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The argon laser shows promise as an effective clinical method for the treatment of tattoos. Although clinical follow-up has been limited to 3 years and less in a series of 30 patients, the preliminary results are sufficiently optimistic to recommend further clinical use of the argon laser for such treatment.
The use of a Q-switched pulsed Ruby laser was studied in removing tattoos. The results were very satisfactory, but there are several major disadvantages which at present would probably preclude the use of this therapy on a routine basis.
A review of out-patient treatment of tattoos with trichloracetic acid has been undertaken. Six hundred and seventy patients have been treated during the 6-year period between 1979 and 1984. The simple and inexpensive technique is described and the results presented.
A technique of preoperative localisation of pharyngeal wall implants for velopharyngeal incompetence is described. The nasal approach in the non-sedated patient permits precise and permanent posterior pharyngeal wall tattooing for accurate implant location.
We report the case of a patient with a black and turquoise tattoo who developed sarcoid granulomas on the areas of black pigment. Patch tests showed a positive reaction to nickel, cobalt, and cadmium; spectrophotometric analysis of the black pigment revealed the presence of nickel and cobalt among other metals. Although the pathogenesis of sarcoid granulomas is unknown, it seems that a delayed type hypersensitivity reaction is one of the mechanisms involved.
Oral amalgam tattoos (AT) are distinct pigmentations of the oral mucosa resulting from accidental incorporation of dental amalgam in the oral soft tissues. Dental amalgams and in particular mercury, one of the constituents of dental amalgams, have for long been considered toxic. Oral ATs are easily accessible to study soft tissue reaction to amalgam and its degradation products. In this study, 17 oral ATs were examined by transmission electron microscopy and energy dispersive X-ray microanalysis. Ultrastructurally, in the ATs, three kinds of electron-dense particles were observed. The largest particles ranged in size from 0.5 up to several 100 microm. Smaller electron-dense inclusions (0.5-0.1 microm) were seen extracellularly associated with meshworks of elastic fibers and collagen bundles. The third and smallest type of particles (5-30 nm in diameter) was found with basement membranes of small vessels and pericytes and particularly decorating collagen bundles. Element analysis regularly revealed the presence of silver, sulphur, copper and lead in the AT decay products. Mercury was found in only one instance. Tissue reactions due to ATs seem to be minimal. No acute inflammatory changes were seen. Larger inclusions occasionally were surrounded by macrophages and multinucleated cells. TEM and element analysis may in specific cases be helpful in the differential diagnosis of pigmented lesions of the oral mucosa.
Henna is a plant with coloring properties which is used as a dye for hair and skin, on occasion mixed with other substances. Paraphenylenediamine (PPD) is one of the additives used to accelerate drying, improve definition and darken its reddish color. There are several descriptions in literature of sensitization to the PPD contained in henna. We describe 3 new cases of allergic contact dermatitis to temporary tattoos, with skin tests positive for PPD in 2 of them. The lesions resolved in one of the patients, leaving persistent hypopigmentation. It is important for the population to be aware of this circumstance and the risk entailed by sensitization to PPD.
BACKGROUND: The side effects attributed to interferon alpha are numerous, including autoimmune events such as lupus, arthritis or thyroiditis. Emergence of sarcoidosis in patients with interferon alpha therapy is much more rare. We describe a case occurring in a patient treated for melanoma. CASE REPORT: A 54 Year-old woman who had been treated for fifty Months with low dose interferon alpha (Roféron(R), 3 millions units, three times a week) for a melanoma of the scalp (adjuvant therapy), developed labial nodules on a permanent tattoo. The diagnosis of sarcoid granuloma was confirmed by histopathologic analysis. Physical examination revealed dyspnea on exertion with a moderate pulmonary interstitial infiltrate on the CT Scan. The diagnosis of cutaneous and pulmonary sarcoidosis in association with interferon alpha therapy was made. Within 4 weeks, skin nodules began to regress although interferon was pursued at the same dose. Four Months later, at the end of interferon therapy, the nodules had totally disappeared. DISCUSSION: About forty cases of cutaneous or systemic sarcoidosis in patients treated with interferon alpha have been reported, but none of these cases concerned patients treated for melanoma. Interferon alpha might promote the development of sarcoid granuloma by inducing a switch of cytokine secretion from a Th2 to a Th1 cytokine pattern. It is very important to recognize cutaneous sarcoidosis during interferon alpha treatment because pulmonary sarcoidosis can be confused with common general side effects observed with such treatment.
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.
PURPOSE: To guarantee invariable skin markings in patients undergoing a course of external radiotherapy, especially using conformal techniques. Cutaneous markings with henna also increase patient comfort, because washing and showering are allowed. METHODS AND MATERIALS: Henna, a completely natural product, is a skin colorant with a history of 5,000 years. It is applied to the skin in the form of a paste. While drying, henna stains the superficial skin layers for several weeks, and the marked area can be exposed to water arbitrarily. In case of fading of the stain before the end of radiotherapy, the marking procedure can be repeated. From November 1998 until March 2000, we performed skin markings with henna in 158 patients with different tumor sites. The majority of patients received conformal radiotherapy techniques. All patients have been evaluated concerning durability of the markings, the RESULTS: The median durability of henna staining is 23 days (range 12-48 days). On average, two marking procedures (range 1-4) are necessary for a patient treated with curative intent. Although washing and showering are freely permitted, no adverse cutaneous side effects (e.g., erythema, allergic reactions) have been observed. CONCLUSIONS: Skin marking by temporary tattooing with henna increases the accuracy of external radiotherapy. It yields stable and invariable markings for the entire course of radiotherapy and also increases the comfort of patients.
The methods of determining the anterior-posterior isocentre location in pelvic radiotherapy are either by aligning lateral localization lasers to tattoo marks on skin, or by setting a constant daily couch-to-isocentre distance. While using the former method the day-to-day vertical couch movement was recorded and combined with measurements of day-to-day anterior-posterior patient movement made with an electronic portal imaging device to determine whether couch vertical movement contributes to anterior-posterior setup variation. Seven unimmobilized patients were studied, four supine prostate and three prone rectum patients. The two motions were found to be highly correlated (correlation coefficient = 0.82) which supports the constant couch-to-isocentre distance approach. When the day-to-day couch vertical movement was subtracted from the anterior-posterior movement results the setup variation was reduced in six of the seven patients.
Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Immune alterations involving heightened T-helper-1 responses have been proposed to play a major role in the pathogenesis of sarcoidosis. Interferon-alpha therapy and hepatitis C infection have been implicated in the development of a variety of autoimmune diseases. However, despite the wide use of IFN-alpha therapy for hepatitis C, only a few cases of sarcoidosis have been reported in this context. We report the case of a 42-year-old white female with hepatitis C, who developed systemic sarcoidosis shortly after therapy with IFN-alpha2b. The disease was heralded by the appearance of a cutaneous sarcoid/ foreign body granulomatous reaction at the site of an old tattoo. The sarcoidosis responded to a short course of oral prednisone therapy. We also reviewed the other reported cases and discussed the possible immunological mechanisms involved.
A young girl presented with a hypopigmentation in the shape of the sun. During a holiday in Egypt 3 months before a non-permanent henna tattoo had been applied on her right upper arm. Three to 4 days later there was a severe cutaneous reaction followed by massive swelling of the arm. The lesion took 6 weeks to subside. Patch testing revealed positive reactions to para-phenylenediamine (PPD) but not to henna or any other standard allergen. Especially in Arabic countries PPD is a common additive in natural henna preparations to enhance the weak colouring properties of the natural henna dye. We conclude that henna preparations may contain 'hidden' allergens, such as PPD, which can provoke severe cutaneous reaction without any cosensitization to the henna dye itself.
Free flaps are usually needed for the reconstruction of extensive facial burns, but the final result is often a poor texture and color match. The authors report a burn case managed with a radial forearm free flap. The aesthetic result was improved by surgical tattooing of the flap, including the appearance of a beard.
We report the development of a lymphoproliferative reaction in the red areas of a tattoo in a 53-year-old man. The results of histologic and immunohistochemical studies were consistent with a diagnosis of lymphadenosis benigna cutis. Patch tests showed a strong, delayed-type hypersensitivity to several mercury products. The pathogenetic mechanisms operative in the development of this reaction are discussed.
Our preliminary experience with tattoo removal utilizing the carbon dioxide laser at the Vancouver General Hospital is reviewed. We developed the method by trial and error until we produced a system yielding an acceptable procedure time with good results.
Seven patients with either homemade or professional decorative tattoos have been treated with both the argon and CO2 lasers and studied clinically as well as histologically. The argon laser is absorbed by dermal pigment and vaporizes this pigment out of the skin. The CO2 laser vaporized tissue layer by layer and must be accompanied by mechanical debridement. Results and complications of treatment with the two lasers were markedly similar, as were histological studies.
A method of tattoo removal using a precise partial thickness tangential excision of foreign body and dermis followed by dermal overgrafting with thin, split-thickness skin grafts is presented.