Tattoo removal

Tattoos have been a part of costume, expression, and identification in various cultures for centuries. Although tattoos have become more popular in western culture, many people regret their tattoos in later years. In this situation, it is important to be aware of the mechanisms of tattoo removal methods available, as well as their potential short- and long-term effects. Among the myriad of options available, laser tattoo removal is the current treatment of choice, given its safety and efficacy.     

Necrotizing Black Tattoo Reaction

We report the rare case of an 18-year-old man who developed a necrotizing cutaneous reaction 5 days after having a permanent black tattoo on his left forearm spelling his name. Three cases of reactions to permanent black tattoos have been reported within the literature. These cases described the development of cellulitis of the skin adjacent to the tattoo but none reported florid necrotizing cutaneous reactions. The initial management with oral antibacterials failed to resolve the symptoms and use of intravenous antibacterials and topical corticosteroids was needed. Six weeks after presentation the tattoo lettering showed the presence of hyperpigmented skin. Subsequent patch testing confirmed that the patient had no allergy to black tattoo pigments suggesting that the necrotizing cutaneous reaction was secondary to infection. We show that successful treatment of this rare infective complication of permanent black tattoos involves the early institution of intravenous antibacterial agents and topical corticosteroids.     

Tattoo removal using infra-red coagulation

Using a radiation source from which the output is maximal in the near infra-red range, we have successfully treated thirty-six tattoos in twenty-one patients. This technique is described and its place in practice is discussed.     

Tattoo removal using a liquid nitrogen cryospray

Fifteen patients with relatively small self-induced tattoos on the forearm or fingers were treated with liquid nitrogen spray cryotherapy. Eleven patients had cither a satisfactory or good result and four showed little change.     

Tattoo inks in general usage contain nanoparticles

Background To our knowledge tattooing has never been thought of as a method of introducing nanoparticles (NPs) into the human body by the intradermal route, and as such it has never been a topic of research in nanotoxicology. The content of NPs in tattoo inks is unknown. Objectives To classify the particle sizes in tattoo inks in general usage. Methods The particle size was measured by laser diffraction, electron microscopy and X‐ray diffraction. Results The size of the pigments could be divided into three main classes. The black pigments were the smallest, the white pigments the largest and the coloured pigments had a size in between the two. The vast majority of the tested tattoo inks contained significant amounts of NPs except for the white pigments. The black pigments were almost pure NPs, i.e. particles with at least one dimension < 100 nm. Conclusions The finding of NPs in tattoo inks in general usage is new and may contribute to the understanding of tattoo ink kinetics. How the body responds to NP tattoo pigments should be examined further.     

Tattoo removal using infra-red coagulation: a dose comparison

Using an infra-red coagulator, 42 tattoos were treated using pulses of 1.125 s (27 tattoos) or 1.25 s (15 tattoos). Treatment failures occurred only in three professional tattoos. Amateur tattoos were satisfactorily treated in over 80% of cases regardless of dose. Deeper collagen necrosis occurred with 1.25 s, but scarring was clinically similar. Pre-treatment biopsy to assess pigment depth was of no value in selection of the optimum pulse duration and increased the complication rate. The possible mechanism of pigment removal is discussed.     

Tattoo removal – state of the art

Tattooing has been around since the early beginnings of modern civilization. The discovery of selective photothermolysis at last has made it possible to remove tattoos without leaving a scar. Q‐switched neodymium: yttrium‐aluminum‐garnet, alexandrite, and ruby lasers with pulse durations in the nanosecond domain fulfill this need. Argon or cw‐CO₂ lasers as well as intense pulsed light sources should not be used since they often produce significant scarring. This article provides an overview of current laser systems.Developments leading to new tattoo inks, feedback systems to detect the absorbance characteristics of tattoo inks, dermal clearing agents, and perhaps even lasers with shorter pulse‐durations might improve the results in the future.     

Tattoo pigment mimics positive sentinel lymph node in melanoma.

A 42-year-old man with metastasizing melanoma from an unknown primary is presented. Initially a subcutaneous metastasis in the scapular region and a single lung metastasis were resected. Thorough examinations did not show any evidence of a primary tumour. From the site of the metastasis on the right scapular region, lymphoscintigraphy with axillary sentinel lymph node biopsy was performed. One axillary lymph node could be identified intra-operatively with the gamma probe as sentinel node. The sentinel node and 4 adjacent lymph nodes clinically showed black pigmentation. However, histopathological examination of the lymph nodes did not detect micrometastases. The pigmentation of the lymph nodes was due to decorative tattoos of the scapular skin.     

Tattoo ink darkening of a yellow tattoo after Q-switched laser treatment

The popularity of tattoos is burgeoning with 20-30 million tattooed individuals in the Western World. Requests for removal can be expected to rise concurrently with increased applications. Laser removal of tattoos is potentially a more cosmetically acceptable method of removing tattoos than surgical excision or dermabrasion. Nevertheless, complications and side-effects can result from laser treatment and include scarring, hypopigmentation, hyperpigmentation, partial removal, infection, bleeding and tattoo ink darkening. The latter has been reported for flesh-toned and red tattoos. Such a complication has never been reported for the laser treatment of a yellow tattoo in the dermatological literature. We describe a case of tattoo ink darkening of a yellow tattoo after treatment with the 532 nm quality-switched Neodymium : Ytrrium-Aluminium Garnet laser to highlight clinicopathological features. The mechanism by which some tattoos darken after laser treatment is not clearly understood. We review darkening of tattoos after laser treatment to raise awareness of this important complication. This paper will help to facilitate discussions with the patient and in obtaining informed consent prior to commencing treatment. Tattoo ink darkening of a yellow tattoo adds to the growing list of complications resulting from attempts at tattoo removal.