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Amateur tattooing practices and beliefs among high school adolescents.

PURPOSE: The objective of this research was to investigate the reasons, experiences, methods, and perceived health consequences of obtaining tattoos among a sample of Western Australian high school adolescents. METHODS: Information pertaining to levels of health awareness and school social behavior were obtained. Data were gathered in two phases using a questionnaire and follow-up interviews. RESULTS: Findings revealed that over 13% of participants had acquired tattoos and that the majority had been self-administered with crude implements. Some participants identified possible methods of removal, with a small number having attempted removal, again using crude implements. CONCLUSIONS: Statistical analyses revealed a number of significant main effects for gender, age, and tattoo status on the dependent variables for health awareness and school social behavior.

Adolescent↗

A silver tattoo of the nasal mucosa after silver nitrate cautery.

We report a silver tattoo of the nasal mucosa that occurred after silver nitrate cautery for nasal bleeding. This type of tattoo is a very rare potential mimic of melanoma and appears not to have been described before. It has similar features to an amalgam tattoo of the oral mucosa on histology and energy dispersive X-ray analysis (EDAX).

Aged↗

Para-incisional tattooing with electrocautery.

The authors present a technique using electrocautery diathermy to make surgical tattoos. This method has been used in over 300 patients who underwent head and neck surgery at Aberdeen Royal Infirmary and Albany Medical College, New York, over a period of five years. A wide variety of operative procedures such as total laryngectomies and neck dissections were performed. The electrocautery surgical tattoos have a major advantage of persisting until the end of the operative procedure by which time other types of tattoos have faded. The technique is widely available, inexpensive, and has to date been complication free.

Electrocoagulation↗

Association between heroin use, needle sharing and tattoos received in prison with hepatitis B and C positivity among street-recruited injecting drug users in New Mexico, USA.

This study aimed to assess the seroprevalence and risk factors for hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV-1 infections among injecting drug users (IDU) in New Mexico. Serological and behavioural surveys were conducted in conjunction with street-based outreach, education and HIV counselling and testing. High rates of antibody positivity for HCV (82.2%) and HBV (61.1%), and a low rate for HIV (0.5%) were found. In multivariate analyses, both HBV and HCV infection were positively associated with increasing age, increasing years of injection and heroin use. Receipt of a tattoo in prison/jail was associated with HBV (odds ratio = 2.3, 95% confidence interval 1.4, 3.8) and HCV (OR = 3.4, 95% CI = 1.6, 7.5) infections. Prevention of bloodborne pathogens among IDUs should focus on young users, early in their drug use experience. Studies examining the relationship between tattooing and HBV and HCV infection are needed as are efforts to promote sterile tattooing, in prisons and elsewhere.

Adolescent↗

[Intestinal perforation after preoperative colonic tattooing with India ink].

Since the ability to palpate the bowel is lost in laparoscopic colon surgery preoperative marking of lesions is required to avoid "blind" resection. Endoscopic tattooing with India ink is the agent of choice because of its simplicity and the long-lasting stain. Only few complications have been reported using this technique. We present a case with localized necrosis and retroperitoneal perforation after endoscopic tattooing. Due to the formation of a local inflammatoric pseudotumor laparoscopic resection was impossible and open right hemicolectomy was necessary. Fever, abdominal pain and signs of local peritonitis after endoscopic tattooing should remind clinicians of this rare complication.

Aged↗

Evaluation of autologous cultured epithelium as replacement skin after tattoo excision: correlation between skin texture and histological features.

BACKGROUND: Cultured epidermal autographs (CEAs) are currently used as a coverage treatment for burn wounds, for disfiguring burn scars involving depigmentation and in restoring the elasticity of the skin. The advantage of CEAs is that epidermal sheets prepared from small skin pieces can be enlarged sufficiently to cover large burn areas. OBJECTIVES: We examined the correlation between recovery of skin texture, and elastic fibre formation and keratinocyte differentiation (assessed by immunohistochemistry) in CEAs used as replacement skin after tattoo excision in a Japanese patient. METHODS: The tattooed skin was excised down to the deep dermal layer and then CEA was transplanted onto the patient. The skin textures were evaluated by taking replicas of the skin surface, and histological changes of filaggrin, transglutaminase, involucrin, fibrillin and elastin in the autograft skin were examined by immunohistochemistry. RESULTS: The skin texture improved with time after grafting the CEA, and appeared similar to that of normal skin at 39 months. Among keratinocyte differentiation markers, filaggrin recovered to a normal pattern at around 6 months, and transglutaminase did so at 39 months, whereas involucrin expression remained abnormal at 39 months. Fibrillin expression appeared similar to that of normal skin by 39 months, except for sparse candelabra-like structures of short fibres. Elastin expression remained at a low level throughout. CONCLUSIONS: Our results show that the recovery of skin texture after application of CEAs following tattoo excision is associated with the normalization of epidermal differentiation markers, except involucrin, and with the regeneration of elastic fibres in the dermis.

Adult↗

Red tattoo reactions.

Considering the ever increasing popularity of tattoos, significant reactions remain unusual. Red pigments are the commonest cause of delayed tattoo reactions. Histology typically shows extensive lichenoid basal damage, well away from the dermal pigment. We report two cases of lichenoid reactions to red tattoo pigment and review the literature on the subject.

Coloring Agents↗

[Adverse reaction to the azo dye Pigment Red 170 in a tattoo].

A 30-year old white male presented with sharply demarcated pruritic lesions in a black and red tattoo on his wrist. The strongly infiltrated and slightly scaly eruptions started four months after tattoo application and were notably restricted to the red-colored areas. Symptoms got worse after UV exposure. Patch testing and photo patch testing with the used azo dye Pigment Red 170 (C.I. 12475) was negative. Histology revealed lichenoid dermatitis without signs of a granulomatous reaction. The verification of allergic sensitization in hypersensitivity reactions to tattoos by patch testing may be difficult due to the poor penetration into the skin of the applied azo pigments. Intradermal testing may be more sensitive but bears the risk of long lasting skin reactions.

Adult↗

Severe allergic contact dermatitis induced by paraphenylenediamine in paint-on temporary 'tattoos'.

Paraphenylenediamine (PPD) is a black dye with well known sensitizing properties. Its increasing use as a skin paint to produce temporary 'tattoos' has led to recent reports of allergic contact dermatitis. Hitherto, such cases of allergic contact dermatitis due to PPD have been localized to the original site of application of the skin paint. We report two cases of severe allergic reactions to paint-on 'tattoos'. Both of these patients had no prior history of sensitivity to PPD, although case 2 had previously used permanent hair dyes. In both cases, the primary eruption at the 'tattoo' site was followed within days by a generalized eruption which ultimately required treatment with oral corticosteroids, because the initially prescribed topical corticosteroids proved ineffective.

Adult↗

Lupus vulgaris over a tattoo mark--inoculation tuberculosis.

Lupus vulgaris developing after tattooing and remaining exclusively confined to it, in a 40-year-old-lady is reported. The tattooing was done one year earlier by a roadside tattoo artist. Diagnosis was suggested by the clinical features and confirmed by histopathology.

Adult↗

Tattooing agents for nerve marking in experimental surgery.

Experimental nerve surgery involves test procedures, including those for nerve lesions in continuity, that leave no visible traces of impairment after surgery. In such cases, non-resorbable sutures are usually used to mark the lesion sites on the nerves. However, this method has two drawbacks: it is not completely atraumatic, and may be frustrating due to displacement of the suture material. The authors demonstrate the use of carbon tattoo pigment to mark nerve lesions permanently, thus allowing their identification reliably at any later date. Following successful preliminary experiments, the tattooing procedure was used in 12 New Zealand White rabbits that had been operated on for a specific nerve regeneration problem. Altogether, 56 tattoo marks were set. The small pigment spots were well-preserved and clearly visible during a second and third operation 4 and 15 weeks later. Histologic examination identified the carbon granules in the outer epineurium; there were no signs of inflammation. This simple, atraumatic, inert, and permanent method for nerve markings in the experimental animal is recommended.

Animals↗

Indocyanine green is an ideal dye for endoscopic ultrasound-guided fine-needle tattooing of pancreatic tumors.

Endoscopic ultrasound-guided fine-needle tattooing (EUS-FNT) is an ideal technique for preoperative marking of lesions detected on preoperative examination. Although India ink has been used for endoscopic tattooing, there have been numerous reports of complications associated with its use. This is the first report of EUS-FNT using indocyanine green (ICG) and describes its use for preoperative marking of a tumor in a 78-year-old man with multiple pancreatic tumors. There were no complications associated with the EUS-FNT procedure and it is suggested that ICG is a more suitable dye for tattooing of pancreatic lesions than India ink, being far less frequently associated with side effects.

Aged↗

A tattooed butterfly as a vector of atypical Mycobacteria.

We report the first case of cutaneous inoculation of atypical Mycobacteria secondary to tattooing. The diagnosis of atypical Mycobacteria infection of the skin was confirmed on the basis of the clinical and histologic appearance, the detection of acid-fast bacilli on Ziehl-Neelsen stain, and positive polymerase chain reaction. The medical complications of tattooing, which are manifold, are briefly summarized. This case emphasizes the need for federal regulation of tattooing, which is an invasive procedures associated with infectious and noninfectious complications.

Adult↗

Infectious complications of tattoos.

Tattooing carries several medical risks, including the transmission of infectious diseases. We review the published literature on the transmission of hepatitis B virus, human immunodeficiency virus, Treponema pallidum, papillomavirus, Mycobacterium tuberculosis, and other organisms by tattooing. Education, through public health measures, should promote the prevention of infectious disease transmission. Particular populations who could benefit from education include prisoners, individuals involved with correctional facilities, youths, military personnel, and health care providers coming in contact with populations at risk for tattoos.

Female↗

Endoscopic tattoo agents in the colon. Tissue responses and clinical implications.

Laparoscopic surgery frequently requires tattooing of endoscopically identified sites for localization during surgery. Some tattooing agents cause serious tissue injury, which must be recognized in pathologic examination. Seven surgically resected colons were reviewed after injection with methylene blue or India ink at intervals of 1 day to 7 weeks before surgery. Early reactions to India ink included necrosis, edema, and neutrophilic infiltration in the submucosa and muscularis propria. Vessels were inflamed but without fibrinoid necrosis. Early reactions to methylene blue included ischemic ulceration, necrosis, and eosinophilic infiltration in the submucosa as well as fibrinoid necrosis of vessel walls. In the repair of methylene-blue injury, obliterative intimal fibrosis was seen in vessels. Such changes were absent in the colons injected with India ink. The India ink remained remained visible with the naked eye and microscopically 7 weeks after injection. Methylene blue was not grossly visible 7 days after injection, and only microscopic particles of pigment remained in widely scattered macrophages. In light of these findings, the amount of ink injected should be minimized and the injection site should be completely resected at surgery. Methylene blue is a poor tattoo agent, but its occasional use continues, and pathologists should recognize the resulting reaction.

Adipose Tissue↗

Treatment of tattoos with pure epidermal sheet grafting.

We treated tattoos with a new method in which the epidermis of the tattooed skin was replaced after removing the dermis, which contained tattoo pigments. The separation of the epidermis from the dermis was performed enzymatically with the use of dispase. The time required for healing of the wound was markedly shortened.

Female↗

Grafting of autologous-cultured epithelium after excision of tattoos.

Nine patients with tattoos were treated with cultured epidermal autografts. The tattoos were excised down to the deep dermal layer, and the wounds were covered with cultured epidermal autografts. The areas grafted with cultured epidermal autografts were an average of 907 cm2 in size. The average percentage "take" of the cultured epidermal autografts was 86%. The average time for complete wound epithelialization was 20 days. The pain at the grafted sites was minimal. There was minimal scarring and no tendency for scar contracture. The appearance and elasticity of the grafted sites resembled those of adjacent normal skin 2 1/2 years after grafting. These findings demonstrate that cultured epithelium autografting is a suitable method for coverage of the tangentially excised tattoo wound.

Adult↗

Q-switched ruby laser treatment of tattoos and benign pigmented skin lesions: a critical review.

The Q-switched ruby laser (694 nm, 25-40 nsec) is an effective and safe therapeutic device for the treatment of tattoos and well-defined, benign, pigmented epidermal and dermal lesions. Because of its selective mode of action, dermal pigments of natural and artificial origin are destroyed photothermically and removed without scar. This method is exceptionally suited for the elimination of lay and professional tattoos, traumatic tattoos, and permanent makeup. Other frequent indications include benign pigmented lesions such as lentigines, freckles, café-au-lait spots, seborrheic keratosis, and Becker nevi. As a dermal pigmented lesion, the nevus of Ota is perfectly treatable. However, chloasma can no longer be considered an indication for ruby laser treatment due to unsatisfactory results. Melanocytic nevi and congenital nevi should be treated only in clinical studies. The effectiveness of the long-term epilation of dark hair with this laser device has to be verified in future investigations. Particularly attractive is the nonproblematic and straightforward removal of pigmented lesions in precarious anatomic regions like the lips, eyelids, and genitals (e.g., benign melanosis of the lips or of the penis, seborrheic keratosis of the lid angle).

Dermatologic Surgical Procedures↗