Clinical Research on Laser-Assisted Tattoo Removal

Late fall and winter are great times to have a tattoo removed, as a New York Times article points out.

Why? Because the laser treatments used to remove tattoos are most effective on un-tanned skin.

“The danger is that your natural sun pigment—melanin—absorbs the laser light, and you end up with scabbing and crusting, then a temporary period of skin lightening,” a dermatologist told the Times.

But, as the Times article notes, “with winter on the horizon, patients are likely to keep their inked shoulder blades under chunky knits, safely out of the sun, for the duration of treatment.”

Tattoo removal often requires 6 to 12 sessions, so experts recommend scheduling before the winter season begins. Be sure to seek care from a physician experienced in removing tattoos.

Source: Saint Louis, Catherine. “A Change in Season and Regimen.” New York Times. Nov. 10, 2010.

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Getting a tattoo triples a person’s risk of acquiring hepatitis C, a large multinational study has found.

The odds were even higher when the study’s authors ruled out people already participating in other behaviors that raise the risk of hepatitis C. For example, people who get tattoos but who are not drug users are almost six times more likely to acquire hepatitis C than their peers.

The study, which was published in a recent issue of the International Journal of Infectious Diseases, analyzed data from 83 published studies from 30 countries.

As the study’s background information points out, hepatitis C is a viral disease that attacks the liver. If not diagnosed and treated, it can lead to liver failure. The virus is spread through contaminated blood. Infection is possible among people who get tattoos when the tattoo needles and other instruments are not properly sterilized.

The authors of the study call for more inspections of tattoo establishments, better safety training (for tattoo proprietors and clients), and prevention programs, especially among young people. An estimated 36 percent of Americans under the age of 30 have some kind of tattoo.

Source: Jafari S, Copes R, Bahariou S, Etminan M, Buston J. Tattooing and the risk of transmission of hepatitis C: a systematic review and meta-analysis.” Int J Infect Dis. 2010: July 2010 [Epub ahead of print].

The information found on this website is not designed to replace the patient/physician relationship.

In a recent issue of Dermatology, physicians from the Korea University College of Medicine report on what may be the first case of a pseudolymphoma induced by a semi-permanent tattoo. Pseudolymphoma is an inflammatory response that results in benign lymphoma-like cells.

The case involved a 49-year-old woman with a 1-year history of linear swelling on both lips. The swelling had developed gradually after the application of a red semi-permanent lip-liner tattoo. A skin biopsy was taken, and it was discovered that the cells in the swollen area consisted mainly of lymphocytes.

The physicians were able to obtain and analyze a sample of the semi-permanent dye used in the woman’s tattoo. They found metal iron, copper fumes, metal manganese, and metal cobalt in the dye. Interestingly, the analysis did not find mercury, which is believed to be the main source of red tattoo reactions.

Pseudolymphomas can appear from a few months to many years after permanent tattooing. They usually appear as swellings or nodular growths. There is no standard treatment for tattoo-induced pseudolymphomas. Topical or injected corticosteroids are usually tried, but results have varied. There has been 1 case in which a pseudolymphoma progressed to lymphoma. Despite the rareness of this outcome, surgical excision of the tattoo should be considered.

“In our case, surgical excision would have been inadequate due to the cosmetic outcome and functional morbidity,” wrote the authors of this case study. The physicians attempted to treat the patient with a 595-nm pulsed dye laser, but no improvement was seen after 4 sessions. The patient then underwent intralesional triamcinolone injections at 2- or 3-week intervals for four months. A gradual clinical improvement was observed.

As this case study illustrates, semi-permanent tattoos should not be considered benign. “Careful dermatologic examination for complications of a semi-permanent tattoo is important, given the increased number of such procedures being performed today,” the authors concluded.

Source: Shin JB, Seo SH, Kim BK, Kim IH, Son SW. Cutaneous T cell pseudolymphoma at the site of a semipermanent lip-liner tattoo. Dermatology. 2009;218:75-78.

The information found on this website is not designed to replace the patient/physician relationship.

It’s probably a sign of these economic times, but tattoo-related advertising may be on the upswing, suggests a recent news report in the New York Times.

The article focused on people who have shaved their heads to make them available for a temporary tattoo advertisement. Last November, for example, some 30 people volunteered to be “cranial billboards” for Air New Zealand. For two weeks they went about with a brief slogan for the airline and its Web site URL displayed across the backs of their heads.

Their payment? A round-trip ticket to New Zealand (worth about $1,200) or a cash payment of $777. Half took the cash.

These tattoos involved a henna dye, which, although not risk-free (it can cause allergic contact dermatitis), is at least temporary.  More worrisome are reports of people undergoing permanent tattooing to earn advertising money. The Times article also reported that since 2005, Dunlop Tires has permanently tattooed about 200 people with its logo or trademarked tire tread. Participants receive a set of tires worth $500 to $1,000.

Studies have shown that 28 percent of people who receive permanent tattoos almost immediately regret having gotten them. Many more regret them as time passes. As any dermatologist knows, skin reactions to the tattoos, including serious ones, can also occur.

Let’s hope tattoo advertising is one cultural trend that will quickly run its course. Otherwise more people will be spending more on tattoo removal than they received getting the tattoo in the first place.

Source:  Newman AA. The body as billboard: your ad here. New York Times. February 18, 2009.

The information found on this website is not designed to replace the patient/physician relationship.

Temporary tattooing using henna dye, a dark green power made from the leaves of the henna (Lawsonia inermis) plant has become very popular in recent years, both among adults and children. A recent article in the Journal of Dermatology details the case of a 9-year-old boy who developed allergic contact dermatitis after receiving a henna tattoo. Testing showed the boy had an allergy to para-phenylenediamine (PPD), the chemical often added to henna dye to make the color blacker and to speed up the dyeing process. After treatment with a cortocosteroid cream and oral antihistamines, the lesion went away, although some residual hypopigmentation remained.

Henna tattooing is not as risk-free as it seems. “The active substance from henna leaves is naphthoquinone,” the article’s authors note. “But for dying and tattooing, henna dye is usually mixed with other darkness-enhancing substances, such as PPD or para-toluenediamine, both very potent contact allergens. Heavy metals, such as nickel, cobalt, chromium, lead and mercury, also potentially strong contact allergens, can be found in henna tattoo mixtures.”

Topical corticosteroids and oral antihistamines are usually all that’s needed to treat these allergic reactions, the authors added, although in some cases a short-term systemic corticosteroid may also be needed.

Source: Jovanovic DL, Slavkovic-Jovanovic MR. Allergic contact dermatitis from temporary henna tattooing. J Dermatol. 2009:36:63-65.

The information found on this website is not designed to replace the patient/physician relationship.

A case study review, published in Dermatology, reports on 12 patients who came to the authors’ outpatient clinic with severe side effects after undergoing laser tattoo removal procedures performed elsewhere. All the patients had hypo- or hyper-pigmentations and scarring at the treatment site. Three had received their treatments from beauticians, the rest from physicians (dermatologists or plastic surgeons).

The authors conclude that the extensive scar formation and pigment changes that occurred in these 12 patients were most likely due to the use of improper light parameters. Two of the patients had been treated with an intense pulse light (IPL) laser, 1 with a radiofrequency device, and 9 with millisecond pulses of different laser systems.

Tattoo removal requires laser pulses of short duration (nanoseconds) and high intensities (unlike varicosities, for more info click here). After reviewing the treatment history of these 12 patients, the authors concluded that:

“the pulse duration of the light sources or lasers applied were considerably longer than those required by the principles of selective photothermolysis. The light intensities of those devices are normally not sufficient to destroy the pigment particles. Instead of destruction, the pigment particles in the skin are heated up and the heat is conducted to the adjacent tissue causing unspecific tissue injury. Lasers or intense pulsed light sources with millisecond pulses and low light intensities are clearly not suitable to be applied for tattoo removal.”

Source: Wenzel S, Landthaler M, Baumler W. Recurring mistakes in tattoo removal: a case series. Dermatology. 2009;218:164-167.<–>

The information found on this website is not designed to replace the patient/physician relationship.

In a recent issue of Acta Dermato-Venereologica, French dermatologists report on a 47-year-old female patient’s unusual and severe “scleroderma-like” reaction to the red-only parts of a tattoo.

The authors of the case study point out that although other kinds of skin reactions to tattooing are common, dermal sclerosis (a hardening of the skin tissue) is rare.

The woman in this case had been tattooed three other times before experiencing any kind of severe reaction. With this fourth tattoo (a red, yellow, orange, white and black “sacred heart” on her ankle), she immediately noticed unusual swelling and intense itching, and, eventually, dermal sclerosis. She did not seek medical help, however, for 18 months, even though the symptoms interfered with her daily life and her sleep. Interestingly, the patient developed a concomitant itchy reaction on the red areas of another tattoo on her back. That tattoo had been drawn by the same tattoo artist and with the same red ink 6 months before the ankle tattoo.

The authors concluded their case study report with the following remarks:

Source:Kluger N, Mathelier-Fusade P, Moguelet P. Scleroderma-like reaction restricted to the red parts of a tattoo. Acta Derm Venereol. 2009;89:95-96.

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Researchers from the University of Maryland Department of Dermatology published a report in the Journal of Cutaneous Pathology about a case of a patient presenting a superficially invasive squamous cell carcinoma (SCC), keratoacanthoma (KA) type, of the left forearm in a 1-month-old tattoo.

They took an initial biopsy and in the time following, he developed four more additional lesions. In the area of the lesions the patient had recently received a multicolored tattoo. Here is an excerpt from their report:

On physical examination, the patient had a large, multicolor tattoo on his left forearm, a well-healed surgical biopsy site and four erythematous hyperkeratotic papules within differently pigmented areas of the patient’s tattoo. Histopathological examination showed KA and tattoo pigment. Based on the eruptive nature of these lesions, their clinical presentation and the histopathological changes, we report this as the first case of eruptive KA arising in a multicolor tattoo.

Has anyone else heard or seen of a similar case?

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A new French study published this month describes some potentially lethal allergic reactions patients have had following Henna tattoos received on vacation. Henna tattoos are the temporary tattoos common in India and other Eastern nations which many Westerners will receive while visiting on vacation. They are especially popular among children and young adults.

The inks used to perform the tattooing include a powerful allergen, Para-phenylenediamine (PPD), which is responsible for the majority of complications which arise from Henna tattoos. Typically Henna tattoo side effects are localized contact dermatitis, keloid or hypertrophic scarring, temporary or sometimes permanent hyper and hypo pigmentation.

The study also reports cases of type I hypersensitivity reactions (urticaria, angioedema, or anaphylaxis) with potentially lethal outcomes.

The researchers recommend the greater education of Western consumers about the risks involved in Henna tattooing.

The information found on this website is not designed to replace the patient/physician relationship.

A new study by Mass General researchers Drs. Rox Anderson, Avram and Izikson have shown two patients who’ve had an immunologic reaction following laser tattoo removal. There have been reports of patients who are undergoing an allergic reaction to a tattoo ink who, upon receiving laser tattoo removal, have gone into full body anaphylactic shock. This may potentially be life threatening in some cases.

This is, however, rare. The purpose of the study done by Anderson et al was to study the potential immunologic reactions following laser tattoo removal.

As laser tattoo removal is one of most commonly used indications for medical lasers the concern is obvious, will patients be at risk for some unwanted complication due to the inks?

Anderson et al report that:

Two patients developed transient immunoreactivity that presented as regional lymphadenopathy after laser tattoo removal of professional black and blue-green tattoos. These reactions resolved without any complications.

CONCLUSIONS: Tattoo pigments released or modified by laser therapy may trigger transient immunoreactivity in susceptible individuals.

Clearly there is some potential complication to laser assisted tattoo removal, but given how often it is performed with few reported complications, the risk is low.

More information about the use of laser to remove unwanted tattoos

The information found on this website is not designed to replace the patient/physician relationship.