TATTOO REMOVAL: TANNIC ACID METHOD OF VARIOT

Background. There are many methods for tattoo removal (e.g., surgery, cryosurgery, laser, dermabrasion), but none can restore the skin to its original state. Methods. Tattoo removal was obtained with a combination of tattoo machine, tannic acid, and silver nitrate. Results. This technique proved to be effective for the removal of amateur tattoos of any size. The results with professional tattoos were much less satisfactory. The estimation of the depth of pigment in pretreatment biopsies showed no correlation with the success rate of treatment. No indication of systemic side effects on the liver from tannic acid was found in the concentration and amount used in this study. Conclusions. This technique is effective for the removal of amateur tattoos of any size and is comparable with cryotherapy, infrared coagulation, and focal salabrasion.     

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.     

The Fate of the Phagocyte in Dermabrasion of Tattoos with Table Salt

A study has been carried out to show the cellular response in dermabrasion of tattoos with table salt. Initially neutrophils and later both neutrophils and macrophages were involved in pigment removal.     

Melanoma and melanocytic nevi in decorative tattoos: three case reports

Background: In response to the demands of style and fashion, the number of decorative tattoos has been increasing worldwide. This has been paralleled by a rising incidence of melanocytic proliferations, including melanoma. The coincidence of various dermatological diseases and skin tumors with tattoos has been documented with some frequency, but reports of melanoma associated with tattoos are exceedingly rare. To date, only 13 cases have been documented in the English language literature. The possibility of an association between melanocytic proliferations and tattoos remains an area for further study. Observations: This report presents two cases of melanocytic nevi and one of melanoma occurring in association with a decorative tattoos. Conclusions: At present, the pathogenesis of melanoma developing in a tattoo is unknown. Mere coincidence cannot be ruled out. However, trauma, ultraviolet light exposure, a photoallergic effect, or an inflammatory reaction may promote malignant transformation. Clinicians and histopathologists should be aware of the clinical and pathological features if they are to make a correct diagnosis. Varga E, Korom I, Varga J, Kohán J, Kemény L, Oláh J. Melanoma and melanocytic nevi in decorative tattoos: three case reports.     

Extended clinical use of the argon laser for cutaneous lesions.

A safe, easy, and effective outpatient modality for the treatment of various cutaneous lesions such as hemangiomas and decorative tattoos has long been sought. The argon laser has proved satisfactory for such treatment of port-wine hemangiomas, capillary/cavernous hemangiomas, telangiectasia, and decorative tattoos as well as a variety of cutaneous pigmented lesions. The intense laser light is attracted and absorbed by pigmented skin lesions producing heat that selectively destroys the intradermal pathologic condition and spares overlying skin. Hemangiomas and tattoos have undergone satisfactory subtotal blanching in the majority of cases with a low incidence of hypertrophic scarring. Thus, the argon laser has proved useful in the outpatient treatment of a variety of pigmented cutaneous lesions.     

Efficacy of laser treatment of tattoos using lasers emitting wavelengths of 532 nm, 755 nm and 1064 nm

BACKGROUND: Multifunctional laser devices can be used to treat tattoos successfully. OBJECTIVES: To report the efficacy of laser treatment in professional, amateur, accidental and permanent make-up tattoos from our own experience and to compare it with the literature. METHODS: We retrospectively studied 74 consecutive patients with professional, amateur, make-up and accidental tattoos between June 1998 and November 2000. Patients were treated with a Q-switched Nd:YAG laser (wavelengths of 532 nm and 1064 nm), a Q-switched alexandrite laser (755 nm) and a variable pulse Nd:YAG laser (532 nm). RESULTS: Fourteen patients (19%) achieved a complete response (>95% lightening of treated tattoos), 23 (31%) an excellent response (76-95% lightening) and 21 (28%) a good response (51-75% lightening). Sixteen patients (22%) showed only a slight improvement (< or =50% lightening). Make-up tattoos and blue-black professional tattoos were most successfully treated. Multicoloured professional tattoos needed more treatments (mean +/- SD 5.7 +/- 5.4) in comparison with single-colour tattoos (3.5 +/- 2.0). The amateur tattoos needed fewer treatments (2.8 +/- 1.1) in comparison with professional tattoos. With accidental tattoos the results depended on the particles which had penetrated the skin. In contrast to literature reports, newer tattoos showed a trend to better treatment results than older tattoos. CONCLUSIONS: Using modern Q-switched lasers, tattoos are removed successfully with minimal risk of scarring and permanent pigmentary alterations. Even multicoloured tattoos can be treated successfully and with a low rate of side-effects.     

Akkumulation von Tatoo-Pigment im Sentinellymphknoten

A 22-year-old woman presented with a superficial spreading melanoma on her right thigh (tumor thickness 1.0 mm, Clark-Level III). She also had decorative tattoos on her right ankle, right groin and coccyx. The staging results gave no indication for metastases. Intra-operatively, we observed a black pigmented lymph node highly suspicious for metastatic disease, but histological examination excluded metastatic spread and detected the accumulation of black pigment within the lymph node. Clinical differentiation between tattoo pigments and metastatic disease within lymph nodes is not possible. Histological confirmation of an enlarged pigmented lymph node is therefore essential before radical surgery is performed. Hence, accumulation of tattoo pigment within enlarged and pigmented lymph nodes needs to be included into the differential diagnosis and the documentation of decorative tattoos is important during skin cancer screening as well as during the follow-up of melanoma patients.     

In vivo imaging of intradermal tattoos by confocal scanning laser microscopy

BACKGROUND/AIMS: In vivo confocal laser scanning microscopy (CLSM) is a new method for high-resolution imaging of intact skin in situ. Horizontal mapping of the outer skin is provided (magnification x 1000). OBJECTIVES: Tattooing is popular all over the world; however, tattooed skin has not been studied in using CLSM. RESULTS: Tattoos in two volunteers were studied using the Vivascope1500 of Lucid Inc. Subepidermal massive deposits of dense, clustered pigment granules up to about 3 mum in size corresponding to black tattoos, and more scarce and diffuse deposits, corresponding to red, blue and green tattoos, were observed. Diffuse pigment granules tended to accumulate in the outer dermis underneath the level of the basement membrane zone. CONCLUSIONS: Dermal pigments from tattoos can be imaged in vivo using CLSM. This application of CLSM has an important future potential for pre-evaluation of tattoos before laser removal, predicting good or poor outcome of laser removal.     

Delayed purpuric reaction following superficial dermabrasion.

A hemorrhagic reaction of unknown cause can occur approximately five weeks after superficial dermabrasion of tattoos. This reaction may lead to alarm in the patient and possibly to increased scarring the area treated. Intralesional corticosteroid injections have sped resolution. It is wise to forewarn patients of this potential complication of tattoo dermabrasion.     

The use of lasers for decorative tattoo removal

As the incidence of tattoo placement continues to increase, so does the demand for tattoo removal, with more than 10 million people in the US alone with a tattoo. Used in an appropriate clinical setting, Q-switched lasers provide relatively efficacious clearance of decorative tattoo pigment with minimal side-effects. We present our clinical experience along with literature findings on decorative tattoo removal and the important issues practitioners should consider in the management of tattoos.     

Laser tattoo removal: Fundamental principles and practical approach

Tattoos have long become a part of human civilization. However, as the number of people who get tattoos increases, so is the number of people who wish to have their tattoos removed. Compared to other methods, laser‐based devices are associated with the best efficacy and least side effects in tattoo removal. Lack of understanding of the fundamental principles of laser and managing its parameters may result in suboptimal result and increased risk of side effects. Recognizing and mastering multiple factors including skin types, nature and color of tattoos, and proper selection of laser parameters such as wavelength, fluence, and pulse, are central in achieving an optimal tattoo removal outcome. This review provides a comprehensive overview on the fundamental principle of laser and practical approaches in tattoo removal.     

Der Nd:YAG-Laser im Wandel der (Impuls-) Zeiten – Einsatzgebiete in der Dermatologie

The neodymium:yttrium-aluminium-garnet-(Nd:YAG) laser is one of the most versatile and interesting lasers in dermatological laser medicine. Almost no other laser has such a wide spectrum of applications. Depending on wave length (1064 nm, frequency-doubled 532 nm) and mode (continuous, Q-switched, long-pulsed), benign pigmented lesions (tattoos, traumatic tattoos, naevus of Ota, cafe-au-lait-macules, lentigines) and vascular lesions (hemangiomas, portwine stains, essential teleangiectasias, angiomas) can be treated. Additionally this laser has been occasionally used to remove Kaposi sarcomas and epithelial skin tumors.     

Imaging of intradermal tattoos by optical coherence tomography

BACKGROUND/PURPOSE: Tattoos have become increasingly popular followed by a growing demand for tattoo removal, and yet there is little knowledge and monitoring of tattoo pigment deposition in skin layers. The purpose of this pilot study is to describe optical coherence tomography image characteristics of intradermal tattoos. METHODS: We included five black tattoos in 3 female volunteers, 39, 35 and 30 years old. In vivo imaging of tattoo pigments in the skin is possible with optical coherence tomography (OCT), a novel non-invasive, in vivo optical imaging technology with a resolution and a penetration in skin high enough for visualization of tattoo pigment in the dermis. RESULTS: In optical coherence tomography images tattoo pigments clusters appear as dark, homogenous vertical columns and structures in the papillary dermis. OCT-scanned normal skin (without tattoos) appeared to be free of this dark structure. CONCLUSION: We have demonstrated that OCT can be used to visualize clusters of light absorbing pigments in a predictable manner.     

Removal of tattoos with the Nd:YAG laser

Irradiation of 20 tattoos using the Q-switched Nd:YAG laser (energy density 3-5 J/cm2, asymmetrical pulse shape with 50% energy output in 18 ns, spot size 3 mm in diameter) gave the impression that black ink tattoos can be completely removed without scarring. Some patients needed several treatments. The results continued to improve even some months after the irradiation. In preliminary experiments on excised tattooed and untattooed skin the non-Q-switched Nd:YAG laser had distinct burning effects. It was therefore not tested in patients. The results of chemical, physical, and histological examinations are discussed with special reference to toxic side-effects that might be induced by laser irradiation.     

Squamous neoplasms arising within tattoos: clinical presentation,histopathology and management

Tattooing, which involves the placement of ink into the skin, is an ancient decorative technique that has remained popular in modern society. Tattoos have long been known to cause cutaneous reactions, which include the emergence of neoplasms such as keratoacanthoma (KA) and squamous cell carcinoma (SCC) in tattooed areas of the skin. We review the clinical presentations, histology and treatment options for squamous neoplasms, primarily KA and SCC, arising in tattoos.     

Neodymium:YAG laser in dermatologic therapy

We report on our experiences with a powerful neodymium:YAG-laser in treatment of benign and malignant skin tumors as well as various other conditions such as removal of tattoos. The rapidity of the laser treatment which can be carried out under local anaesthesia, allows the treatment of even large tumors in critical locations as well as in the elderly. The cosmetic results are comparable to those obtained by dermatologic X-ray therapy. Before complete healing of the coagulated area is achieved, however, a rather long period elapses. The cosmetic outcome after removal of tattoos largely depends on the level of the dermis the pigment is deposited in; all in all, our results are not superior to other treatment schedules.     

Comparison of the infrared coagulator and the carbon dioxide laser in the removal of decorative tattoos

A comparative study of the removal of decorative tattoos by the infrared coagulator and the CO2 laser was performed. The comparison was made by following the parameters of length of healing time, postoperative pain, presence of residual pigment, and tendency for scarring. The results showed that the infrared coagulator had the advantages of a more rapid healing time, an easier-to-care-for treatment site, and an equivalent cosmetic result in comparison with the CO2 laser. The CO2 laser had the advantage of total pigment removal in a single treatment, whereas the infrared coagulator often left residual pigment.     

Laser Removal of Tattoos

Tattoos are placed for different reasons. A technique for tattoo removal which produces selective removal of each tattoo pigment, with minimal risk of scarring, is needed. Nonspecific methods have a high incidence of scarring, textural, and pigmentary alterations compared with the use of Q-switched lasers. With new advances in Q-switched laser technology, tattoo removal can be achieved with minimal risk of scarring and permanent pigmentary alteration. There are five types of tattoos: amateur, professional, cosmetic, medicinal, and traumatic. Amateur tattoos require less treatment sessions than professional multicolored tattoos. Other factors to consider when evaluating tattoos for removal are: location, age and the skin type of the patient. Treatment should begin by obtaining a pre-operative history. Since treatment with the Q-switched lasers is painful, use of a local injection with lidocaine or topical anaesthesia cream may be used prior to laser treatment. Topical broad-spectrum antibacterial ointment is applied immediately following the procedure. Three types of lasers are currently used for tattoo removal: Q-switched ruby laser (694nm), Q-switched Nd:YAG laser (532nm, 1064nm), and Q-switched alexandrite laser (755nm). The Q-switched ruby and alexandrite lasers are useful for removing black, blue and green pigments. The Q-switched 532nm Nd:YAG laser can be used to remove red pigments and the 1064nm Nd:YAG laser is used for removal of black and blue pigments. The most common adverse effects following laser tattoo treatment with the Q-switched ruby laser include textural change, scarring, and pigmentary alteration. Transient hypopigmentation and textural changes have been reported in up to 50 and 12%, respectively, of patients treated with the Q-switched alexandrite laser. Hyperpigmentation and textural changes are infrequent adverse effects of the Q-switched Nd:YAG laser and the incidence of hypopigmentary changes is much lower than with the ruby laser. The development of localized and generalized allergic reactions is an unusual complication following tattoo removal with the Q-switched ruby and Nd:YAG lasers. Since many wavelengths are needed to treat multicolored tattoos, not one laser system can be used alone to remove all the available inks and combination of inks. While laser tattoo removal is not perfect, we have come a long way since the advent of Q-switched lasers. Current research is focusing on newer picosecond lasers, which may be more successful than the Q-switched lasers in the removal of the new vibrant tattoo inks.     

Diffused traumatic dirt and decorative tattooing. Removal by Q-switched lasers

BACKGROUND AND OBJECTIVE: Pigment fanning or spread is one complication of decorative tattooing, but is also seen after traumatic tattoos. The reason for this spreading remains unclear. While excision of the diffused pigment was previously considered the treatment of choice, today destruction of the pigment with Q-switched laser systems is the therapy with the highest efficiency and lowest rate of side effects. Therefore areas of pigment spread should be excised only in rare exceptional cases. PATIENTS/METHODS: 4 patients with pigment fanning after permanent make up and traumatic tattooing of the periorbital region were treated with the Q-switched ruby (694 nm) and Q-switched Nd:YAG (1064 nm) lasers. RESULTS: All patients showed a significant (70-80%) clearance of the spread pigment; two had complete clearing. Side effects such as hyper- or hypopigmentation, scarring or ink darkening were not seen. CONCLUSIONS: The Q-switched ruby- and Q-switched Nd:YAG-lasers are a therapeutic modality for pigment fanning with high efficiency and low rate of side effects. Attempts of explanation for pigment spread after tattoos are given, but further histological and electron microscopical investigations are needed to find the pathogenetic mechanism.     

Emotional healing with unconventional breast tattoos: The role of temporary tattoos in the recovery process after breast carcinoma and mastectomy

The healing process after breast cancer treatment is predominantly focused toward the physical changes to the body that a patient has experienced. Breast reconstructions are considered standard of care after mastectomy, and the nipple and areolar complex is often reconstructed as well, using a combination of skin graft and tattoo. A patient who decided to forego nipple reconstruction and areolar tattooing and instead chooses to apply decorative temporary tattoos to her breast reconstruction is described. Compared with permanent tattoos, these unconventional tattoos allow the patient to change the design to fit her mood. Unconventional tattoos are an alternative and creative approach to the healing process, in which artistic and individual expression allows the patient to embrace the physical change she has undergone as a breast cancer survivor.