Paradoxical darkening and removal of pink tattoo ink

It is widely accepted that Q‐switched lasers are the gold‐standard treatment for the resolution of unwanted tattoo ink. Although much safer than other tattoo removal modalities, the treatment of tattoo ink with Q‐switched devices may be associated with long‐term adverse effects including undesired pigmentary alterations such as tattoo ink darkening. Darkening of tattoo ink is most often reported in cosmetic, flesh‐toned, white, peach, and pink tattoos. In this paper, we briefly review a case of pink tattoo ink that initially darkened paradoxically but eventually resolved with continued Q‐switched laser treatments.     

Tattoo darkening and nonresponse after laser treatment: a possible role for titanium dioxide

OBJECTIVE: To examine relationships between chemical composition, biopsy findings, and clinical outcome in laser-treated tattoos. DESIGN: Observational nonblinded retrospective study. SETTINGS: University-based dermatology clinic and private practice. PARTICIPANTS: Twenty patients who underwent biopsy of laser-treated tattoos. MAIN OUTCOME MEASURES: Biopsy specimens were analyzed after laser treatment, and the depths of changed particles were recorded. Ultrastructure of the changed particles was examined by electron microscopy. Presence of inorganic chemicals was determined by x-ray diffraction. Correlation between x-ray diffraction, microscopy, and clinical response was attempted. RESULTS: Of the 20 tattoos, 7 lightened, 9 failed to change, and 4 darkened after laser treatment. There was a significant association between presence of titanium dioxide and poor response to laser therapy. Microscopic studies showed variable changes in the ink particles, but there was a trend toward residual deep green pigment in the resistant tattoos. Also, round dark stippling was observed superficially in the darkened specimens. CONCLUSIONS: Titanium is overrepresented in tattoos that respond poorly to laser treatment. Further studies are necessary to show whether this metal is the primary cause of this poor response.     

Red ink tattoo reactions: successful treatment with the Q-switched 532 nm Nd:YAG laser

BACKGROUND: In the South-west Thames region there were an unprecedented number of lichenoid tattoo reactions to red ink in patients who had visited a local tattoo parlour. The red ink was found to contain mercuric sulphide, a compound known to cause allergic reactions. Topical Dermovate (clobetasol propionate 0.05%, GlaxoWellcome) ointment alone had little impact. OBJECTIVES: To investigate whether the Q-switched 532 nm Nd:YAG laser could produce permanent flattening of the reaction. METHODS: This was an open nonrandomized clinical trial. Biopsies were taken from the lichenoid areas within the tattoos. Subjects were patch tested to 1% ammoniated mercury in petrolatum prior to treatment with the Q-switched 532 nm Nd:YAG laser. Laser treatments were delivered at 6-weekly intervals by a single operator. Patients also applied topical Dermovate between treatments. Therapy was discontinued when the lesions flattened. Clinical photographs were assessed at baseline and prior to each laser treatment. RESULTS: Seven patients with Fitzpatrick skin types I-III were enrolled in the study (four females, three males, mean age 39 years). All patients completed the trial. Patch testing to mercury was universally negative at 48 and 96 h. Substantial flattening and depigmentation of the red ink within the tattoos was noted after six laser treatments. No adverse effects were recorded. CONCLUSIONS: The Q-switched 532 nm Nd:YAG laser in combination with topical Dermovate ointment is a safe and effective method of treating red ink tattoo reactions.     

Paradoxical darkening of unperceived tattoo ink after relatively low fluence from a Q‐switched Nd:YAG (1064‐nm) laser in the course of treatment for melasma

Although Q‐switched (QS) lasers are the mainstay of modern tattoo removal, paradoxical darkening of tattoo ink may occur. This darkening of tattoo ink is dependent on laser wavelength, pulse duration and fluence, with high‐energy, nanosecond‐pulsed lasers more prone to induce tattoo‐ink darkening. Laser toning, consisting of multiple‐passed QS neodymium:yttrium–aluminum–garnet (Nd:YAG), 1064‐nm laser treatment with low fluence, short pulse duration (< 10 ns), and a repetition rate of 10 Hz has been successful in the treatment of melasma. A mistake commonly made during laser toning is to scorch scalp hair, eyebrows or eyelashes, but this phenomenon is reversible. A more problematic error is caused by treatment of eyeliner or eyebrow tattoos. We report a patient who experienced changes in unperceived, skin‐coloured tattoos, turning them blue after QS Nd:YAG laser treatment of melasma.     

Treatment of traumatic tattoo with the Q-switched Nd:YAG laser.

Traumatic tattoos are undesirable tattoos caused by different foreign bodies such as fireworks' particles, sand, metals, glass, gunpowder, asphalt, dust, or petroleum products embedded forcefully in the dermis. We report the case of a 54-year-old man who presented with sand and asphalt tattooing on his face following a bomb explosion 15 years ago. Q-switched Nd:YAG laser at a wavelength of 1064 nm with a spot size of 4 mm and a fluence of 7.96 J/cm(2) were applied to treat the patient. The patient tolerated the treatment very well. Most of the blue dots became whitened immediately after the procedure and remained almost clear after a 6-month follow-up.     

Tattoo removal by Q-switched Nd:YAG laser: an objective evaluation using histometry

Background: Tattoos have played an important role in various human cultures for thousands of years. The creation of high power, short pulse Q-switched lasers (QS) has provided a tool for considerable therapeutic advances in tattoo removal. Objective: The aim of the study is to correlate the clinical efficacy of QS Nd: YAG laser for tattoo removal with histological as well as histometric findings. Patients and Methods: QS Nd: YAG laser was used for blue tattoo removal in 12 Egyptian patients. Sessions were done every 2 months for about 6–10 sessions (average 7). Skin phototypes of patients ranged from phototype III to V. Photographs were taken before and after every treatment session. Skin biopsies were taken from the patients before treatment and after six sessions to perform histological and histometric analysis. Results: Eight patients (66.7%) showed excellent response and four patients (33.3%) good response. No textural change or scarring was observed in any patient. Histological examination confirmed the clinical response. Haematoxylin and Eosin (H&E) stained sections showed a significant decrease or almost complete disappearance of the tattoo pigment. Meanwhile, histometric study objectively confirmed a significant decrease in ink particle surface area after treatment. Conclusion: QS Nd: YAG laser effectively treats tattoos in dark-skinned Egyptian patients with excellent cosmetic outcome and minimal side effects. The histopathologic and histometric findings significantly correlated with the clinical response.     

Comparison of Q-switched Nd:YAG laser alone versus its combination with ultrapulse CO2 laser for the treatment of black tattoo

Background: Q-switched lasers are conventionally used for the treatment of black tattoo. However, they require multiple sittings, and the response may be slow due to competing epidermal pigment in dark skin. Objective: To compare the efficacy of Q-switched Nd:YAG laser alone with its combination with ultrapulse CO₂ for the removal of black tattoo. Materials and methods: Sixty patients with black tattoo were randomized into two groups viz., group A and group B. Group A was treated with QS Nd:YAG laser (1064 nm) alone, and group B received combination of ablative ultrapulse CO₂ followed by fixed-dose QS Nd:YAG laser (1064 nm), at 6-week interval for a maximum of 6 sittings. After each sitting, 3 independent physicians noted percentage of improvement that was evaluated using visual analogue scale (VAS) and grading system for tattoo ink lightening (TIL). Results: Combination laser (group B) showed statistically significant improvement in mean VAS score in the last 2 noted visits as compared to 1st session (p < 0.007, p < 0.001) and TIL mean score in last three noted visits as compared to 1st session (p < 0.008, p < 0.020, and p < 0.004). There was no statistically significant difference in the side effect profile of both the groups. Conclusion: For refractory professional tattoos, combination of ultrapulse CO₂ laser and QS Nd:YAG laser is superior to QS Nd:YAG laser alone.     

Minocycline-induced pigmentation resolves after treatment with the Q-switched ruby laser

Summary Four patients with minocycline-induced cutaneous pigmentation were treated with the Q-switched ruby laser. The pigmentation resolved and there was no adverse effects.     

Facial scars after a road accident--combined treatment with pulsed dye laser and Q-switched Nd:YAG laser

We report the case of a woman who presented with several facial scars following a road accident. Treatment was carried out using combined laser treatment with pulsed dye laser (PDL) and Q-switched neodymium:yttrium-aluminum-garnet laser (QS Nd:YAG laser). No side effects or complications from treatment were noted or reported. The patient had very good cosmetic results with this combined technique. A variety of facial scars – erythematous, pigmented, atrophic, and hypertrophic – may occur as a result of trauma, surgery, burns, and skin disease. Surgery with other adjunctive methods including radiotherapy, intralesional steroids, and pressure therapy have shown variable results. Laser treatment has been attempted for scar revision since the 1980s. The PDL is the optimal treatment for reducing scar bulk and symptoms. It also decreases erythema and telangiectasia associated with scars, normalizes the skin surface texture, and improves the scar pliability. The QS Nd:YAG laser (1064 nm) is highly effective for traumatic tattoo removal, resulting in complete clearance in the majority of cases.     

Tattooing in the Gulf region: A review of tattoo practices and response to treatment with the Q-switched ruby laser

Abstract

Background: Data regarding tattoo practices in the Gulf region and response to treatment are almost non-existent in the medical literature. Objective: To study the profile of patients with permanent tattoos in the Arab world, and to evaluate their response to Q-switched ruby laser treatment. Methods: A total of 468 consecutive patients with permanent tattoos consulting us for tattoo removal were recruited in the present study. Before starting the treatment each patient was given a set of questionnaires to answer. The patients were then treated with the Q-switched ruby laser, with a time interval of 8 weeks between each laser session, until complete clearance or up to a maximum of 10 sessions. Results: A total of 292 patients out of 348 patients achieved excellent lightening to complete clearance of tattoo pigment after an average of six sittings (range 2–10 sittings). Female patients with fair complexions and amateur tattoos on the face responded best. Seventy-eight (22.4%) patients developed pigmentary changes. Conclusion: More females than males had tattoos, and at a very young age and mostly on the advice of their parents. The majority of patients wanted to remove the tattoos because of religious reasons. The Q-switched ruby laser seems to be highly effective in removing amateur blue-black tattoos in patients with colored skin.     

Comparison of a single treatment with Q-switched ruby laser and Q-switched Nd:YAG laser in removing black-blue Chinese tattoos

Abstract

Background: Black and blue are two popular colors in Chinese tattooing. Two Q-switched lasers, ruby and Nd:YAG, are effective for tattoo removal. No reference with regard to a comparison of the effects and adverse reactions in Chinese individuals has been made in the literature. Objective: To compare a single treatment of black-blue tattoos with the Q-switched ruby laser and Q-switched Nd:YAG (1064 nm) laser. Methods: A total of 35 Chinese patients with black-blue tattoos at the laser center of the Institute of Dermatology, Chinese Academy of Medical Sciences were enrolled into a self-control study. Tattoos were split into two parts or two nearby tattoos on the same body part were used; one side was treated with the Q-switched ruby laser and the other with the Q-switched Nd:YAG laser. Immediate response, treatment outcome and adverse effects were compared. The statistical significance level was set at p< 0.05. Results: Edema and exudation were more common immediately after ruby laser treatment (p< 0.05). The Q-switched Nd:YAG laser had a significant difference in tattoo lightening versus the Q-switched ruby laser after a single treatment (p<0.05). There was no significant difference in adverse effects between the two lasers. Conclusion: The Q-switched Nd:YAG laser is more effective at tattoo lightening for Chinese individuals. Its immediate response after treatment is slighter than the Q-switched ruby laser.     

Influence of a commercial tattoo ink on protein production in human fibroblasts

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 α1 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 α1 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.     

Pain inhibition in Q-switched laser tattoo removal with pneumatic skin flattening (PSF): a pilot study.

BACKGROUND: Tattoo removal with a Q-switched laser is often a painful procedure. The sensation of pain associated with the treatment is immediate and acute. Application of topical anesthesia to the treated area of the skin is time-consuming, with only very moderate pain relief. OBJECTIVE: To determine the efficacy of pneumatic skin-flattening (PSF) technology which utilizes an evacuation chamber that generates skin compression and activates tactile neural receptors in the skin, resulting in afferent inhibition of pain transmission in the dorsal horn (the 'gate theory'). METHODS: Eleven young patients aged 17-25 years old (nine females, two males) who were treated for tattoo removal were enrolled in the study. The patients were treated by a Q-switched Nd:YAG laser. Acute pain evaluation was performed on all 11 patients: one to two sites per patient with PSF and one to two control sites without PSF. When patients were treated with PSF, they knew they were being treated with a device that might reduce pain. This may have influenced patients' perception of pain. The evaluation was based on a modified McGill pain questionnaire. RESULTS: All 11 patients completed the study. A lower pain score with PSF was observed in all but one patient (10/11 or 91%). The average reduction of pain is by two levels: from very painful to very mild pain. The energy transmission of the PSF window is 95%, resulting in essentially identical efficacy of the PSF treatment and the regular non-PSF treatment. CONCLUSION: This pilot study indicates that PSF technology may reduce pain in tattoo removal with medium energy density Q-switched lasers (3-5 J/cm(2)).