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PubMed2000

Tattooed Army soldiers: examining the incidence, behavior, and risk.

Primary prevention is a priority for medical personnel. Despite societal popularity and a long association of the military with tattooing, little is known about the tattooed Army soldier, which hampers primary health planning. Basic recruits and advanced individual training students (N = 1,835) at one mid-western military installation completed a questionnaire about any tattooing experiences. Almost half (48%) of the soldiers were serious/very serious about getting a tattoo, with 31% stating that there were "no reasons" to keep them from getting a tattoo. More than one-third (36%) were tattooed, with 22% possessing three or more tattoos. Many soldiers (64%) entered the military with the tattoos. Limited use (15%) of alcohol and/or drugs before tattooing was reported. Findings included a high incidence of tattooing, a strong determination to obtain tattoos, the possession of tattoos for self-identity reasons, and the supportive role of friends. Reported procedural bleeding (76%) documents the potential for blood-borne disease transmission. These results confirm the need for targeted health education regarding the safety and potential risks of tattooing.

Adolescent↗
PubMed1998

Successful removal of traumatic tattoos in Asian skin with a Q-switched alexandrite laser.

BACKGROUND: Traumatic tattoos result from mechanical penetration of the skin by foreign-body particles associated with puncture, abrasive, or explosive trauma. Until the recent development of the Q-switched lasers, it was not possible to remove tattoo pigments without scar and pigmentary changes. OBJECTIVE: The objective of this study was to determine the effectiveness of the Q-switched alexandrite laser (wavelength, 755 nm; pulsewidth, 100 ns), in treating the 27 cases of Asian skin with 36 traumatic tattoos and to observe any side effects such as scarring or pigmentary change. METHODS: The results of treatments on 16 patients with 19 penetrant tattoos, 10 patients with 16 abrasive tattoos and 1 patient with bomb explosion were clinically analyzed. RESULTS: Greater than 76% removal of tattooed pigments required an average of 1.7 treatment sessions in penetrant tattoos in contrast with 2.4 sessions in abrasive tattoos. The excellent removal of traumatic tattoos required 7.5 J/cm2 except the scarred region of one explosive tattoo and one abrasive tattoo on soil. There were no permanent side effects such as scar or permanent pigmentary changes. CONCLUSION: In conclusion, the Q-switched alexandrite laser is a safe and highly effective modality for removal of various traumatic tattoos without scar or permanent pigmentary change in Asian skin.

Adolescent↗
PubMed2000

[Traditional tattoos with neurological diseases in Togo].

In Africa, there are two types of health systems: the modern system and the traditional one. Traditional medicine attracts more patients, because it is more financially accessible and corresponds to cultural representations of disease in society. Traditional therapeutic tattoos are not well known by the conventional health system in West Africa, although they are commonly used by traditional healers. We report here our experience of these tattoos. We examined the skin of 36,000 patients in the neurological department of the teaching hospital of Lome from 1985 to 1995. We found three types of tattoos amongst patients. The first are tribal or social tattoos: they are large, homogeneous, located on exposed parts of the body and can be seen easily by others (fig 1: g, h, i), whilst therapeutic tattoos are slight and hidden under clothes and can also be repeated (heterogeneous). The second type of tattoo is one that reveals the patient's pathological history. The third is linked to the motive of consultation. Seventy-five per cent (75%) of patients had traditional therapeutic tattoos. Epilepsy tattoos are slim, located on the forehead (fig 1a); peripheral facial paralysis tattoos are found on the facial nerve (fig 1 b). In cases of peripheral neuropathy, tattoos are symmetrically distributed on hands and legs (fig 1 f). As for medullar compression, the highest tattoos correspond to the level of compression. Studying the localisation, age, and aim of tattoos brings to light their diagnostic, prognostic, and epidemiological interests. Skin can thus reveal itself to medical staff as an open, though coded, medical file. They need only to learn how to read it.

Epilepsy↗
PubMed1994

Laser ablation of facial cosmetic tattoos.

The application of facial cosmetic tattoos (eyeliner, lipliner, and rouge) has become popular over the past five years and has resulted in an increasing number of patients requesting removal of these permanent cosmetics. Poor positioning or misapplication of the tattoo pigment has been the most common reason for requesting removal. Because of the almost inevitable probability of scarring, removal of these facial tattoos has been difficult at best. We report the successful removal of facial cosmetic tattoos in ten different patients with the use of five different lasers. We have found the superpulsed CO2 laser and the Q-switched alexandrite laser to be effective in removal of black tattoo pigment. The alexandrite laser is effective without causing scarring, and the CO2 laser is extremely precise and provides the capability of removing tattoo pigment between eyelash or eyebrow hairs without damaging the hair follicles. Both the argon laser and the flashlamp pumped dye laser reacted with red tattoo pigment and offered some improvement but were not ideally suited for tattoo removal. However, the flashlamp pumped dye laser for pigment was very effective in removing red tattoo pigment possibly because of its short pulse width (300 ns) in addition to its appropriate wavelength. The combination of these three lasers (super-pulsed CO2, alexandrite, and flashlamp pigment lasers) is very effective in removing black and red (or shades thereof) facial tattoos. Caution must be taken to determine the presence of flesh-colored tattoo pigment, as this pigment (FE2O3) will reduce to black (FeO) upon laser impact.

Adult↗
PubMed2002

Epidural anesthesia in three parturients with lumbar tattoos: a review of possible implications.

PURPOSE: To discuss the possible ramifications of neuraxial analgesia and anesthesia in women with tattoos involving their midline lumbar area. CLINICAL FINDINGS: Recently the authors have received requests for epidural anesthesia in three women with tattoos over the midline of their lumbar spine. In one patient the tattoo covered her entire back. In the other two, it was possible to locate a lumbar interspace that did not have tattoo pigment in the overlying skin. All three women received uneventful epidural analgesia. A Medline and EMBASE search for relevant publications using the keywords: epidural, spinal, tattoos, tattooing, complications did not find any reports of complications from inserting a needle through a tattoo. As none were found, the literature on tattoos and on coring with neuraxial anesthesia was reviewed to see if neuraxial anesthesia might be problematic if the needle passed through the tattoo. Coring is a complication of neuraxial anesthesia that may lead to epidermoid tumours in the subarachnoid space. Theoretically, a pigment-containing tissue core from a tattoo could be deposited into the epidural, subdural or subarachnoid spaces, leading to later neurological complications. CONCLUSIONS: There is no information in the literature about possible risks from inserting needles through tattoos during the performance of neuraxial anesthesia. This report discusses the possible implications.

Anesthesia, Epidural↗
PubMed1995

Q-switched alexandrite laser treatment (755 nm) of professional and amateur tattoos.

BACKGROUND: Several laser techniques have been proposed for the removal of decorative tattoos. The lasers that have been used most successfully are Q-switched red or near-infrared systems because of their ability to target tattoo pigment selectively with minimal risk of scarring or permanent pigmentary changes. OBJECTIVES: The objectives of this study were to determine the clinical effectiveness of the newest Q-switched system, the alexandrite laser, in removing amateur and professional tattoos and to observe side effects. METHODS: Twenty-four multicolored professional tattoos and 18 blue-black amateur tattoos were treated with the Q-switched alexandrite laser (755 nm, 100 nsec) at 2-month intervals until total clearing was achieved. The 510 nm pulsed dye laser was used to treat tattoos that contained red pigment. RESULTS: Professional tattoos required an average of 8.5 alexandrite laser treatments for total clearance, whereas only 4.6 treatments were necessary to remove amateur tattoos. Red tattoo pigment was successfully treated with an average of two 510 nm pulsed dye laser sessions. No scarring or long-standing pigmentary changes were seen in laser-irradiated skin. CONCLUSION: The Q-switched alexandrite laser is highly effective in removing multicolored professional and amateur tattoos without adverse sequelae. The 510 nm pulsed dye laser was useful in eliminating red tattoo pigment.

Humans↗
PubMedDate not supplied

Tattoo pigments are cleaved by laser light-the chemical analysis in vitro provide evidence for hazardous compounds.

In the western world, more than 80 million people decorate their skin with tattoos. Tattoo colorants are injected into the skin, like medical drugs. Most tattoo colorants are industrial pigments, and chemical industries have never produced them for human use but only to stain consumer goods. Up to 10% of tattooed people request removal of their tattoos because of an improved self-image or social stigmatization. In contrast to tattooing, physicians usually perform the tattoo removal. For that purpose laser light at very high intensities irradiates the skin to destroy the tattoo pigments. Based on a recent analysis of tattoo pigments, two widely used azo compounds were irradiated in suspension with laser and subsequently analyzed by using quantitative high-performance liquid chromatography and mass spectrometry. The high laser intensities cleaved the azo compounds, leading to an increase of decomposition products such as 2-methyl-5-nitroaniline, 2-5-dichloraniline and 4-nitro-toluene, which are toxic or even carcinogenic compounds. Moreover, the results of the chemical analysis show that the tattoo colorants already contain such compounds before laser irradiation. Because of a high number of patients undergoing laser treatment of tattoos and based on the results of our findings in vitro, it is an important goal to perform a risk assessment in humans regarding laser-induced decomposition products.

Azo Compounds↗
PubMed2002

College students and tattoos. Influence of image, identity, family, and friends.

Tattoos are popular among many groups of people. College students from a large university in the southwestern United States were queried using the 134-item Armstrong Team Tattoo Attitude Survey. Findings documents a progressive increase in tattooing and reflect significant support for tattoos, even from non-tattooed students. Similar and positive demographic characteristics were present in individuals who were both non-tattooed and tattooed. In addition, tattooed people were viewed positively, even among non-tattooed respondents. Friends significantly affected procurement and possession of tattoos, whereas of all family members, the sister was the only significant influence. Overall, friends, identity, and image seem to be the major influences for obtaining tattoos.

Adolescent↗
PubMed1975

[Survey of voluntary tattooing (analytic study of 43 Navy recruits].

We report a new inquiry on 43 tattooed naval recrutees. Mean age: 19. Mean age at the time of the first tattooing: 16 1/2. Social and familial history shows frequent conflictual, divorced, separated parents; the father is often ill, old or missing. Most family have many children. Low socio-cultural and economical level is common. Forensic and pyschological history is already heavily rich. However tattooing and delinquency cannot be assimilated. As found in many other studies, most of the tattooed did not undergone this type of inquiry. Only particular tattooed are probably investigated, and comparative samples of non-tattooed are lacking most of the time. Tattooing indicate more social and psychological misery of the milieu during childhood of this adolescents than their own pathological problems. It is more sociopathy than psychopathy. The analysis of the tattooed drawings is provided. They are stereotyped and commonplace, and very similar to graffiti. Circumstances at the times of tattooing are described as their present attitude to their tattooing, specially the wish to remove their tattooed figures. Recent literature is reviewed.

Adult↗
PubMed1990

An increased risk of hepatitis B virus infection from tattooing in Taiwan.

From among 2,375 young men, examined by doctors, 111 tattooed subjects were found. Twenty one subjects reported engaging in promiscuous sexual behavior or being intravenous drug abusers, and so were excluded. The other 90 were evaluated. To make up the control group, 180 non-tattooed subjects from the remaining 2,264, who neither engaged in promiscuous sexual activity nor were intravenous drug abusers, were matched from household registry reports by age, sex, education, occupation, and geographic origin from Mainland China, where their parents were born. IgG antibody of hepatitis A (anti-HAV) and markers of hepatitis B were tested in serum with radioimmunoassay. In the prevalence rate of hepatitis A and carrier rate of HBsAg there were no differences between the tattooed and the non-tattooed groups. However, the prevalence odds ratio of hepatitis B virus (HBV) infection for the tattooed group was 8.1 (95% CI 1.9-34.8) as compared to the non-tattooed groups. Moreover, there was a trend correlation when the prevalence rates of hepatitis B were compared for the group with multiple sites of tattoos, for the group with one site of tattoos, and for the non-tattooed group (p = 0.002). These findings suggested an association between HBV infection and tattooing. Tattoo exposure, with improper or no sterilization of the needle, seems to appear to increase the risk of HBV infection in the already high risk endemic area in question.

Adolescent↗
PubMed1952

Complications of tattooing.

Pathologic consequence of tattooing is relatively rare, but in light of the great number of persons in military service, where tattooing seems to be popular, consideration of the complications seems worth while.Four unusual cases of patients with cutaneous lesions in tattoos are reported. One patient had Boeck's sarcoid, in which the cutaneous eruption was limited solely to the tattooed areas on the body and involved all the various colors of the tattoo. The cutaneous eruption was only a single manifestation of generalized sarcoidosis. Another patient had secondary syphilis with the cutaneous lesions involving multi-colored tattoos, including the red areas. These tattoos were applied in Hawaii, and presumably the red dye was not the usual cinnabar (mercuric sulfide). As a general rule, the cutaneous lesions of secondary syphilis do not involve the red areas because of the treponomicidal action of mercuric sulfide.In the third case the characteristic eruption of discoid lupus erythematosus was present. It began over the red areas of a tattoo on the patient's forearm. It has been stated that mercuric sulfide is a photo-sensitizing agent, and it is believed that this explains the localization of the eruption in this case. The fourth patient had eruption, caused by mercury sensitivity, in an area of tattoo. The eruption was noted soon after the tattooing was done, and it persisted for seven years.

Color↗
PubMed1992

Tattooing as a risk of hepatitis C virus infection.

The association of hepatitis C virus (HCV) infection and tattooing was studied in 87 tattooed and 126 tattoo free healthy young men who did not engage in intravenous drug use or multiple sexual activity. Antibody against HCV (anti-HCV) was tested in serum specimens by enzyme immunoassay with C100-3, NS3, and core antigens; 11 of the 87 (12.6%) tattooed and 3 of the 126 (2.4%) tattoo free subjects were positive for anti-HCV (odds ratio = 5.9, 95% CI = 1.6-22.0). A relationship was demonstrated by an increased risk for HCV infection with an increasing number of tattooed site (P(trend) = 0.002). All but one of the 87 tattooed subjects had been infected by hepatitis B virus (HBV) and 25 were carriers of hepatitis B surface antigen (HBsAg). None of the 25 HBsAg carriers was positive for anti-HCV whereas 11 of the 62 HBsAg non-carriers had anti-HCV, suggesting a negative association between the HBsAg carriage and the long lasting anti-HCV (P = 0.02, Fisher's exact). The status of the tattooer was also an important determinant for HCV infection; the risk was higher if tattooing was done by a non-professional friend than by a professional tattooist. Tattooing, probably with improperly sterilized needles, can clearly pose an increased risk for HCV infection in Taiwan. This study indicates the need for legal standards for hygienic tattooing as part of preventive measures for the control of parenterally transmitted infections.

Adolescent↗
PubMed2002

Laser-tattoo removal--a study of the mechanism and the optimal treatment strategy via computer simulations.

BACKGROUND AND OBJECTIVE: The physical mechanisms for laser-tattoo interactions and the tattoo particle breakup process are not well understood. This study investigates whether the mechanism of the breakup process can be identified via computer simulations and proposes a treatment strategy that can potentially minimize the collateral damage to the surrounding tissues. Note that the "removal" of tattoo particles is defined here as breakup of particles into smaller ones with sizes approaching or smaller than the visible wavelength of light so that they become less visible. STUDY DESIGN/MATERIALS AND METHODS: The radiation-hydrodynamics code LATIS is used for the modeling. We first identify the magnitude of the tensile stress generated inside graphite tattoo particles as functions of laser pulse length and particle size. We then calculate the relationship between the surface laser fluence (defined as the time integrated energy flux) and the tensile strength of the tattoo particle at a given depth. RESULTS: If the laser pulse length is sufficiently short, strong acoustic waves with tensile strengths exceeding the fracture thresholds for graphite are generated. The strength of the wave decreases with particle size and increases as the laser pulse length decreases. Simulation results are in general agreement with clinical studies. Although temperatures of the tattoo particles never reach the melting point, a cavitation bubble around the particle can be formed. The steam generated can get into the cracked particles and induce steam-carbon reactions. Laser energy density decreases rapidly with the skin depth. Therefore, the minimum surface laser fluence, for a given pulse length, required for breaking up tattoo particles at a given skin depth, increases with particle depth. CONCLUSIONS: Computer simulations confirm that the breakup of tattoo particles is photoacoustic. For the same amount of laser energy, a shorter pulse is more efficient. The optimal pulse length is approximately 10-100 picosecond to minimize the laser fluence and the collateral damage. It is more difficult to break up the smallest tattoo particles that have diameters smaller than 10 nm; however, smaller particles are less important because they are less visible. Tissue surrounding the tattoo particles can be damaged by cavitation bubbles. These bubbles could be the cause of the empty vacuoles in the ash-white lesions throughout the dermis seen after treatment. Steam-carbon reactions can be induced. Particles then become grossly transparent because of this reaction. Different laser intensity should be used for pigments at different depths in order to minimize the collateral damage to the dermis.

Computer Simulation↗
PubMedDate not supplied

Laser treatment of tattoos.

Tattooing has been around since the early beginnings of modern civilization. Modern tattoo artists use a myriad of colors to produce striking designs, resulting in permanent works of body art; however, we humans have been changing our minds since the beginning of time. Our fickle nature results in the desire to change what has been placed as a permanent reminder of a friend, spouse, or work of art. Removing tattoos began with abrasive and destructive measures to destroy the tattoo, and unfortunately, the skin it was contained in. The discovery of selective photothermolysis, the ability to selectively remove target structures without disrupting the surrounding skin, made it at least possible to remove tattoos without destroying the surrounding skin leaving a scar. Theory predicted that pulse durations in the nanosecond domain would be optimal for tattoo removal, and the Q-switched neodymium:yttrium-aluminum-garnet, alexandrite, and ruby lasers fulfilled this need. Too often, older lasers or intense pulsed light sources are used to treat tattoos, often with significant scarring. Since the advent of the Q-switched lasers more than a decade ago, improvement in tattoo-removal lasers has been incremental. Developments leading to new tattoo inks, feedback systems to detect the absorbance characteristics of tattoo inks, dermal clearing agents, and perhaps even shorter pulse-duration lasers should result in improved results for the future.

Humans↗
PubMed1997

Long-term safety of India ink tattoos in the colon.

BACKGROUND: When the India ink tattoo is used as a guide for follow-up examinations, the tattoo may remain in the colon for the remainder of that patient's life. This raises the question of the long-term safety of India ink tattoos. The long-term clinical and histologic consequences of the tattoo have not been studied in a large group of patients. METHODS: Biopsy specimens were taken from all tattoo marks encountered during postpolypectomy surveillance colonoscopy in 55 patients. Seventeen of these patients were followed serially with two biopsies in 16 patients and three biopsies in 1 patient. A total of 74 biopsy specimens were obtained from tattoos that had been placed an average of 36 months prior to biopsy (range 1.5 to 117 months). RESULTS: There were no clinical complications such as infection, fever, or abdominal pain in any of the 55 patients. There were no endoscopic abnormalities on or adjacent to the tattoos. There were no histologic changes seen at the tattoo sites in 48 patients, mild chronic inflammation in 6 patients, and hyperplastic change in 1 patient. There were no neoplastic changes of the mucosa overlying the tattoo. CONCLUSIONS: Small-volume India ink tattooing of the colon appears to remain endoscopically identifiable over a long term and to be safe based on histologic analysis of sequential biopsies.

Adult↗
PubMed2002

Experimental nonsurgical tattoo removal in a guinea pig model with topical imiquimod and tretinoin.

BACKGROUND: Tattoo removal is a common request in dermatologic surgery practices. Conventional tattoo removal modalities consist of mechanical, chemical, and thermal methods, but these interventions may result in undesirable dermal damage, disfiguring scars, and pigmentary changes. OBJECTIVE: To evaluate the efficacy of topical imiquimod and tretinoin for the removal of tattoos in a guinea pig model. METHODS: Five albino guinea pigs (A-E) were tattooed with black, red, green, and yellow. Beginning 6 hours after tattooing, A received no treatment, B was treated with petrolatum, C had imiquimod cream alternating with tretinoin gel, D had imiquimod cream alone, and E received tretinoin gel alone. The animals were treated for 7 days. Biopsies of the tattoos were taken at 6 hours, 7 days, and 28 days. RESULTS: Control guinea pig B had normal-appearing tattoos with consistent histopathology on day 28. Guinea pig D, treated with imiquimod cream clinically, had no visible tattoo, consistent with greatly diminished or no dye evident on histopathology. Guinea pig E, treated with tretinoin gel, and guinea pig C, treated with combination tretinoin gel and imiquimod cream, had faded tattoos and moderate clearance of pigment on histopathology. CONCLUSION: In the guinea pig, the use of imiquimod was successful as a nonsurgical method of acute-phase tattoo removal, but was associated with fibrosis and the loss of dermal appendages.

Administration, Topical↗
PubMed2003

Massive pseudoepitheliomatous hyperplasia: an unusual reaction to a tattoo.

We document an unusual tattoo reaction presenting as verrucous plaques, which on histopathologic examination showed marked pseudoepitheliomatous epidermal hyperplasia. The patient is a 27-year-old female who presented to her dermatologist complaining of itchy overgrowth of her tattoo. Her symptoms began 2 months after tattoo placement approximately 1 year ago. Physical examination revealed verrucous plaques in the purple areas of the tattoo, suggesting a clinical diagnosis of a granulomatous tattoo reaction. A superficial biopsy showed epidermal hyperplasia somewhat reminiscent of a regressing keratoacanthoma. No tattoo was identified. A repeat shave biopsy demonstrated marked epidermal hyperplasia with focal keratin filled cystic dilatations, and local mild reactive keratinocytic atypia. In the surrounding dermis, there was dense chronic inflammation, fibrosis, and granules of dark red pigment. These findings suggest marked pseudoepitheliomatous hyperplasia secondary to the tattoo. Different reaction patterns have been described in association with tattoos, such as granulomatous and/or perivascular lymphocytic inflammation. However, there have been few cases reported of pseudoepitheliomatous hyperplasia arising at a tattoo site. Therefore, we encourage physicians to consider massive epidermal hyperplasia in the differential diagnosis of a verrucous tattoo reaction.

Adult↗
PubMed1996

The Q-switched ND:YAG laser effectively treats tattoos in darkly pigmented skin.

BACKGROUND: Laser therapy for removal of cosmetic tattoos has been proven efficacious in lighter skin. Few studies have been reported using the Q-switched neodymium-yttrium-aluminum-garnet (Nd:YAG) laser to treat tattoos in darkly pigmented or type VU skin, however. OBJECTIVE: To report results using the Q-switched Nd:YAG laser to remove tattoos from type VI skin. METHODS: Eight darkly pigmented patients had 15 amateur tattoos treated with the Q-switched Nd:YAG laser. Treatments numbered three or four on average and were given at 8-week intervals. Results were rated by the patients and by a panel of four physicians. RESULTS: Eight of 15 tattoos were rated as 75-95% cleared after therapy. Another five tattoos were 50% cleared. Two tattoos were only 25% cleared, but underwent only two treatments. None of the patients reported any changes in texture of their skin post therapy. Thirteen of 15 tattoos were removed without any change in the color of the involved skin. The other two tattoos were removed with only slight lightening of the skin. CONCLUSION: When treating patients in whom there is a significant risk for keloid scarring or destruction of natural pigment as a consequence of tattoo removal, the Q-switched Nd:YAG laser appears to be an excellent choice of therapy.

Humans↗