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[Forum: dermopigmentation or medical tattooing. History of tattooing].

Tattooing has been performed all over the world since prehistoric times, as indicated by numerous ancient relics. The significance of tattoos has differed at times and in different civilisations (means of communication, social identification mark, religious origin). Today, it is performed by real artists who have inspired its medical applications. Medical dermopigmentation was initially used in the context of breast reconstruction (nipple areola complex) and, with subsequent refinements, its indications have been extended to the treatment of residual scars and to the permanent make-up.

Esthetics

[Forum: dermopigmentation or medical tattooing. In practice ... how to perform medical tattooing?].

Dermopigmentation is now part of the therapeutic armamentarium of plastic surgeons. In good indications and when applied according to a few simple rules, every surgeon can obtained reliable and reproducible results with medical dermography. This therapeutic procedure is performed on an outpatient basis, usually in several sessions; subsequent revisions are always possible provided certain basic errors are avoided. The authors describe each step of this technique.

Alopecia

[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

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

An experimental study of powder tattooing of the skin.

Test firings were conducted on specially prepared live rabbits to determine the approximate maximum ranges at which powder tattooing occurs for different forms of gunpowder. For .38 caliber, powder tattooing from cartridges loaded with flake powder disappears at a range of 18 to 24 in. (0.4 to 0.6 m). Powder tattooing with flattened ball powder extends to 36 in. (0.9 m), while that due to ball powder extends to 48 in. (1.2m) of range. In .22 caliber, powder tattooing was observed out to 24 in. (0.6 m) with flake powder and 18 in. (0.4 m) with flattened ball. Attempts to reproduce the animal powder tattoo patterns on paper revealed that the paper patterns are consistent with skin tattoo patterns only up to 18 in (0.4 m) of range.

Animals

The removal of amateur tattoos by salabrasion.

Due to the recent upsurge in self-inflicted tattoos in teenagers it was decided to employ for their removal the method of salabrasion, i.e. abrasion with table salt. This technique was recently used by Manchester (1973, 1974) for the removal of commercial tattoos. Fourteen patients with twenty-eight tattoo or only tiny flecks of pigment remaining visible; eleven showed a fair response, i.e. the tatoo, although much lighter in colour, was still legible but the patient was satisfied with the result; three showed a poor response, i.e. the tattoo appeared as if untreated; four (two patients) defaulted. In general, as could be expected, the darker the tattoo the more difficult was its removal and those on fingers were particularly resistant.

Administration, Topical

Salabrasion of tattoos. A correlation of the clinical and histological results.

Twenty-six tattoos were treated by salabrasion. The salt was left on the abraded surface from zero to 24 hours. The percentage of residual pigment varied from 50%, when the salt was removed immediately after salabrasion, to 5%, when the salt was left in place for over 12 hours. When the salt was left on for variable periods, some degree of scarring and hypopigmentation occurred in 79% and in 59% of the tattoos, respectively. When the salt was removed immediately after salabrasion, 29% of the tattoos showed scarring and 29% showed hypopigmentation. Our results show that the best method is to remove the salt immediately after salabrasion, but that this form of therapy should only be done on those lesions where the eventual cosmetic result is not important.

Cicatrix

An outbreak of hepatitis B from tattooing.

An outbreak of 34 cases of hepatitis B not all of them notified, is described. 31 was tattooed by one artist; 3 were secondary infections. All primary infections occurred in males aged 16-28 years. Several defects in hygiene in the tattooing procedure were noticed. Recommendations are made for the licensing and routine inspection of all tattoo parlours.

Adolescent

Mucosal tattooing in oral cavity carcinoma.

Tattooing provides accurate localization for tumor surgery following radiation therapy. This paper describes studies done on tattooing technique and instruments available currently. Procedures tested included hypodermic needles and three types of surgical instruments. Chemical tested included india ink, iron oxide, and colored pigments. India ink and iron oxide used with the Spaulding-Rogers Outliner gave satisfactory tattoos.

Adult

[Forum: dermopigmentation or medical tattooing. Needles and ink].

Tattooing has been performed since ancient times. It has survived religions, development of education, wars and all forms of repression. Tattooing has gained a new lease of life at a time when this practice appeared to be dying out; why? In reality, tattooing corresponds to a need to be different, to make oneself attractive and to see oneself as a unique being and the age of uniformity in which we live is a very important factor for requests for dermography. Techniques have progressed together with conditions of asepsis and sterilisation. Until the profession of tattooist is officially recognised, it will always be associated with the idea of sordid techniques in makeshift quarters. The very survival of this artistic profession requires serious training and standards of hygiene. Failure to recognise this profession would result in its prohibition in the short-term, leading to clandestine activity in which standards would obviously not be respected.

Art

Amalgam tattoos: light and electron microscopy and electron-probe micro-analysis.

A common tattoo occurring in the mouth is caused by the insertion of amalgam filling material into the soft tissues. Fifteen amalgam tattoos were examined. Amalgam or its derivatives were found within macrophages, fibroblasts and multinuclear giant cells. Fine particles were found associated with: the basement-membranes of mucosal epithelium, of striped muscle fibres, and of muscle cells of blood vessels; collagen; elastic tissue; and the connective tissue of nerves. Amalgam consists mainly of mercury, silver and tin. The analytical results suggest that corrosion occurs and that mercury and some tin are lost from the tattoos, leaving silver and tin in macrophages and giant cells, and silver in fibroblasts and in the above-mentioned extracellular sites.

Biopsy

Oral amalgam pigmentations (tattoos): a retrospective study.

Oral amalgam tattoos are typically asymptomatic, benign, solitary or multiple clinical lesions produced by inadvertent placement of dental silver amalgam restorative material into the oral soft tissues. Diffuse lesions often display a grayish brown discoloration while other tattoos present a darker blue-black contrast. One hundred sixty-eight biopsy reports that confirmed the diagnosis of amalgam tattoo were analyzed to find age, sex, and race of the patients and size, location, and duration of occurrence of the lesions. Among the 168 cases, 235 individual tissue specimens were identified. A majority of the specimens were taken from the buccal mucosa, gingiva, and alveolar mucosa. The most common site for the lesion was the mandibular arch. The size of the individual specimens ranged from 0.10 cm to 1.50 cm. Almost two thirds of the specimens were 0.40 cm or less.

Adolescent

Tattoo marking for registration of relapse after oral vestibuloplasty.

A simple method for registering extension and relapse after vestibuloplasty based upon tattoo marking has been developed. Tattoo marking with autoclaved India ink was tested on 10 rats and seems to be harmless. This method is considered an alternative to other numerical expressions of extension and relapse after vestibuloplasty, such as radiocephalometrics and analysis of standardized impressions and castings.

Animals

Traumatic tattooing.

Traumatic tattoos may be classified into abrasive and explosive types. The abrasive form leaves the pigment deposit in the more superficial layers of the skin. Explosive forms of traumatic tattooing usually have a central focus of deeply embedded detritus with more superficially placed particles radiating from the central focus. In either form, the best results are achieved by immediate meticulous care of the wound. Many instruments and abrasive devices have been used to remove the embedded pigmented debris, yet the stimplest and most successful is the sterile, hard, natural-bristle toothbrush. This can easily be sterilized, packaged, and kept available in the emergency room and in the operating room.

Foreign Bodies

Lichenoid tattoo hypersensitivity.

Four patients are described who developed granulomatous reactions in the red portions of their tattoos. Histopathological and immunofluorescence studies showed features of lichen planus. Mercury was identified in only one patient's lesion, and hypersensitivity to mercury was shown by patch testing in one other patient. Tattooing may provide a localised antigenic challenge resulting in spontaneously occurring lichen planus.

Adult

Tattooing, a new hope for secondary leukoderma.

A 10-year material of 1,000 post-burn patients have been reviewed. Dyschromia was found to be one of the commonest post-burn sequelae in both partial thickness and superficial burn. Patches of leukoderma surrounded by a zone of hyperpigmentation was the main feature in partial thickness burn, while hyperpigmentation follows superficial burn. Tattooing was tried on 30 patients as a permanent camouflage for leukodermic patches in exposed areas. Histological studies on 7 volunteers were carried out, showing the histological pattern of dyschromia and tattooing. The trial proved to be a success, though it still needs further refinement and improvement.

Burns

Tattoo removal by superficial dermabrasion. Five-year experience.

A 5-year clinical experience using superficial dermabrasion to remove tattoos is presented. This procedure can be done quickly in the office with low patient risk. Good pigment removal is obtained with little or no scar formation. Cases are presented which are typical of the 250 tattoos removed in the last 5 years.

Dermabrasion

Tattoo removal by split thickness tangential excision.

Split thickness tangential excision is a simple means of tattoo removal with very acceptable cosmetic results. The technique has several advantages. (1) The depth of skin removal may accurately be controlled as the tattoo pigment is excised with a dermatome. The major portion, if not all of the remaining pigment, is extruded and sloughs with the crust. (2) Scar formation, if it occurs at all, is negligible. (3) No donor site is created. (4) The procedure may be carried out rapidly without admitting patients to hospital, is inexpensive for patients and conserves time for physicians.

Humans