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PubMed1995

Tattoo removal with the Q-switched ruby laser and the Q-switched Nd:YAGlaser: a comparative study.

The Q-switched ruby and the Q-switched neodymium YAG lasers are both widely used in the treatment of amateur and professional tattoos. Comparative evaluation of these two laser systems has not previously been performed; thus, the advantages of each laser have not been delineated. Forty-eight amateur and professional tattoos were treated with both the Q-switched ruby and Q-switched Nd:YAG lasers. The tattoos were divided in half and one side of the tattoo was treated with each laser. After one treatment, the patients returned for evaluation to assess the degree of lightening achieved by each laser. The Q-switched ruby laser was found to be superior in lightening black dye in both professional and amateur tattoos. A significant advantage was noted for the ruby laser in the removal of green tattoo pigment. The differences with the Q-switched ruby laser and the 1064 nm option of the Q-switched YAG laser were not clinically significant in the lightening or removal of other colors. The 532 nm option of the Q-switched YAG laser was superior to the Q-switched ruby and the 1064 nm option of the YAG laser in the removal of red tattoo colors in professional tattoos. Hypopigmentation was found more commonly with the Q-switched ruby laser, while textural change was noted more commonly with the Q-switched Nd:YAG laser. One of the patients treated with the Nd:YAG laser at 1064 nm showed a hypertrophic scar.

Adolescent↗
PubMed1993

The Q-switched Nd:YAG laser effectively treats tattoos. A controlled, dose-response study.

BACKGROUND AND DESIGN: The Q-switched ruby laser was recently shown to remove tattoos without scarring. The Q-switched neodymium: yttrium aluminum garnet (Nd:YAG) laser, which targets black ink with a longer wavelength that has less absorption by melanin, should effectively treat tattoos with fewer pigmentary alterations. A prospective, blinded, controlled study was conducted to assess the ability of the Q-switched Nd:YAG laser (1064 nm, 10 ns, 5 Hz) to remove tattoos. Twenty-five patients with 39 blue-black or multicolored tattoos (14 previously untreated, 25 Q-switched ruby laser-resistant) were exposed in randomly derived quadrants with 6, 8, 10, or 12 J/cm2 at 3 to 4 week intervals for a total of four treatment sessions. RESULTS: An excellent response (> 75% ink removal) was seen in 77% of the black tattoos and more than 95% of the black ink cleared in 11 (28%) of 39 tattoos at 10 to 12 J/cm2 after four treatment sessions. Colored inks were not as effectively removed. Response was related to fluence with greatest improvement noted in the quadrants treated with 10 and 12 J/cm2. No significant side effects, including pigmentary changes or scarring, were noted. Histopathologic examination demonstrated persistence of tattoo ink in clinically clear areas and confirmed the absence of fibrosis and granulomatous changes. CONCLUSION: The Q-switched Nd:YAG laser (1064 nm) effectively treats black tattoos with an excellent cosmetic outcome. Bright colors were minimally responsive to treatment. Higher doses were more effective and equally well tolerated.

Adult↗
PubMed1996

Colonic tattooing with India ink: benefits, risks, and alternatives.

OBJECTIVE: To provide comprehensive information on key issues concerning colonic tattooing with India ink in reported literature. METHODS: A total of 735 citations on India ink alone were present in the English literature (1966-1995), including 16 on India ink and colonic tattooing. Nine major studies were identified and reviewed for 1) preparation before tattooing (type of ink used, sterilization process, colonic preparation, and antibiotic prophylaxis), 2) the tattooing process (technique and volume injected), 3) success in localization, and 4) complications. RESULTS: A'total of 447 cases of colonic tattooing with India ink have been reported. Major indication was preoperative marking of tumor site. Various India ink preparations were used. Ink was unsterilized in 57% (255/447), autoclaved in 42% (187/447), and gas sterilized in 1% (5/447) of cases. Colonic preparation varied similarly. Prophylactic antibiotics were used in 1% (5/447) of cases. Dilution of India ink varied from undiluted to 1:100 (with 0.9% saline). The volume injected ranged from 0.1 to 2 ml per site injected, commonly with tangential needle insertion and delivery of ink into the submucosa in the majority of the cases. Intraoperative localization was easier with multiple tattoo injections. Five reports of complications have been made. In only one instance did overt clinical complications develop. Risk of a clinical complication with colonic tattooing with India ink is 0.22%. CONCLUSION: Marked variability in technique, as well as potential for reporting bias, limit the quantitative conclusions. In general, colonic tattooing with India ink is a safe, accurate, and inexpensive method for preoperative marking and prospective study of colonic lesions.

Animals↗
PubMed2003

Epidemiology of tattoo skin disease in bottlenose dolphins Tursiops truncatus from the Sado estuary, Portugal.

We report on the epidemiology of tattoo disease in a community of bottlenose dolphins Tursiops truncatus from the Sado estuary, Portugal. The presence of tattoos (T++) and tattoo-like (T+) lesions was examined in 586 photographic records of 35 dolphins taken from 1994 to 1997. Images were rated into 3 categories: good (GI), average (AI) and poor (PI). Dolphins positive for T++ lesions were observed in 19 GI. Dolphins with T+ lesions were seen in 39 GI, 23 AI and 6 PI. For statistical analysis the dolphins were divided into 2 age classes (immature and adult) and the data grouped into 2 periods (1994-1995 and 1996-1997). Minimum prevalence of T++ lesions in 32 dolphins was 21.9% in 1994-1995 and 15.6% in 1996-1997. Variation in prevalence of tattoo disease between the 2 age classes was examined for each period, excluding animals with T+ lesions or considering them either positive or negative for tattoos. Prevalence of the disease was significantly higher in immature dolphins than in adults during both periods, except in the first one when T+ lesions were considered as true tattoos. Temporal variation in prevalence of tattoo disease was examined in 23 adults. Prevalence was significantly higher in 1994-1995 (39.1%) than in 1996-1997 (17.4%). Differences in the number and quality of pictures did not cause significant biases that could have favoured the detection of lesions between age classes or periods. Minimal persistence of the disease ranged between 3 and 45.5 mo. The lesions converted into light grey marks when healing, but may recur. The presence of very large lesions in 2 adult dolphins affected for years may be related to the contamination of the estuary. The high prevalence of the disease, its long persistence, as well as higher frequency in immature individuals, suggest that it is endemic in bottlenose dolphins from the Sado estuary. The contribution of tattoo disease to the decline of this community should be investigated. Three of the 5 dolphins that died during this study had T++ and T+ lesions.

Age Factors↗
PubMed1998

Comparison of responses of tattoos to picosecond and nanosecond Q-switched neodymium: YAG lasers.

OBJECTIVE: To test the hypothesis that picosecond laser pulses are more effective than nanosecond domain pulses in clearing of tattoos. DESIGN: Intratattoo comparison trial of 2 laser treatment modalities. SETTING: A large interdisciplinary biomedical laser laboratory on the campus of a tertiary medical center. PATIENTS: Consecutive patients with black tattoos were enrolled; all 16 patients completed the study. INTERVENTION: We treated designated parts of the same tattoo with 35-picosecond and 10-nanosecond pulses from 2 neodymium:YAG lasers. Patients received a total of 4 treatments at 4-week intervals. All laser pulse parameters were held constant except pulse duration. Radiation exposure was 0.65 J/cm2 at the skin surface. Biopsies were performed for routine microscopic and electron microscopic analysis at the initial treatment session and 4 weeks after the final treatment in 8 consenting patients. Also, ink samples were irradiated in vitro. MAIN OUTCOME MEASURES: In vivo, on the completion of treatment, a panel of dermatologists not associated with the study (and blinded to the treatment type) evaluated photographs to assess tattoo lightening. Formalin-fixed specimens were examined for qualitative epidermal and dermal changes as well as depth of pigment alteration. Electron micrographs were examined for particle electron density and size changes (in vivo and in vitro). The gross in vitro optical density changes were measured. RESULTS: In 12 of 16 tattoos, there was significant lightening in the picosecond-treated areas compared with those treated with nanosecond pulses. Mean depth of pigment alteration was greater for picosecond pulses, but the difference was not significant. In vivo biopsy specimens showed similar electron-lucent changes for both pulse durations. In vitro results were similar for both pulse durations, showing increases in particle sizes and decreased electron density as well as gross ink lightening. CONCLUSIONS: Picosecond pulses are more efficient than nanosecond pulses in clearing black tattoos. Black tattoos clear principally by laser-induced changes in the intrinsic optical properties of the ink.

Aluminum Silicates↗
PubMed2002

Clinicopathologic features of skin reactions to temporary tattoos and analysis of possible causes.

BACKGROUND: Recently, temporary paint-on tattoos have become increasingly popular as a safe alternative to permanent tattoos in Asia and other regions. The most common dye for such temporary tattoos is henna, a vegetable dye. Henna is considered to possess low allergenicity because the incidence of allergic contact dermatitis to henna has rarely been reported. However, recently, allergic reactions to henna used in temporary tattoos have been reported frequently. OBSERVATIONS: Ten patients developed inflamed skin eruptions after receiving temporary paint-on tattoos in either Thailand or Indonesia. The 6 patients who were patch tested all exhibited moderate to strong positive reactions to p-phenylenediamine (1% in petrolatum). Four of the 6 patients were then tested with commercial black henna obtained from Thailand, and all 4 had strong positive reactions. A skin biopsy specimen showed lichenoid dermatitis. Mass spectrometry analysis of commercial black henna for molecular weight revealed a major peak at the mass-charge ratio of 108.1, which corresponds to the molecular weight of p-phenylenediamine. CONCLUSIONS: The most likely causative agent for the lichenoid reaction associated with use of commercial black henna for temporary tattooing, currently popular in Southeast Asia, is p-phenylenediamine. With the increased popularity of temporary paint-on tattoos, clinicians should be aware of the possible associated complications.

Adolescent↗
PubMed1991

Tattooing behavior in adolescence. A comparison study.

We characterize associations with and motivations for tattooing in adolescents through data from a controlled, three-group comparison of adolescents from a substance abuse treatment program, detention center, and private pediatric practice. We surveyed 474 adolescents (12 to 18 years old) with tattoos (12%) and without tattoos (88%). The private pediatric practice was the control site. A 34-item questionnaire was used to profile the three groups and their primary associations with tattooing with respect to race, drug use, school attendance, school grades, parental marital status, family income, tattooing by family members, criminal activity, and involvement with satanic rituals. Tattooing was significantly (P less than .005) associated with all of these variables in the ways described, as was knowledge of its association with human immunodeficiency virus infection. No interventions were made. Tattooing is common in adolescents and is associated with low self-esteem, delinquency, drug abuse, family and peer modeling, and participation in satanic rituals. Addressing the behavior as a health problem is discussed.

Adolescent↗
PubMed1983

Significance of tattooes in narcotic abusers.

Social aspects of tattooed compared to non-tattooed narcotic addicts attending a methadone maintenance programme were investigated. It was found that those who were tattooed reported greater current social instability and a more deprived background compared to those without tattooes. None of the tattooes specifically identified the subjects as belonging to the drug scene nor could the age at which the subject was first tattooed be used to predict subsequent drug abuse. The presence of tattooes was unrelated to the current dose of methadone and to the duration of attendance on the methadone programme.

Adult↗
PubMed2006

The patient's experience of a nurse-led nipple tattoo service: a successful program in Warwickshire.

INTRODUCTION AND AIMS: Although once the preserve of tattoo artists, units within the UK have increasingly begun making use of the Clinical Nurse Specialist (CNS) to perform areola tattooing. Bringing the technique within the Breast Unit enhances continuity of care and makes use of skills that can be provided by the CNS. Our CNS is involved with both the patients' oncological management and the areola tattoo service. MATERIALS AND METHODS: The CNS-led service was investigated and patients' experiences of nipple tattooing were assessed. We present the results of a postal questionnaire and a prospective clinical audit of the procedure. RESULTS: Forty tattoos were done over a 2-year period with one self-limiting complication. Patient satisfaction was high both with the outcome and the experience of the procedure. Fading of the tattoo is a consistent finding frequently requiring further shading. CONCLUSION: Overall the patient's experience of a nurse lead 'in-house' tattoo service has been highly satisfactory and this is reflected by their high confidence rating and ease of access to the nurse. We believe that the role of the CNS in oncological treatment and reconstructions helps integrate the multidisciplinary experience for the patient.

Color↗
PubMedDate not supplied

Safety and reliability of tattooing colorectal neoplasms prior to laparoscopic resection.

Accurate tumor localization is critical to performing minimally invasive colorectal resection. This study reviews the safety and reliability of tattooing colorectal neoplasms prior to laparoscopic resection. We retrospectively reviewed 50 consecutive patients with colorectal neoplasms who underwent endoscopic tattooing prior to laparoscopic resection. Data were obtained from medical charts, endoscopy records, and pathology reports. No complications related to endoscopy or tattooing were incurred. Five neoplasms (10%) were in the ascending colon, five (10%) were in the transverse colon, eight (16%) were in the descending colon, 23 (46%) were in the sigmoid colon, and nine (18%) were in the rectum. Tattoos were visualized intraoperatively and accurately localized the neoplasm in 44 patients (88%). Six patients (12%) did not have tattoos visualized laparoscopically and required intraoperative localization. On average, the pathology specimens in this series had a 15 cm proximal margin, a 12 cm distal margin, and 15 lymph nodes. In the context of laparoscopic colorectal resection, preoperative endoscopic tattooing is a safe and reliable method of tumor localization in most cases. Localizing colon and proximal rectal lesions with tattoos may be preferable to other localization techniques including intraoperative endoscopy.

Adenoma↗
PubMed1983

Self-tattooing by schoolchildren.

Of 779 third-year pupils from seven secondary schools examined for evidence of self-tattooing, 31 (4%) had tattooed themselves. More boys (27/513, or 5.2%) than girls (4/266, or 1.6%) had tattooed themselves. One hundred and fifty six separate marks were identified in the tattooed boys and sixteen in the girls. The most popular sites were the fingers and back of the left hand, and the front and back of the left forearm. Only 2 pupils remained pleased with their tattoos and 19 expressed strong remorse. Waiting lists for the removal of such tattoos are very long. The craze for self-tattooing by schoolchildren should be curbed.

Adolescent↗
PubMed2000

A case-control study of tattoos in young suicide victims as a possible marker of risk.

BACKGROUND: The goal was to examine tattooing in suicides, as tattoos have been associated with several risk factors for suicide. METHOD: A chart review of a three-year sample of 134 consecutive suicides in Mobile County, Alabama, was conducted. The prevalence of tattoos was compared between young (<30) white suicides and accidental deaths matched for age, gender and race, in a case-control study. RESULTS: Tattoos were found in 21% of suicides. Fifty-seven percent of young white suicides were tattooed compared to 29% of matched accidental deaths. LIMITATIONS: Findings are preliminary due to the small sample size. The study methodology precluded obtaining information of psychiatric diagnoses prior to death. CONCLUSIONS: Tattoos may be possible markers for lethality from both suicide and accidental death in young people, presumably because of shared risk factors such as substance abuse and personality disorder. Affective disorders should receive further, more specific studies. The clinical value of inquiring about tattoos in young people at risk of suicide needs further study.

Accidents↗
PubMed1996

Laser treatment of tattoos in darkly pigmented patients: efficacy and side effects.

BACKGROUND: Many modalities for the treatment of tattoos and pigmented lesions produce a greater risk of complications in Fitzpatrick types V and VI skin because of an increased incidence of adverse pigmentary changes and keloidal scarring. In fair-skinned persons Q-switched lasers have proved effective in removing pigmented lesions and tattoos without scarring. OBJECTIVE: This study was conducted to determine the efficacy and effects of Q-switched lasers on a small series of darkly pigmented patients with tattoos. METHODS: Four patients of Ethiopian origin with facial and neck tribal tattoos were treated with both the Q-switched ruby and Nd:YAG lasers. One black woman with a multicolored tattoo on the mid chest was treated with the Q-switched ruby laser. RESULTS: Clearing of all lesions was seen. The treatments did not result in scarring or permanent pigment changes other than the ones intended. CONCLUSION: Our results indicate that in darkly pigmented patients, Q-switched laser treatment of tattoos can be performed successfully. The longer wavelength Q-switched Nd:YAG laser is recommended when removing tattoos in darker complected persons. A test treatment is advised before treatment of large skin areas.

Adult↗
PubMed1997

Tattooing: another adolescent risk behavior warranting health education.

A cross-sectional, convenient sample of adolescents (N = 2101) from 8 states were queried regarding interest in tattooing. Permanent markings and blood-borne diseases were reasons respondents refrain from tattooing, yet 55% (n = 1159) expressed an interest in tattooing. Tattooed adolescents in the sample (10%, n = 213) responded with their experiences. Tattooing was frequently done around the 9th grade and as early as 8 years of age; over half (56%, n = 120) report academic grades of As and Bs. Potential health risks and definite psychosocial findings of purchase and possession risks were evident, building on data from a similar 1994 study by Armstrong and McConnell. Health providers and educators should initiate applicable health education and become community adolescent advocates regarding this risk-taking behavior. Findings indicate that adolescents who want a tattoo will obtain one, regardless of money, regulations, or risks. Adolescents view the tattoos as objects of self-identity and body art, whereas adults perceive the markings as deviant behavior. Informed decision-making could be promoted in health education by incorporating information about the possibility of blood-borne diseases, permanent markings, and themselves as growing and changing people.

Adolescent↗
PubMed1999

Piercing and tattooing in patients with congenital heart disease: patient and physician perspectives.

PURPOSE: The frequency and safety of ear piercing and tattooing were assessed in a group of children, adolescents, and adults with congenital heart disease (CHD). Also, a group of physicians who care for adolescents and adults with CHD were surveyed for opinions and experiences regarding piercing and tattooing. METHODS: An eight-question survey was mailed to 445 patients (181 adults and 264 children) from one center. A different five-question survey was mailed to 176 physician members of the International Society of Adult Congenital Cardiac Disease. RESULTS: The patient survey was completed by 152 of 445 (34%) patients (mean age +/- standard deviation 19.8 +/- 16.2 years; range 0.25-67 years). Eighty-eight of 152 (58%) patients were female. Ear piercing occurred in 65 of 152 (43%) patients (mean age 12.4 +/- 8.7 years; range 0.25-45 years). Prior to piercing, only 4 of 65 (6%) patients took antibiotics, but 15 of 65 (23%) had piercing-related infections. No patient had endocarditis. Infections occurred 1 week to 3 years after piercing. All were local skin infections. Tattoos were placed in 8 of 152 (5%) patients (median age 17.5 years; range 13-56 years). No antibiotic use or infections were reported in patients with tattoos. The physician survey was completed by 118 of 176 (67%) physicians. The majority of physicians did not approve of patients having piercing or tattooing performed. However, 60% of physicians believed that antibiotic prophylaxis is indicated for these procedures. CONCLUSIONS: Despite the opinion of many physicians, most patients do not take antibiotic prophylaxis for piercing and tattooing. Patients apparently do not suffer serious sequelae. The efficacy of standard antibiotic regimes as applied to ear piercing and tattooing requires further study, since these procedures are increasingly popular in modern society.

Adolescent↗
PubMed2006

Establishment of an extraction method for the recovery of tattoo pigments from human skin using HPLC diode array detector technology.

Tattooing is a widespread process of puncturing pigments into skin, whereas the resulting concentration inside the skin remains unknown. Many tattoo colorants are organic pigments, such as azo pigments, manufactured for other uses. To remove tattoos from skin, laser pulses at very high intensities are applied to the skin to destroy the tattoo pigments. Recent investigations have shown that several azo compounds are cleaved by laser light leading to potentially toxic or carcinogenic compounds. To assess the risk of tattooing and laser treatment of tattoos, the concentration of the pigments and their decomposition products in the skin must be determined. Therefore, an extraction method was established to determine the concentration of tattoo pigments and decomposition products quantitatively. The extraction of two widely used azo compounds, Pigment Red 22 and Pigment Red 9, and their laser-induced decomposition products, 2-methyl-5-nitroaniline, 4-nitrotoluene, 2,5-dichloraniline, and 1,4-dichlorobenzene, was accomplished using recovery experiments and HPLC-DAD technology. Despite the poor solubility of the pigments, a nearly complete recovery from aqueous suspension (> 92%) or lysed skin (> 94%) was achieved. The decomposition products were extracted from aqueous suspension or skin showing a recovery of up to 100%, except for the very volatile 1,4-DCB.

Azo Compounds↗
PubMed1998

Attitudes of health care providers and students towards tattooed people.

Attitudes of health care providers and medical and nursing students (n = 513) towards tattooed adults and adolescents were examined. No respondent group had mean scores reflecting a positive attitude towards tattooed persons. Overall, physicians (MDs) and registered nurses (RNs) rated tattooed people less positively than did students. Womens' attitudes were consistently less favourable than those of men, especially towards tattooed professional women. Attitudes towards tattooed adolescents were generally less positive than attitudes towards the adult groups. Research has found that negative attitudes impact patient care. This study suggests that tattooed persons, especially adolescents, may be at risk of being negatively perceived when they seek health care. Increased efforts are needed to assure that those with tattoos receive non-judgemental and sensitive care.

Adolescent↗
PubMedDate not supplied

Regulation of tattooing in Minneapolis and St. Paul, Minnesota: tattooists' attitudes and relationship between regulation and practice.

OBJECTIVE: This study investigated tattooists' attitudes regarding government regulation and the relationship between existing tattooing regulation and tattooists' knowledge and practice of infection control. METHODS: Self-reported and observational data were collected in a cross-sectional study of professional tattooists. A written survey was used to investigate knowledge and practice of infection control and attitudes toward government regulation. Infection control practice was also examined through direct observation of tattooing. Rating scales were used to compare tattoo artists subject to local tattooing ordinances with those in areas without ordinances. RESULTS: Sixty-one tattooists (45 regulated, 16 unregulated) completed surveys and 25 (17 regulated, 8 unregulated) were observed. Attitudes toward regulation were generally positive. Most participants supported health department inspections and training requirements. The presence of local tattooing ordinances was not associated with tattooists' knowledge (p=0.53), but was associated with self-reported practices (p=0.05). A more positive attitude toward regulation was associated with the use of more self-reported infection control procedures (p<0.01). CONCLUSION: Tattoo artists in areas with local tattooing ordinances may implement more bloodborne pathogen precautions than those in areas without ordinances, despite working from a similar knowledge base. Tattooists most in need of improvement may be difficult to reach due to opposition to government intrusion. Federal guidelines, clarification of OSHA rules applying to tattooists, and statewide regulation are needed. Tattooists should be involved in the development of regulations.

Attitude to Health↗