorganic pigments may provoke a cutaneous inflammatory response.
Article
In a broad market survey, 145 samples of tattoo- and permanent make-up pigments were bacteriologically analysed. The pigments originated from 39 unopened vials and 106 opened vials in use. The samples were collected from 33 tattoo shops and 22 beauty studios and the analyses were effected by direct plating on four agar media and by enrichment in a non-selective broth. None of the used media could detect all contaminated samples. The best performance was obtained with sheep blood agar (BA), which detected bacterial counts in 7 of 39 (17.9 %) of unopened vials and in 22 of 106 (20.8 %) opened vials. In 12 of 145 samples (8.3 %), bacterial growth was observed in the enrichment broth but not on sheep BA. In most cases, contaminations were in a low range of 101-102 cfu / mL. Counts in the range of 103-108 cfu / mL were registered in only four samples that were from different tattoo shops and from different manufacturers. Among the 31 bacterial species that were detected in the examined pigments, 20 (64.5 %) belonged to Gram positive rods or to Bacillus or related genera, respectively, 8 (25.8 %) to Gram positive cocci and only 3 (9.7 %) to Gram negative rods. Bacterial