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Are tattooing and body piercing indicators of risk-taking behaviours among high school students?

PURPOSE: To date, studies pertaining to possible links between body modification and risk-taking behaviours have been conducted mainly among targeted groups. The objective of this study is to examine the influence of a number of risk-taking behaviours on the probability of being pierced or tattooed among a general adolescent population. METHODS: Data come from a cross-sectional study conducted among a sample of 2180 students aged 12-18. Data were collected directly from students through a self-report survey. RESULTS: Findings confirm the "risky" nature of these practices even though the tattooed and pierced subjects of this study were from a general adolescent population. Factors that contribute significantly to the likelihood of teenagers being tattooed or pierced, for both genders, are associated with "externalized risk behaviours" such as multiple drug use, illegal activities, gang affiliation, problem gambling, school truancy and rave attendance. CONCLUSION: Nowadays, tattooing and body piercing are perceived by many as body decoration, increasingly belonging to the realm of generational conformity. Contrary to this view, our results suggest that these practices among adolescents are mostly adopted by those who are involved in various deviant or illegal activities, which are often interrelated.

Adolescent↗

Tattoo removal among Ethiopian Jews in Israel: tradition faces technology.

BACKGROUND: Many Jews in Ethiopia adopted the Christian custom of tattooing various parts of the body, either after conversion or to hide their Jewish origin. After emigrating to Israel, they sought to remove these foreign symbols to better blend with society. The aim of this study was to describe the use of laser technology for tattoo removal in a high-risk dark-skinned population and to highlight one way in which the interaction of modern medical communities with people from developing countries can open new avenues of research. PATIENTS AND METHODS: The study sample consisted of 401 women and 3 men of Ethiopian origin with Fitzpatrick skin type V or VI. Ages ranged from 15 to 53 years. All tattoos were blue/black and had been made by injecting charcoal into the skin. Most (n = 392, 97%) were located on the forehead or the forehead and temples (n = 312); 69% were cross-shaped. Patients underwent 3 to 6 laser treatments (average 3.6) with the Q-switched Nd:YAG (n = 380, 94%) or ruby (n = 24) laser at intervals of at least 8 weeks. The percent of clearing was scored by two independent investigators as follows: 1 = 0%-25%; 2 = 26%-50%; 3 = 51%-75%; 4 = 75%-100%. Pigmentary and textural changes were classified as none, mild, moderate, or severe. The duration of follow-up after the last treatment was 6-8 months. RESULTS: At the last follow-up, the clearance score was 4 in 92% of the patients and 3 in the remainder. Transient (2-4 months) mild hyperpigmentation was noted in 177 (44%) patients, and mild textural changes in two, both treated with the Q-switched laser. There were no cases of scarring or permanent pigmentary changes. CONCLUSION: Laser removal of carbon-based tattoos in an Ethiopian population yielded an excellent to good aesthetic outcome with no complications, similar to results in light-skinned patients. These findings have important implications for improving the quality of life of Ethiopian immigrants in Israel.

Adolescent↗

[Allergic contact eczema caused by henna tattoo].

INTRODUCTION: Henna dye is obtained from the leaves of an indigenous tree, Lawsonia inermis. Contact dermatitis to henna is rarely reported. It is usually related to additives, especially oils or paraphenylenediamine. We report the case of a 9-year- old boy who developed an eczematous reaction at the site of application of a henna tattoo. CASE REPORT: A henna tattoo was applied on the arm of a healthy 9-year-old boy on a Mediterranean beach. Four days later, the child noted pruritus followed multiple small papules and vesicles overlying the pattern of tattoo. He was treated with topical mometasone for 20 days, which produced gradual improvement and resolution. MATERIAL AND METHODS: Two months later, a patch test (True test) was performed on the upper back. The results were observed after 48 and 96 hours and showed positive reactions to p-phenylenediamine, PPD mix (black rubber mix) and paraben mix and was negative to natural henna. DISCUSSION: Skin painting with henna is traditionally performed in Muslims or Hindus. The painting is usually performed on the hair, palms, soles of the feet and nails with henna that gives a red color. The addition of p-phenylenediamine to the henna mixture darkens the color. The mixtures used by the "artists" contained natural henna (a rare sensitizer) and chemical coloring agents: diaminotoluenes and diaminobenzenes such as paraphenylenediamine. Today, paint-on tattoos drawn on the skin by street or beach artists are very fashionable among Europeans in holiday resorts. Because of the worldwide fashion of skin painting, future cases of sensitization to p-phenylenediamine are expected.

Administration, Cutaneous↗

Laser eradication of pigmented lesions and tattoos.

Laser treatment of pigmented lesions can be a rewarding experience when appropriate lesions are treated. Accurate diagnosis of pigmented lesions is needed before treatment. In some lesions, adjuvant topical therapy is greatly beneficial, and for others it may be the only option. The treatment of melanocytic nevi is controversial but worth pursuing. All tattoos respond well to Q-switched lasers; the appropriate wavelength depends on the color of ink. Amateur and traumatic tattoos clear readily with laser treatment. Cosmetic tattoos should be approached with caution. In addition, the use of laser-responsive ink and higher-powered or shorter-pulsed (picosecond) lasers may further enhance the ability to treat tattoos.

Follow-Up Studies↗

Treatment of gunpowder traumatic tattoo by Q-switched Nd:YAG laser: an unusual adverse effect.

BACKGROUND: The Q-switched Nd:YAG laser can completely eliminate traumatic tattoos. OBJECTIVE: We report the results of the unsuccessful removal of traumatic tattoos among three patients with dermal inclusions of gunpowder who were shot at close range. METHODS: Treatment was tried in each patient with a Q-switched Nd:YAG laser at a medium fluence (4-6 J/cm2). RESULTS: During treatment of our patients, each pulse provoked sparks and the immediate formation of bleeding trans- epidermal pits. After the healing process was completed, we observed poxlike scars and the spreading of pigments in the skin around the initial points of the tattoo. CONCLUSION: We hypothesize that the rapid transfer of high-energy pulses to powder particles creates microexplosions of these fragments resulting in cavitation and provoking transepidermal holes and subsequent scars. This adverse effect was only produced if the tattoo resulted from gun powder being shot at a short distance from the skin.

Adult↗

Sensitization to para-phenylenediamine from a streetside temporary tattoo.

"Temporary" henna tattoos (skin painting or pseudotattooing) are in vogue among American and European youngsters, particularly when vacationing. A 17-year-old girl presented with a severe contact dermatitis of her scalp and face after having dyed her hair with a permanent oxidative hair dye. She denied previous use of oxidative hair dye. Eight months earlier she had a "temporary" henna tattoo applied on her shoulder by a transient artist in downtown Montreal and developed an acute, erythematous, edematous eruption that resolved with residual, prolonged hyperpigmentation. As henna tattooing is a lengthy and tedious procedure, para-phenylenediamine (PPD) may be added to the mixture to accelerate the process, to darken, and to give more precision to the design. This short-lived fad can have longer-term sequelae then expected, ranging from postinflammatory hyperpigmentation of the tattoo site to permanent sensitization to PPD and related compounds.

Adolescent↗

Patch testing over tattoos.

BACKGROUND: There is little, if any, literature regarding placing and reading of patch-tests on tattooed skin. METHOD: A patient whose entire back was covered with multiple tattoos was patch-tested. RESULTS: Multiple positive patch-tests were seen with no apparent reduction in intensity related to tattooed skin. CONCLUSION: If necessary, patch-tests can be placed and read on tattooed skin.

Adult↗

Retinal vasculitis and cystoid macular edema after body tattooing: a case report.

BACKGROUND: To report a case of retinal vasculitis occurring after the placement of permanent tattoos. HISTORY AND SIGNS: A 21-year-old male was referred to our department with impairment of visual acuity. Permanent tattoos covered the head, body, arms and legs. The patient was examined with ophthalmoscopy, fluorescein angiography, indocyanine green angiography and optical coherence tomography. Systemic medical and laboratory work-up were performed in order to exclude an infectious agent or an inflammatory disease. He had no history of intravenous drug abuse. THERAPY AND OUTCOME: Our patient presented severe posterior uveitis associated with retinal vasculitis and cystoid macular edema. Laboratory tests ruled out all diseases causing vasculitis. HIV and B, C hepatitis tests were negative. Cystoid macular edema and vasculitis were resolved after immunosuppressive therapy. CONCLUSIONS: This is the first description of a retinal vasculitis associated with cystoid macular edema in a completely healthy individual after the placement of permanent tattoos. A phagocytosis of tattoo pigments leading to their lysis is described in the literature as a mechanism causing vasculitis.

Adult↗

Jaggers in the pokey: understanding tattooing in prisons and reacting rationally to it.

The legalisation of tattooing in prisons, as well as the provision of access by inmates to professional tattooists during incarceration, have remained contentious issues between custodial and health authorities in most Western prisons. This article examines the arguments of both stakeholders as well as the attitudes of inmates vis-à-vis tattooing, and suggests a multifaceted approach that takes cognisance of inmates' motivation to have prison tattoos, and (potential) public health implications of tattooing in correctional settings.

Attitude↗

The use of Q-switched alexandrite laser (755 nm, 100 ns) for eyeliner tattoo removal.

BACKGROUND: Eyelid tattooing for cosmetic reasons has increased in the past few years, and unsatisfied customers may request pigment removal. Q-switched laser systems have been useful in these cases. OBJECTIVE: To evaluate the clinical result of a patient with a bluish-black eyelid tattoo treated with Q-switched alexandrite laser. METHODS: Threshold fluence was determined and a spot test made on the first visit. Treatment was with QSAL, with a fluence range of 6.75-7.50 J/cm2 (mean fluence 7.125 +/- 0.26) and overlapping +/- 10% at 4-week intervals. RESULTS: The eyeliner tattoo was not completely removed after five treatments with QSAL, but noticeable pigment lightening was obtained. No side effects were seen. CONCLUSIONS: Q-switched alexandrite laser may be a useful device to remove the bluish-black pigment used in cosmetic eyeliner tattoo.

Aged↗

Cosmetic tattoo refractive to Q-switched alexandrite laser.

BACKGROUND: Lip tattooing is a common cosmetic technique not exempt from certain risks and which may lead an unsatisfied customer to seek tattoo elimination. OBJECTIVE: To assess the clinical outcome of a patient with a brownish-colored cosmetic lip tattoo after treatment with the Q-switched alexandrite laser (QSAL). METHODS: Two sites were tested using the pigment lesion dye laser (PLDL) and QSAL. The patient received 10 monthly sessions with QSAL, with an average fluence of 6.925 J/cm2. The double and triple shot technique was applied. RESULTS: The brownish pigmentation turned black after the PLDL and QSAL tests. Epidermal splattering and bleeding made a fluence increase with QSAL inadvisable. Treatment was unsuccessful. CONCLUSIONS: PLDL and QSAL may induce a photochemical alteration in brownish pigment. Factors that may contribute to the poor response of a cosmetic lip tattoo to QSAL treatment are related to pigment characteristics and laser parameters.

Cosmetic Techniques↗

'Black henna' tattoos: an occult source of natural rubber latex allergy?

Temporary 'black henna' tattoos are an increasingly popular body decoration with a growing incidence of associated adverse events. We report the case of a 14 year old girl presenting with an acute allergic contact dermatitis to hair dyes. Some years previously she had a 'black henna' tattoo with prior application of a tacky transfer to the skin to outline the design followed some days later by an acute localised blistering reaction. Patch testing to an extended British Contact Dermatitis Society standard series showed relevant positive reactions to paraphenlyenediamine (PPD) and thiuram mix, as well as to several of the azo disperse dyes. We went on to perform prick testing to natural rubber latex (NRL), showing a positive reaction to the commercial HEP 100 concentration. We propose that through the initial acute reaction caused by PPD in the 'black henna' our patient was not only sensitized to PPD, but also to thiuram and natural rubber latex which may have been present in the tacky transfer applied prior to 'tattooing.' We would add that temporary 'black henna' tattoos may have more important consequences than previously thought on patients' future health by sensitization to NRL.

Adolescent↗

Lemon juice, sunlight, and tattoos.

In folklore, tattoos are thought to fade if rubbed with lemon juice and exposed to sunlight. The authors tested this hypothesis on shaved, tattooed rats. Tattooed controls were used. Additional substances and conditions were included in the study (tretinoin gel, liquid nitrogen, and dermabrasion). The authors conclude that India ink tattoos do not fade significantly with sunlight and lemon juice nor with the application of tretinoin gel, liquid nitrogen, or combinations thereof.

Animals↗

Employer attitudes toward persons with visible tattoos.

A total of 242 employers were surveyed over the telephone to assess their attitudes toward prospective employees with visible tattooing. Employers were divided into eight categories according to type of industry. Responses to the survey were tabulated and confidence intervals produced. It would appear that significant bias exists against the employment of persons with visible tattoos in the hospitality, beauty, retail and office sectors where less than 30% of those surveyed would employ a person with a tattoo. All industries except building and the public service admitted that they would be influenced by a visible tattoo in over 40% of cases.

Attitude↗

Corneal tattooing revisited: excimer laser in the treatment of unsightly leucomata.

BACKGROUND: Corneal tattooing, a procedure first used by Galen in the treatment of unsightly leucomata, has in recent times received relatively little attention due to major advances in intraocular and corneal surgery. Resurrection of the technique, however, may be reasonably considered in 'high risk' cases of leucomata or leucocoria where corneal transplantation would lead to rejection and failure, or, in eyes with no visual potential, where removal of cosmetically unacceptable dense, white cataracts carries an unreasonable risk of phthisis bulbi or sympathetic ophthalmitis. METHODS: Corneal tattooing requires the accurate and limited removal of corneal epithelium to act as the tattoo bed and unfortunately, if removal of the epithelium exceeds, or goes beyond the circumference of, the chosen area, a ragged cosmetically less pleasing 'pupil' is created. The excimer laser appears to be an ideal tool to create a perfectly circular corneal bed to improve upon older techniques. CONCLUSION: We report, for the first time, an updated, simple and improved technique for successful corneal tattooing using excimer laser technology.

Adult↗

Hepatitis C transmission through tattooing: a case report.

We report the case of a prisoner for whom tattooing was the likely source of hepatitis C virus (HCV) infection. Many of the tattoos were carried out within prison using equipment that was multiply shared with other prisoners with limited access to means of disinfection. This case supports previous reports that prison is a risk factor for HCV infection and that HCV can be transmitted through tattooing. Use of unsterilised equipment for tattooing within prison must be a high-risk activity, given the high prevalence of HCV infection among those incarcerated. Harm reduction approaches are required to diminish risk in this environment.

Adult↗

Delayed onset of warts over tattoo mark provoked by sunburn.

Multiple warts in a 32-year-old-man are reported that developed after tattooing and remaining exclusively confined to that area. The tattooing was done 2.5 years earlier by a professional tattoo artist. It was previously a lesion-free tattoo, but when damaged by sunburn developed multiple skin warts. The ability of a latent virus to induce warts after cutaneous ultraviolet exposure was discussed.

Adult↗

A simplified method of focal salabrasion for removal of linear tattoos.

A simple method for the removal of linear tattoos is described, where tissue destruction is limited to tattooed skin and the resulting necrosis does not extend more than 1 mm into non-tattooed skin. The epidermis overlying tattooed skin can easily be scraped after heat separation. Table salt is rubbed into and left on the area where epidermis has been removed. The achieved necrosis appears only in the heat-treated skin and heals with an acceptable scar.

Dermatology↗