1
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Schubert S, Kluger N, Schreiver I. Hypersensitivity to permanent tattoos: Literature summary and comprehensive review of patch tested tattoo patients 1997-2022. Contact Dermatitis 2023; 88:331-350. [PMID: 36772861 DOI: 10.1111/cod.14291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 02/01/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023]
Abstract
We outline constituents of tattoo and permanent make-up ink with regard to inflammatory tattoo reactions and population-based confounders. The comprehensive review of patch-tested tattoo patients between 1997 and 2022 shows that tattoo allergy cannot be reliably diagnosed via patch testing with today's knowledge. Weak penetration and slow haptenization of pigments, unavailability of pigments as test allergens and a lack of knowledge concerning relevant epitopes hamper the diagnosis of tattoo allergy. Patch testing p-phenylenediamine and disperse (textile) dyes is not able to close this gap. Sensitization to metals was associated with all types of tattoo complications, although often not clinically relevant for the tattoo reaction. Binders and industrial biocides are frequently missing on ink declarations and should be patch tested. The pigment carbon black (C.I. 77266) is no skin sensitizer. Patch tests with culprit inks were usually positive with cheap ink products for non-professional use or with professionally used inks in patients with eczematous reactions characterized by papules and infiltration. Tape stripping before patch testing and patch test readings on Day 8 or 10 may improve the diagnostic quality. The meaningfulness of the categorical EU-wide ban of Pigment Green 7 and Pigment Blue 15:3 is not substantiated by the presented data.
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Affiliation(s)
- Steffen Schubert
- Information Network of Departments of Dermatology (IVDK), Institute at the University Medical Center Göttingen, Göttingen, Germany
| | - Nicolas Kluger
- Department of Dermatology, 'Tattoo' Consultation, Bichat-Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.,Department of Dermatology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Ines Schreiver
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Berlin, Germany
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2
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Hernandez L, Mohsin N, Frech FS, Dreyfuss I, Vander Does A, Nouri K. Laser tattoo removal: laser principles and an updated guide for clinicians. Lasers Med Sci 2022; 37:2581-2587. [DOI: 10.1007/s10103-022-03576-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/12/2022] [Indexed: 11/25/2022]
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3
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Wong IT, Cheung LW. Id reaction and allergic contact dermatitis post-picosecond laser tattoo removal: A case report. SAGE Open Med Case Rep 2021; 9:2050313X211057934. [PMID: 34925838 PMCID: PMC8673861 DOI: 10.1177/2050313x211057934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The novel picosecond lasers have emerged as a mainstay device in laser tattoo removal alongside Q-switch lasers, considered the gold standard in the field. Here, we present a 45-year-old female who developed a severe reaction to both her treated and untreated tattoos after two picosecond laser treatments and subsequent widespread eczematous eruption. Skin biopsies revealed findings consistent with hypersensitivity to exogenous red pigment. The clinicopathologic findings were consistent with an id reaction (autoeczematization) associated with allergic contact dermatitis to tattoo pigment. This case report highlights the potential for tattoo hypersensitivity following picosecond laser treatment and the dilemma associated with tattoo removal in sensitized patients. Additional therapeutic approaches are needed to provide patients with a safe means of tattoo removal while mitigating the risk of hypersensitivity reactions.
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Affiliation(s)
- Ian Ty Wong
- The Skin Care Centre, Department of Dermatology & Skin Science, The University of British Columbia, Vancouver, BC, Canada
| | - Larry Wk Cheung
- The Skin Care Centre, Department of Dermatology & Skin Science, The University of British Columbia, Vancouver, BC, Canada
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4
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Sindoni A, Valeriani F, Gallè F, Liguori G, Romano Spica V, Vitali M, Protano C. Adverse effects related to tattoos in the community setting: a systematic review. J Epidemiol Community Health 2021; 75:1023-1028. [PMID: 34253557 DOI: 10.1136/jech-2021-216874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/26/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Tattoos were historically associated with deviant behaviours or religious and other social purposes, but in the last decades, they have gained increasing popularity and have become a mainstream. The aim of this systematic review is to assess the literature evidence about decorative tattoos complications, considering both infective and non-infective risks. METHODS This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. We searched the following electronic bibliographic databases: PubMed, Scopus and Web of Science (science and social science citation index). RESULTS The literature search resulted in 6473 studies. A total of 207 full articles were considered potentially relevant and were reviewed independently by researchers. After full-text evaluation, 152 of 207 articles were excluded, as they did not meet selection criteria. The remaining 55 studies were included in the systematic review and their quality assessment was performed. Ten studies reported microbiological complications, 37 reported non-microbiological effects and eight reported either microbiological and non-microbiological complications. CONCLUSIONS Several well-known and uncommon risks are associated with tattooing and tattoo after-care. Public health authorities could take into account health education programmes for tattooists and customers in order to prevent health complications in people with tattoos. PROSPERO REGISTRATION NUMBER CRD42020177972.
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Affiliation(s)
- Alessandro Sindoni
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Federica Valeriani
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Francesca Gallè
- Department of Movement Sciences and Wellbeing, University of Naples "Parthenope", Naples, Italy
| | - Giorgio Liguori
- Department of Movement Sciences and Wellbeing, University of Naples "Parthenope", Naples, Italy
| | - Vincenzo Romano Spica
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Matteo Vitali
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Carmela Protano
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
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5
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Karregat JJJP, Rustemeyer T, van der Bent SAS, Spiekstra SW, Thon M, Fernandez Rivas D, Gibbs S. Assessment of cytotoxicity and sensitization potential of intradermally injected tattoo inks in reconstructed human skin. Contact Dermatitis 2021; 85:324-339. [PMID: 34029376 PMCID: PMC8453820 DOI: 10.1111/cod.13908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/03/2021] [Accepted: 05/21/2021] [Indexed: 12/25/2022]
Abstract
Background The number of people within the European population having at least one tattoo has increased notably, and with it the number of tattoo‐associated clinical complications. Despite this, safety information and testing regarding tattoo inks remain limited. Objective To assess cytotoxicity and sensitization potential of 16 tattoo inks after intradermal injection into reconstructed human skin (RHS). Methods Commercially available tattoo inks were injected intradermally into RHS (reconstructed epidermis on a fibroblast‐populated collagen hydrogel) using a permanent makeup device. RHS biopsies, tissue sections, and culture medium were assessed for cytotoxicity (thiazolyl blue tetrazolium bromide assay [MTT assay]), detrimental histological changes (haematoxylin and eosin staining), and the presence of inflammatory and sensitization cytokines (interleukin [IL]‐1α, IL‐8, IL‐18; enzyme‐linked immunosorbent assay). Results Varying degrees of reduced metabolic activity and histopathological cytotoxic effects were observed in RHS after ink injection. Five inks showed significantly reduced metabolic activity and enhanced sensitization potential compared with negative controls. Discussion Using the RHS model system, four tattoo inks were identified as highly cytotoxic and classified as potential sensitizers, suggesting that allergic contact dermatitis could emerge in individuals carrying these inks. These results indicate that an RHS‐based assessment of cytotoxicity and sensitization potential by intradermal tattoo ink injection is a useful analytical tool to determine ink‐induced deleterious effects.
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Affiliation(s)
- Joey J J P Karregat
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Academic Tattoo Clinic Amsterdam, Department of Dermatology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Thomas Rustemeyer
- Academic Tattoo Clinic Amsterdam, Department of Dermatology, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Sander W Spiekstra
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maria Thon
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - David Fernandez Rivas
- Mesoscale Chemical Systems Group, MESA+ Institute and Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - Susan Gibbs
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Oral Cell Biology, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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6
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Multiple Lesions Arising Within a Tattoo: Answer. Am J Dermatopathol 2021; 43:390-391. [PMID: 33910224 DOI: 10.1097/dad.0000000000001732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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van der Bent S, Oyen E, Rustemeyer T, Jaspars L, Hoekzema R. Histopathology of Red Tattoo Reactions. Am J Dermatopathol 2021; 43:331-337. [PMID: 32732691 DOI: 10.1097/dad.0000000000001751] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Despite popularity of tattoos, complications may occur. In particular, red tattoo reactions due to allergic reactions are the most frequent chronic tattoo reactions. However, little is known about its histopathology and underlying pathomechanisms. OBJECTIVE The aim of this article is to analyze the histopathology of red tattoo reactions for diagnostic purposes and to acquire more insight into pathogenesis. METHODS A retrospective cross-sectional study was conducted by reviewing the histopathology of 74 skin biopsies of patients with allergic red tattoo reactions. Histopathological findings, such as inflammation patterns, inflammatory cells and pigment depth and color, were semi-quantified with an in-house validated scoring system by 2 independent senior investigators. RESULTS Histiocytes and lymphocytes were both present in >93%. Histiocytes were the predominant inflammatory cells in 74.3%, but well-defined granulomas were mostly absent (78.0%). Eosinophils were uncommon (8.1%) The predominantly histiocytic reaction combined with interface dermatitis was the main inflammation pattern (37.9%). Most biopsies showed more than one reaction pattern. Interface involvement was observed in 64.8%, despite the intended depth of standard tattoo procedures, in which pigment is placed deeper, in the upper- and mid-dermis. Statistical analyses showed a significant association between inflammation severity and pigment depth (P = 0.024). In 6 cases (8.1%) pigments could not be retrieved histologically. CONCLUSIONS In this cohort we demonstrated that cutaneous reactions to red tattoo ink are frequently characterized by the combination of dermal predominantly histiocytic infiltrates and epidermal interface dermatitis. Allergic reactions to red tattoo pigments probably represent a combination of a subtype IVa and IVc allergic reaction. Clinicians should be aware of the specific histopathology of these reactions and therefore the importance of taking a diagnostic skin biopsy.
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Affiliation(s)
- Sebastiaan van der Bent
- Academic Tattoo Clinic Amsterdam, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands ; and
| | - Ellen Oyen
- Academic Tattoo Clinic Amsterdam, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands ; and
| | - Thomas Rustemeyer
- Academic Tattoo Clinic Amsterdam, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands ; and
| | - Lies Jaspars
- Department of Pathology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Rick Hoekzema
- Academic Tattoo Clinic Amsterdam, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands ; and
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8
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Kluger N. Nickel and tattoos: Where are we? Contact Dermatitis 2021; 85:136-140. [PMID: 33880790 DOI: 10.1111/cod.13869] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 12/17/2022]
Abstract
Tattoos are not mentioned as a source of exposure to nickel. Traces of nickel are, however, almost inevitably found in tattoo inks as impurities and sometimes in tattooed skin. Whether nickel in tattoos has any health consequence is debated. We performed a narrative review of what is currently known about this topic. Today, nickel is frequently detected in inks, but at highly variable levels. It appears to be at higher concentrations in green, blue, and sometimes brown and violet inks. Only nickel allergy in tattooed individuals and nickel-associated tattoo ink allergy are addressed in the literature. Reports of tattoo ink allergy related to nickel are rare and heterogenous. Authors often neglect possible implications of other metals or dyes. A positive patch test is not enough to confirm the role of nickel in a reaction observed after tattooing. We found no report of any systemic complication attributed to nickel from tattoos. The Council of Europe ResAP(2008)1 bans the presence of nickel at high levels in tattoo inks, which is a safety net for individuals with nickel allergy. Large epidemiologic case-control studies with systematic biopsies on normal and inflamed tattoos and patch testing would help to understand the role of nickel in tattoo ink allergies.
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Affiliation(s)
- Nicolas Kluger
- Department of Dermatology, Allergology and Venereology, Helsinki University Hospital & University of Helsinki, Helsinki, Finland
- "Tattoo" Consultation, Department of Dermatology, Bichat-Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
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9
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Tammaro A, Magri F, Chello C, Sernicola A, Luzi F, De Marco G, Raffa S. A peculiar adverse reaction to blue pigment tattoo. J Cosmet Dermatol 2020; 19:2401-2403. [PMID: 32428331 DOI: 10.1111/jocd.13494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/18/2020] [Accepted: 05/12/2020] [Indexed: 12/01/2022]
Abstract
The practice of tattooing dates back to 5000 years ago and is currently constantly growing. The most common pigment associated with tattoo complications is the red one. Another pigment, which could be associated with adverse reactions, even if less frequently than red, is blue. Traditionally, blue pigment contains cobalt, which causes allergic reactions. Here, we report a case of blue pigment granulomatous reaction in a 37-year-old male patient.
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Affiliation(s)
- Antonella Tammaro
- Department of Dermatology, Sant'Andrea General Hospital, Sapienza University, Rome, Italy
| | - Francesca Magri
- Department of Dermatology, Sant'Andrea General Hospital, Sapienza University, Rome, Italy
| | - Camilla Chello
- Department of Dermatology, Sant'Andrea General Hospital, Sapienza University, Rome, Italy
| | - Alvise Sernicola
- Department of Dermatology, Sant'Andrea General Hospital, Sapienza University, Rome, Italy
| | - Fabiola Luzi
- Department of Dermatology, Sant'Andrea General Hospital, Sapienza University, Rome, Italy
| | - Gabriella De Marco
- Department of Dermatology, Sant'Andrea General Hospital, Sapienza University, Rome, Italy
| | - Salvatore Raffa
- Department of Clinical and Molecular Medicine, Ultrastructural Pathology Lab, Sapienza University, Rome, Italy
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10
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Evaluation of phototoxicity of tattoo pigments using the 3 T3 neutral red uptake phototoxicity test and a 3D human reconstructed skin model. Toxicol In Vitro 2020; 65:104813. [DOI: 10.1016/j.tiv.2020.104813] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/17/2020] [Accepted: 02/24/2020] [Indexed: 01/03/2023]
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11
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Stowman AM. Educational Case: Granulomatous Dermatitis. Acad Pathol 2019; 6:2374289519892559. [PMID: 31897421 PMCID: PMC6920582 DOI: 10.1177/2374289519892559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 10/14/2019] [Accepted: 11/02/2019] [Indexed: 12/24/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040.1.
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Affiliation(s)
- Anne M Stowman
- University of Vermont Health System, Burlington, VT, USA.,The Robert Larner, MD College of Medicine at the University of Vermont, Burlington, VT, USA
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12
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Schreiver I, Hesse B, Seim C, Castillo-Michel H, Anklamm L, Villanova J, Dreiack N, Lagrange A, Penning R, De Cuyper C, Tucoulou R, Bäumler W, Cotte M, Luch A. Distribution of nickel and chromium containing particles from tattoo needle wear in humans and its possible impact on allergic reactions. Part Fibre Toxicol 2019; 16:33. [PMID: 31451117 PMCID: PMC6710876 DOI: 10.1186/s12989-019-0317-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/09/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Allergic reactions to tattoos are amongst the most common side effects occurring with this permanent deposition of pigments into the dermal skin layer. The characterization of such pigments and their distribution has been investigated in recent decades. The health impact of tattoo equipment on the extensive number of people with inked skin has been the focus of neither research nor medical diagnostics. Although tattoo needles contain high amounts of sensitizing elements like nickel (Ni) and chromium (Cr), their influence on metal deposition in skin has never been investigated. RESULTS Here, we report the deposition of nano- and micrometer sized tattoo needle wear particles in human skin that translocate to lymph nodes. Usually tattoo needles contain nickel (6-8%) and chromium (15-20%) both of which prompt a high rate of sensitization in the general population. As verified in pig skin, wear significantly increased upon tattooing with the suspected abrasive titanium dioxide white when compared to carbon black pigment. Additionally, scanning electron microscopy of the tattoo needle revealed a high wear after tattooing with ink containing titanium dioxide. The investigation of a skin biopsy obtained from a nickel sensitized patient with type IV allergy toward a tattoo showed both wear particles and iron pigments contaminated with nickel. CONCLUSION Previously, the virtually inevitable nickel contamination of iron pigments was suspected to be responsible for nickel-driven tattoo allergies. The evidence from our study clearly points to an additional entry of nickel to both skin and lymph nodes originating from tattoo needle wear with an as yet to be assessed impact on tattoo allergy formation and systemic sensitization.
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Affiliation(s)
- Ines Schreiver
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Max-Dohrn-Strasse 8-10, 10589, Berlin, Germany.
| | - Bernhard Hesse
- The European Synchrotron, CS 40220, 38043, Grenoble Cedex 9, France
- Xploraytion GmbH, Bismarckstrasse 10-12, 10625, Berlin, Germany
| | - Christian Seim
- Xploraytion GmbH, Bismarckstrasse 10-12, 10625, Berlin, Germany
- Department of X-ray Spectrometry, Physikalisch-Technische Bundesanstalt, Abbestrasse 2-12, 10587, Berlin, Germany
- Institute for Optics and Atomic Physics, Technical University Berlin, Hardenbergstrasse 36, 10623, Berlin, Germany
| | | | - Lars Anklamm
- Helmut Fischer GmbH Institut für Elektronik und Messtechnik, Industriestrasse 21, 71069, Sindelfingen, Germany
| | - Julie Villanova
- The European Synchrotron, CS 40220, 38043, Grenoble Cedex 9, France
| | - Nadine Dreiack
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Max-Dohrn-Strasse 8-10, 10589, Berlin, Germany
| | - Adrien Lagrange
- Xploraytion GmbH, Bismarckstrasse 10-12, 10625, Berlin, Germany
- Institute of Materials Science and Technologies, Technical University Berlin, Strasse des 17. Juni 135, 10623, Berlin, Germany
| | - Randolph Penning
- Institute of Forensic Medicine, Ludwig-Maximilians University, Nussbaumstrasse 26, 80336, Munich, Germany
| | | | - Remi Tucoulou
- The European Synchrotron, CS 40220, 38043, Grenoble Cedex 9, France
| | - Wolfgang Bäumler
- Department of Dermatology, University of Regensburg, Franz Josef Strauß Allee 11, 93042, Regensburg, Germany
| | - Marine Cotte
- The European Synchrotron, CS 40220, 38043, Grenoble Cedex 9, France
- Laboratory of Molecular and Structural Archaeology (LAMS), Sorbonne University, CNRS, UMR8220, Paris, France
| | - Andreas Luch
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Max-Dohrn-Strasse 8-10, 10589, Berlin, Germany
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13
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Arshdeep, Chougule A, De D, Handa S. Granuloma Annulare–Like Granulomatous Reaction to Red Tattoo Pigment. J Cutan Med Surg 2018; 22:618-620. [DOI: 10.1177/1203475418771614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cutaneous reactions to tattoos can be attributed either to trauma or to the exogenous pigment introduced into the skin. Red pigment is associated with a high sensitizing potential and is the most frequently implicated pigment inducing various types of histological reactions. Herein, we describe a patient with red tattoo pigment-induced granulomatous dermatitis that histologically revealed a very rare granuloma annulare–like reaction.
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Affiliation(s)
- Arshdeep
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Abhijit Chougule
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dipankar De
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjeev Handa
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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14
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Schreiver I, Hesse B, Seim C, Castillo-Michel H, Villanova J, Laux P, Dreiack N, Penning R, Tucoulou R, Cotte M, Luch A. Synchrotron-based ν-XRF mapping and μ-FTIR microscopy enable to look into the fate and effects of tattoo pigments in human skin. Sci Rep 2017; 7:11395. [PMID: 28900193 PMCID: PMC5595966 DOI: 10.1038/s41598-017-11721-z] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 08/29/2017] [Indexed: 11/26/2022] Open
Abstract
The increasing prevalence of tattoos provoked safety concerns with respect to particle distribution and effects inside the human body. We used skin and lymphatic tissues from human corpses to address local biokinetics by means of synchrotron X-ray fluorescence (XRF) techniques at both the micro (μ) and nano (ν) scale. Additional advanced mass spectrometry-based methodology enabled to demonstrate simultaneous transport of organic pigments, heavy metals and titanium dioxide from skin to regional lymph nodes. Among these compounds, organic pigments displayed the broadest size range with smallest species preferentially reaching the lymph nodes. Using synchrotron μ-FTIR analysis we were also able to detect ultrastructural changes of the tissue adjacent to tattoo particles through altered amide I α-helix to β-sheet protein ratios and elevated lipid contents. Altogether we report strong evidence for both migration and long-term deposition of toxic elements and tattoo pigments as well as for conformational alterations of biomolecules that likely contribute to cutaneous inflammation and other adversities upon tattooing.
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Affiliation(s)
- Ines Schreiver
- German Federal Institute for Risk Assessment (BfR), Department of Chemical and Product Safety, Max-Dohrn-Strasse 8-10, 10589, Berlin, Germany
| | - Bernhard Hesse
- European Synchrotron Radiation Facility (ESRF), 38043, Grenoble, Cedex 9, France
| | - Christian Seim
- Physikalisch-Technische Bundesanstalt, Department of X-ray Spectrometry, Abbestrasse 2-12, 10587, Berlin, Germany.,Technische Universität Berlin, Institute for Optics and Atomic Physics, Hardenbergstrasse 36, 10623, Berlin, Germany
| | | | - Julie Villanova
- European Synchrotron Radiation Facility (ESRF), 38043, Grenoble, Cedex 9, France
| | - Peter Laux
- German Federal Institute for Risk Assessment (BfR), Department of Chemical and Product Safety, Max-Dohrn-Strasse 8-10, 10589, Berlin, Germany
| | - Nadine Dreiack
- German Federal Institute for Risk Assessment (BfR), Department of Chemical and Product Safety, Max-Dohrn-Strasse 8-10, 10589, Berlin, Germany
| | - Randolf Penning
- Institute of Forensic Medicine, Ludwig-Maximilians University, Munich, Germany
| | - Remi Tucoulou
- European Synchrotron Radiation Facility (ESRF), 38043, Grenoble, Cedex 9, France
| | - Marine Cotte
- European Synchrotron Radiation Facility (ESRF), 38043, Grenoble, Cedex 9, France
| | - Andreas Luch
- German Federal Institute for Risk Assessment (BfR), Department of Chemical and Product Safety, Max-Dohrn-Strasse 8-10, 10589, Berlin, Germany.
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15
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A case of multiple squamous cell carcinomas arising from red tattoo pigment. Int J Womens Dermatol 2017; 3:228-230. [PMID: 29234718 PMCID: PMC5715212 DOI: 10.1016/j.ijwd.2017.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 07/10/2017] [Accepted: 07/21/2017] [Indexed: 12/19/2022] Open
Abstract
Ornamental tattooing involves the administration of exogenous pigments into the skin to create a permanent design. Our case focuses on a 62-year-old woman who presented with an inflamed enlarging nodule on her right proximal calf, which arose within the red pigment of an ornamental tattoo. The nodule was diagnosed as squamous cell carcinoma (SCC) and subsequently excised. Over the course of the following year, the patient was diagnosed with a total of five additional SCCs that also arose within the red pigment of the tattoo. The increased popularity of tattooing and the lack of industry safety standards for tattoo ink production, especially metal-laden red pigments, may lead to more cases of skin cancer arising within tattoos among patients of all ages.
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16
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Wu BC, Patel ED, Ortega-Loayza AG. Drug-induced pyoderma gangrenosum: a model to understand the pathogenesis of pyoderma gangrenosum. Br J Dermatol 2017; 177:72-83. [PMID: 27864925 DOI: 10.1111/bjd.15193] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2016] [Indexed: 12/14/2022]
Abstract
Pyoderma gangrenosum (PG) is a rare autoinflammatory condition in which the alteration of neutrophil function and the innate immune response play key roles in its pathogenesis. Cases of PG have been reported in patients being treated with certain medications, which may help us to understand some of the possible pathways involved in the aetiology of PG. The aim of this review is to review the cases of PG triggered by certain drugs and try to thoroughly understand the pathogenesis of the disease. To accomplish this, a PubMed search was completed using the following words: pyoderma gangrenosum, neutrophilic dermatosis, pathophysiology, drug-induced pyoderma gangrenosum. In total, we found 43 cases of drug-induced PG. Most of them were caused by colony-stimulating factors and small-molecule tyrosine kinase inhibitors. We propose that drugs induce PG through various mechanisms such as dysfunctional neutrophil migration and function, dysregulated inflammatory response, promotion of keratinocyte apoptosis and alteration of epigenetic mechanisms. PG is a rare condition with complex pathophysiology and drug-induced cases are even more scarce; this is the main limitation of this review. Understanding the possible mechanisms of drug-induced PG, via abnormal neutrophil migration and function, abnormal inflammation, keratinocyte apoptosis and alteration of epigenetic mechanisms would help to better understand the pathogenesis of PG and ultimately to optimize targeted therapy.
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Affiliation(s)
- B C Wu
- Department of Medicine, Drexel University College of Medicine/Hahnemann University Hospital, Philadelphia, PA, U.S.A
| | - E D Patel
- Virginia Commonwealth University School of Medicine, Richmond, VA, U.S.A
| | - A G Ortega-Loayza
- Center for Wound and Healing, Department of Dermatology, Oregon Health & Science University, 3303 SW Bond Avenue, CHD 16D, Portland, OR, 97034, U.S.A
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17
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Meesters AA, De Rie MA, Wolkerstorfer A. Generalized eczematous reaction after fractional carbon dioxide laser therapy for tattoo allergy. J COSMET LASER THER 2016; 18:456-458. [DOI: 10.1080/14764172.2016.1225962] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Arne A. Meesters
- Netherlands Institute for Pigment Disorders (SNIP), Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Menno A. De Rie
- Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
- Department of Dermatology, VU Medical Centre, VU University, Amsterdam, the Netherlands
| | - Albert Wolkerstorfer
- Netherlands Institute for Pigment Disorders (SNIP), Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
- Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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18
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Sherif S, Blakeway E, Fenn C, German A, Laws P. A Case of Squamous Cell Carcinoma Developing Within a Red-Ink Tattoo. J Cutan Med Surg 2016; 21:61-63. [PMID: 27624899 DOI: 10.1177/1203475416661311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cutaneous reactions to tattoos are well reported and include allergic reactions, infections, and foreign body granuloma or may be a presenting sign of sarcoidosis. There have been very few reported cases of squamous cell carcinoma (SCC) arising in tattoo-treated skin. We report a case of SCC arising within a red-ink tattoo and discuss the potential the role of chronic low-grade inflammation in pathogenesis. This should serve to raise awareness of potential tattoo-related serious adverse effects.
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Affiliation(s)
- Sara Sherif
- 1 Dermatology Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Chris Fenn
- 2 Department of Plastic Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Alyn German
- 3 Department of Histopathology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Philip Laws
- 1 Dermatology Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Escudero-Góngora M, Del Pozo L, Knöpfel N, Saus C, Giacaman A, Hierro F. Reactive perforating collagenosis on a tattoo. J Eur Acad Dermatol Venereol 2016; 31:e87-e89. [DOI: 10.1111/jdv.13782] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M.M. Escudero-Góngora
- Department of Dermatology; Hospital Universitari Son Espases; Palma de Mallorca Spain
| | - L.J. Del Pozo
- Department of Dermatology; Hospital Universitari Son Espases; Palma de Mallorca Spain
| | - N. Knöpfel
- Department of Dermatology; Hospital Universitari Son Espases; Palma de Mallorca Spain
| | - C. Saus
- Department of Pathology; Hospital Universitari Son Espases; Palma de Mallorca Spain
| | - A. Giacaman
- Department of Dermatology; Hospital Universitari Son Espases; Palma de Mallorca Spain
| | - F. Hierro
- Tecnoscientific Department; Universitat de les Illes Balears; Palma de Mallorca Spain
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20
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Meade C, Halvorson C, Kao G, Makhzoumi Z. Acute graft-versus-host disease arising within tattooed skin. JAAD Case Rep 2016; 1:114-6. [PMID: 27051702 PMCID: PMC4808711 DOI: 10.1016/j.jdcr.2015.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Christian Halvorson
- Correspondence to: Christian Halvorson, MD, University of Maryland, Department of Dermatology, 419 West Redwood Street, Suite 240, Baltimore, MD 21201.
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Abstract
Tattoos are common and used extensively as either body art or cosmetic make-up; more rarely, they can be traumatic in nature. We have systemically analysed the literature for the patterns of red pigment tattoo reactions and their treatment options. Our search identified 18 articles; there was 1 non-randomised controlled trial, and the rest were small case studies. In total 139 patients were included within the studies. This review systematically analyses the different subsets of red tattoo reactions including lichenoid, dermatitis, granulomatous, pseudolymphomatous and miscellaneous reactions. The current evidence for the treatment for the above is presented. Dermatitis and lichenoid reactions appear to be the most common subtype of red pigment reactions with various treatment methods applied showing laser intervention to have some degree of success.
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22
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Laux P, Tralau T, Tentschert J, Blume A, Dahouk SA, Bäumler W, Bernstein E, Bocca B, Alimonti A, Colebrook H, de Cuyper C, Dähne L, Hauri U, Howard PC, Janssen P, Katz L, Klitzman B, Kluger N, Krutak L, Platzek T, Scott-Lang V, Serup J, Teubner W, Schreiver I, Wilkniß E, Luch A. A medical-toxicological view of tattooing. Lancet 2016. [PMID: 26211826 DOI: 10.1016/s0140-6736(15)60215-x] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Long perceived as a form of exotic self-expression in some social fringe groups, tattoos have left their maverick image behind and become mainstream, particularly for young people. Historically, tattoo-related health and safety regulations have focused on rules of hygiene and prevention of infections. Meanwhile, the increasing popularity of tattooing has led to the development of many new colours, allowing tattoos to be more spectacular than ever before. However, little is known about the toxicological risks of the ingredients used. For risk assessment, safe intradermal application of these pigments needs data for toxicity and biokinetics and increased knowledge about the removal of tattoos. Other concerns are the potential for phototoxicity, substance migration, and the possible metabolic conversion of tattoo ink ingredients into toxic substances. Similar considerations apply to cleavage products that are formed during laser-assisted tattoo removal. In this Review, we summarise the issues of concern, putting them into context, and provide perspectives for the assessment of the acute and chronic health effects associated with tattooing.
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Affiliation(s)
- Peter Laux
- German Federal Institute for Risk Assessment (BfR), Department of Product Safety, Berlin, Germany
| | - Tewes Tralau
- German Federal Institute for Risk Assessment (BfR), Department of Product Safety, Berlin, Germany
| | - Jutta Tentschert
- German Federal Institute for Risk Assessment (BfR), Department of Product Safety, Berlin, Germany
| | - Annegret Blume
- German Federal Institute for Risk Assessment (BfR), Department of Product Safety, Berlin, Germany
| | - Sascha Al Dahouk
- German Federal Institute for Risk Assessment (BfR), Department of Product Safety, Berlin, Germany
| | - Wolfgang Bäumler
- Klinik und Poliklinik für Dermatologie, Universität Regensburg, Regensburg, Germany
| | | | | | | | | | | | | | - Urs Hauri
- Kantonales Laboratorium Basel-Stadt, Basel, Switzerland
| | - Paul C Howard
- US Food and Drug Administration, National Center for Toxicological Research, Jefferson, AR, USA
| | - Paul Janssen
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Linda Katz
- US Food and Drug Administration, College Park, MD, USA
| | - Bruce Klitzman
- Duke University Medical Center, Research Park, Durham, NC, USA
| | - Nicolas Kluger
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lars Krutak
- Smithsonian Institution, Washington, DC, USA
| | - Thomas Platzek
- German Federal Institute for Risk Assessment (BfR), Department of Product Safety, Berlin, Germany
| | | | - Jørgen Serup
- Bispebjerg University Hospital, Department of Dermatology, The Tattoo Clinic, Copenhagen, Denmark
| | | | - Ines Schreiver
- German Federal Institute for Risk Assessment (BfR), Department of Product Safety, Berlin, Germany
| | - Elena Wilkniß
- German Federal Institute for Risk Assessment (BfR), Department of Product Safety, Berlin, Germany
| | - Andreas Luch
- German Federal Institute for Risk Assessment (BfR), Department of Product Safety, Berlin, Germany.
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Abstract
BACKGROUND Tattoos are regarded as body jewelry and have become widespread in all parts of society. Despite introduction of the tattooing agents' regulation (Tätowiermittelverordnung) in Germany in 2009, consumer protection is incomplete. OBJECTIVES Prevalence of tattoos and their legal basis, ingredients of tattooing agents, clinical findings of adverse reactions, pathogenesis and therapy. METHODS The work is based on a selective literature search in PubMed and on the clinical experience of the authors. RESULTS Adverse reactions by tattooing are a particular problem, because the causing substances are not biodegradable within the tissue. In addition to an agonizing pruritus, the clinical picture is characterized by erythematous plaques. Histopathology reveals different patterns of inflammation, including pseudolymphomatous reactions. Treatment is problematic. In many cases, extensive surgical excision is necessary, which is associated with cosmetic consequences. CONCLUSION A regulation to assess the safety of tattooing does not exist.
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Haber R, Farid S. [Granulomatous tattoo reaction confined to red pigment]. Ann Dermatol Venereol 2015; 143:79-80. [PMID: 26640082 DOI: 10.1016/j.annder.2015.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 07/27/2015] [Accepted: 09/08/2015] [Indexed: 11/27/2022]
Affiliation(s)
- R Haber
- Département de dermatologie, hôpital Hôtel-Dieu de France, centre hospitalier, Beyrouth, Liban; Faculté de médecine, université Saint-Joseph, rue Alfred-Naccache, Achrafieh, Beyrouth, Liban.
| | - S Farid
- Département de dermatologie, hôpital Hôtel-Dieu de France, centre hospitalier, Beyrouth, Liban; Faculté de médecine, université Saint-Joseph, rue Alfred-Naccache, Achrafieh, Beyrouth, Liban
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25
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Høgsberg T, Thomsen BM, Serup J. Histopathology and immune histochemistry of red tattoo reactions. Interface dermatitis is the lead pathology, with increase in T-lymphocytes and Langerhans cells suggesting an allergic pathomechanism. Skin Res Technol 2015; 21:449-58. [PMID: 26031754 DOI: 10.1111/srt.12213] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND The majority of tattoo reactions are affiliated to red pigmented areas and often suspected to be allergic in nature. A sizeable series of biopsies of such reactions has not previously been performed. The aim of this study was to type and grade epidermal and dermal changes in tattoo reactions to red/red nuances by microscopy and immunochemistry relevant for the assessment of a possible allergic pathomechanism. METHODS Skin biopsies were taken from red tattoo reactions, graded by conventional microscopy and stained for T and B-lymphocytes, Langerhans cells, macrophages and tumour necrosis factor (TNF)-α. RESULTS The study included 19 biopsies from 19 patients. The culprit colours were red/pink (n = 15) and purple/bordeaux (n = 4). Interface dermatitis was clearly the lead pathology found in 78% of samples, overlapped with granulomatous (in 32%) and pseudolymphomatous reaction patterns (in 32%). Epidermal hyperkeratosis (in 89%) was common as was leakage of red pigment across the dermo-epidermal junction, with transepidermal elimination (in 28%). The dermal cellular infiltration was dominated by T-lymphocytes (in 100%), Langerhans cells (in 95%) and macrophages (in 100%). TNF-α was common. CONCLUSION The predominant histological pattern of chronic tattoo reactions in red/red nuances is interface dermatitis. T-lymphocytes and Langerhans cells are increased suggesting an allergic pathomechanism. TNF-α may contribute to reactions. In many cases, overlapping reactive patterns were identified.
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Affiliation(s)
- T Høgsberg
- Department of Dermatology, Bispebjerg University Hospital, Copenhagen NV, Denmark
| | - B M Thomsen
- Department of Pathology, Bispebjerg University Hospital, Copenhagen NV, Denmark
| | - J Serup
- Department of Dermatology, Bispebjerg University Hospital, Copenhagen NV, Denmark
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26
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Brady BG, Gold H, Leger EA, Leger MC. Self-reported adverse tattoo reactions: a New York City Central Park study. Contact Dermatitis 2015; 73:91-9. [DOI: 10.1111/cod.12425] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 04/13/2015] [Accepted: 04/27/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Bobbi G. Brady
- Department of Medicine; Norwalk Hospital; Norwalk CT 06850
| | - Heidi Gold
- Department of Medicine; Maimonides Medical Center; Brooklyn NY 11219
| | - Elizabeth A. Leger
- Department of Natural Resources and Environmental Science; University of Nevada; Reno NV 89557 USA
| | - Marie C. Leger
- Ronald O. Perelman Department of Dermatology; New York University; New York NY 10016 USA
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27
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Souza ES, Rocha BDO, Batista EDS, Oliveira RFD, Farre L, Bittencourt AL. T-cell-predominant lymphoid hyperplasia in a tattoo. An Bras Dermatol 2015; 89:1019-21. [PMID: 25387518 PMCID: PMC4230682 DOI: 10.1590/abd1806-4841.20143231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 11/11/2013] [Indexed: 11/22/2022] Open
Abstract
Cutaneous lymphoid hyperplasia (CLH) can be idiopathic or secondary to external stimuli, and is considered rare in tattoos. The infiltrate can be predominantly of B or T-cells, the latter being seldom reported in tattoos. We present a case of a predominantly T CLH, secondary to the black pigment of tattooing in a 35-year-old patient, with a dense infiltrate of small, medium and scarce large T-cells. Analysis of the rearrangement of T-cells receptor revealed a polyclonal proliferation. Since the infiltrate of CLH can simulate a T lymphoma, it is important to show that lesions from tattoos can have a predominance of T-cells.
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Gaudron S, Ferrier-Le Bouëdec MC, Franck F, D'Incan M. Azo pigments and quinacridones induce delayed hypersensitivity in red tattoos. Contact Dermatitis 2014; 72:97-105. [DOI: 10.1111/cod.12317] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 10/14/2014] [Accepted: 10/14/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Sophie Gaudron
- Department of Dermatology; Université d'Auvergne, CHU Clermont-Ferrand Hôpital Estaing; Lucie et Raymond Aubrac 63003 Clermont-Ferrand France
| | - Marie-Christine Ferrier-Le Bouëdec
- Department of Dermatology; Université d'Auvergne, CHU Clermont-Ferrand Hôpital Estaing; Lucie et Raymond Aubrac 63003 Clermont-Ferrand France
| | - Frederic Franck
- Department of Pathology; Université d'Auvergne, CHU Clermont-Ferrand Hôpital Estaing; Lucie et Raymond Aubrac 63003 Clermont-Ferrand France
| | - Michel D'Incan
- Department of Dermatology; Université d'Auvergne, CHU Clermont-Ferrand Hôpital Estaing; Lucie et Raymond Aubrac 63003 Clermont-Ferrand France
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30
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Serup J, Hutton Carlsen K. Patch test study of 90 patients with tattoo reactions: Negative outcome of allergy patch test to baseline batteries and culprit inks suggests allergen(s) are generated in the skin through haptenization. Contact Dermatitis 2014; 71:255-63. [DOI: 10.1111/cod.12271] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 05/12/2014] [Accepted: 05/13/2014] [Indexed: 01/13/2023]
Affiliation(s)
- Jørgen Serup
- Department of Dermatology; The ‘Tattoo Clinic’, Bispebjerg University Hospital; DK-2400 Copenhagen Denmark
| | - Katrina Hutton Carlsen
- Department of Dermatology; The ‘Tattoo Clinic’, Bispebjerg University Hospital; DK-2400 Copenhagen Denmark
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31
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Perforating granulomatous dermatitis reaction to exogenous tattoo pigment: a case report and review of the literature. Am J Dermatopathol 2014; 35:754-6. [PMID: 21986232 DOI: 10.1097/dad.0b013e318209f117] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
: The majority of cutaneous hypersensitivity reactions to exogenous tattoo pigments can be histologically classified as lichenoid or granulomatous. The etiology is still uncertain but is generally accepted to be a delayed-type hypersensitivity reaction to either the pigment itself or its carrier solution. In this report, we review the literature concerning adverse reactions to tattoos. In addition, we describe the second case of a localized granulomatous dermatitis to the red dye within a tattoo that histologically resembled granuloma annulare. This is the first reported example of a perforating granuloma annulare-like reaction.
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Marchesi A, Parodi PC, Brioschi M, Marchesi M, Bruni B, Cangi MG, Vaienti L. Tattoo ink-related cutaneous pseudolymphoma: a rare but significant complication. Case report and review of the literature. Aesthetic Plast Surg 2014; 38:471-8. [PMID: 24570180 DOI: 10.1007/s00266-014-0287-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 01/31/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND The demand for decorative tattoos is steadily growing worldwide, and in the US it is estimated that up to 24% of adults has one or more tattoos. Subsequently, the number of tattoo-related complications is increasing. Among these, lymphoproliferative disorders play a minor but important role. The aim of this article is to arouse the awareness of plastic surgeons and dermatologists about this rare but serious complication and to stimulate stricter clinical control of their tattooed patients. METHODS We report a new case of tattoo-related cutaneous pseudolymphoma (CPL) and perform a review of the last 30 years of literature on the topic in PubMed. RESULTS Apart from this new case, only 18 cases of CPL have been reported in PubMed so far. In contrast to the classic knowledge, the T cell was the predominant phenotype in 68% of cases. Red is confirmed to be the most involved ink. Topical and intralesional steroids, laser therapy, and surgery were used for treatment of CPL. CONCLUSIONS Even if CPL is a very rare and benign complication, we should not forget that in rare cases pseudolymphoma may evolve into a true lymphoma. Diagnosis is still difficult and is based on anamnestic, clinical, and histopathological data. From the review of the literature, the T cell predominance suggests a reclassification of tattoo-induced CPL and there is not a gold standard treatment yet. Finally, once a pseudolymphoma is diagnosed, there must be a long follow-up because of the possibility to transform into a malignancy. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Andrea Marchesi
- Dipartimento di Chirurgia Plastica Ricostruttiva, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy,
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33
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Kluger N. Cutaneous complications related to permanent decorative tattooing. Expert Rev Clin Immunol 2014; 6:363-71. [DOI: 10.1586/eci.10.10] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Körner R, Pföhler C, Vogt T, Müller CSL. Histopathology of body art revisited - analysis and discussion of 19 cases. J Dtsch Dermatol Ges 2013; 11:1073-80. [PMID: 23992121 DOI: 10.1111/ddg.12178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 06/20/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVES With the number of tattoos increasing, a rising number of complications have also been reported, such as allergic and foreign body reactions or the development of malignant tumors. We discuss 19 patients with alterations in skin tattoos, define clinicopathologic characteristics and give a brief review of the literature. PATIENTS AND METHODS Biopsy specimens were obtained in 13 of 19 patients. In all cases, staining was performed with hematoxylin-eosin, periodic acid-Schiff, CD68, CD123, and CD163. The inflammatory infiltrate was classified according to the pattern analysis of Ackerman. RESULTS Three of 19 patients (15.8%) had temporary tattoos with henna and 16 (84.2%) had permanent tattoos. Histologically, among the 13 biopsy specimens we found signs of acute contact dermatitis in 2 (15.3%), lupus-like patterns in 2 (15.3%), foreign body dermatitis in 5 (38.4%), deposition of pigment without inflammation or simple scarring in 2 (15.3%), and tumors in 2 patients (15.2%), 1 of which was a malignant melanoma. CONCLUSIONS Clinical presentation frequently, but not always, correlates with the histologic pattern. Obtaining a biopsy can be helpful in determining further investigations, for example allergy testing or a search for systemic involvement in cases of tattoo sarcoidosis.
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Affiliation(s)
- Rebecca Körner
- The Saarland University Hospital, Department of Dermatology, Homburg/Saar, Germany
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Clarkson H, Birch W. Tattoos and human identification: investigation into the use of X-ray and infrared radiation in the visualization of tattoos. J Forensic Sci 2013; 58:1264-1272. [PMID: 23879600 DOI: 10.1111/1556-4029.12237] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 09/11/2012] [Accepted: 10/06/2012] [Indexed: 01/17/2023]
Abstract
Any person with a tattoo known to their family or friends could potentially be identified from the presence of such personal identifying markers. Problems in identification utilizing tattoos may arise when these markers are removed or defaced in some way. This paper uses infrared wavelengths at 760, 850, and 950 nm to improve the visualization of laser-removed or covered up tattoos and also to establish whether the ink pigments used can be observed on radiographs from any metal that may be present. The results obtained indicate that some older inks have a high enough metallic content to allow them to be viewed on a radiograph, while infrared light can demonstrate latent ink still present in the skin after laser removal and can also be utilized to distinguish an original tattoo through a secondary "cover-up" tattoo. Infrared photography and radiography have been shown to improve tattoo visualization in a forensic context.
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Affiliation(s)
- Helen Clarkson
- UCL Institute of Archaeology, 31-34 Gordon Square, London, WC1H OPY, U.K
| | - Wendy Birch
- Anatomy Laboratory, University College London, Rockefeller Building 21, University Street, London, WC1E 6JJ, U.K
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36
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Høgsberg T, Jacobsen NR, Clausen PA, Serup J. Black tattoo inks induce reactive oxygen species production correlating with aggregation of pigment nanoparticles and product brand but not with the polycyclic aromatic hydrocarbon content. Exp Dermatol 2013; 22:464-9. [DOI: 10.1111/exd.12178] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Trine Høgsberg
- Department of Dermatology; Copenhagen University Hospital; Bispebjerg, Copenhagen NV Denmark
| | | | - Per Axel Clausen
- National Research Centre for the Working Environment; Copenhagen Ø Denmark
| | - Jørgen Serup
- Department of Dermatology; Copenhagen University Hospital; Bispebjerg, Copenhagen NV Denmark
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Gardair Bouchy C, Kerdraon R, Kluger N, Armingaud P, Wakosa A, Estève E. [Cutaneous lymphoid hyperplasia (pseudolymphoma) on the red dye of a tattoo]. Ann Pathol 2013; 33:273-7. [PMID: 23954123 DOI: 10.1016/j.annpat.2013.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Revised: 04/07/2013] [Accepted: 04/08/2013] [Indexed: 10/26/2022]
Abstract
Cutaneous lymphoid hyperplasia (pseudolymphoma) on tattoo is rare. The diagnosis is histological. We report a case of cutaneous lymphoid hyperplasia within the red ink of a tattoo found on a 35-year-old man presenting multiple infiltrated nodules confined to the red areas of his tattoo, which he had done 2 months ago. The pathological examination showed a diffuse lympho-histiocytic dermo-hypodermal infiltrate, associated with a lichenoid reaction. Immunohistochemistry displayed T-cell infiltration (CD3+, CD5+, CD8+). The treatment is difficult, knowing that the spontaneous regression seems possible, and the progression into a lymphoma is exceptional in the case of a chronic evolution over a number of years.
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Wenzel SM, Rittmann I, Landthaler M, Bäumler W. Adverse reactions after tattooing: review of the literature and comparison to results of a survey. Dermatology 2013; 226:138-47. [PMID: 23689478 DOI: 10.1159/000346943] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 12/24/2012] [Indexed: 11/19/2022] Open
Abstract
The number of tattooed people has substantially increased in the past years. Surveys in different countries reveal this to be up to 24% of the population. The number of reported adverse reactions after tattooing has also increased including infections, granulomatous and allergic reactions and tumors. However, the case reports do not reflect the frequency of adverse reactions. This review compares the medically documented adverse reactions published in 1991-2011 with the findings of a nation-wide survey that recently revealed the features and health problems associated with tattoos. To compare the data with the survey, the sex of patients was reported and the location and color of tattoos were evaluated. The results show clearly that colored tattoo inks are mainly responsible for adverse skin reactions and that tattoos on the extremities are involved most.
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Affiliation(s)
- Sabrina M Wenzel
- Department of Dermatology, University of Regensburg Medical Center, Regensburg, Germany
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Høgsberg T, Hutton Carlsen K, Serup J. High prevalence of minor symptoms in tattoos among a young population tattooed with carbon black and organic pigments. J Eur Acad Dermatol Venereol 2012; 27:846-52. [DOI: 10.1111/j.1468-3083.2012.04590.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cruz FAM, Lage D, Frigério RM, Zaniboni MC, Arruda LHF. Reactions to the different pigments in tattoos: a report of two cases. An Bras Dermatol 2011; 85:708-11. [PMID: 21152800 DOI: 10.1590/s0365-05962010000500019] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 03/19/2010] [Indexed: 11/22/2022] Open
Abstract
Tattoos are defined as the intentional or accidental deposit of pigment into the skin. These pigments have been associated with various dermatoses such as allergic contact dermatitis, lichenoid dermatitis, photoinduced reactions, and granulomatous, sarcoid and pseudolymphomatous reactions. The objective of this report was to describe the various types of reactions to pigments and the importance of recognizing them clinically. Two cases are reported: one of lichenoid dermatitis resulting from a reaction to the red pigment of a tattoo and the other of a pseudolymphoma resulting from a reaction to red and lilac pigments and a photo-induced reaction to a yellow pigment. Removal generally requires multiple forms of treatment, most of which fail to remove the colors completely.
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Pasolini G, Ghidini P, Arisi M, Pedretti A, Ungari M, Pinton PC. Pseudolymphoma tattoo-induced. Dermatol Reports 2011; 3:e47. [PMID: 25386299 PMCID: PMC4211496 DOI: 10.4081/dr.2011.e47] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 10/14/2011] [Accepted: 10/24/2011] [Indexed: 11/22/2022] Open
Abstract
Tattooing has become more and more popular in today's society. The most common dermatological tattoo complications are represented by hypersensitivity reaction to tattoo pigments like irritant and allergical contact dermatitis, development of lichenoid areas and granulomatous responses, such as sarcoid granulomas or foreign body granulomas. Less frequently patients developing discoid lupus erythematous have been reported. Pseudolymphoma is an uncommon reactive lymphocytic proliferation mimicking the histological and clinical features of a malignant skin lymphoma. We herein report a pseuldoymphoma limited to the red area of a multicolour tattoo of the leg.
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Affiliation(s)
| | | | | | | | - Marco Ungari
- Department of Pathology, Spedali Civili di Brescia, University of Brescia, Italy
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Les tatouages : histoire naturelle et histopathologie des réactions cutanées. Ann Dermatol Venereol 2011; 138:146-54; quiz 144-5, 155. [DOI: 10.1016/j.annder.2010.08.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 08/05/2010] [Accepted: 08/26/2010] [Indexed: 11/20/2022]
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New Insight into the Pathophysiology of Tattoo Reactions following Laser Tattoo Removal. Plast Reconstr Surg 2010; 126:313e-314e. [DOI: 10.1097/prs.0b013e3181f63fde] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yoong C, Vun YY, Spelman L, Muir J. True blue football fan: Tattoo reaction confined to blue pigment. Australas J Dermatol 2010; 51:21-2. [DOI: 10.1111/j.1440-0960.2009.00608.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Guzzi G, Spadari F, Pigatto PD. Re: Removal of an amalgam tattoo using a subepithelial connective tissue graft and laser deepithelialization. J Periodontol 2009; 80:1909-10; author reply 1910. [PMID: 19961372 DOI: 10.1902/jop.2009.090434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Forte G, Petrucci F, Cristaudo A, Bocca B. Market survey on toxic metals contained in tattoo inks. THE SCIENCE OF THE TOTAL ENVIRONMENT 2009; 407:5997-6002. [PMID: 19766292 DOI: 10.1016/j.scitotenv.2009.08.034] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 08/19/2009] [Accepted: 08/25/2009] [Indexed: 05/28/2023]
Abstract
Tattooing practice is adopted worldwide and represents an important socio-cultural phenomenon, but, the injection into the skin of coloring agents as metals might pose a risk for allergies and other skin inflammations as well as for systemic diseases. In this context, 56 inks for tattooing purchased from 4 different supply companies were analyzed for metal concentration. Aliquots of pigments were microwave digested by nitric acid, fluoridric acid and hydrogen-peroxide and Al, Ba, Cd, Co, Cr, Cu, Fe, Hg, Mn, Ni, Pb, Sb, Sr and V were quantified by sector field inductively coupled plasma mass spectrometry. Limits of quantification varied from 0.07 ng/ml (Cd) to 10 ng/ml (Al and Fe); recoveries ranged from 92% (Cd and Sb) to 109% (Sr); within- and between-day precisions were 3.2% and 4.67% on average. The relative contribution of metals to the tattoo inks composition was highly variable between brands and colors, even in pigments with the same base color. Elements found as the main components of inks were as follows (in microg/g): Al, 1.59-5893; Ba, 0.058-1226; Cu, 0.076-31,310; Fe, 0.717-88,443; Sr, 0.174-36.4. Toxic metals as Cd, Mn, Pb, Sb and V were over the 1 microg/g in a few cases, while Hg was in traces. Among the allergenic metals, Cr was the highest (0.315-147 microg/g), followed by Ni (0.037-9.59 microg/g) and Co (0.0028-6.43 microg/g) then. On 56 tattoo inks, Cr, Ni and Co exceeded the safe allergological limit of 1 microg/g in 62.5%, 16.1% and 1.8% of cases, respectively.
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Affiliation(s)
- Giovanni Forte
- Istituto Superiore di Sanità, Viale Regina Elena 299, Rome, Italy
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Chalmers C. Appraising the need for tighter control over the practices of the tattooing and body piercing industry. J Infect Prev 2009. [DOI: 10.1177/1757177409105650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Tattooing and body piercing have had a resurgence in popularity over the past few decades, taking the activities of the industry from a place on the fringes of society into a position of mainstream status. This shift has led to debate on the level of legislation and control over the industry's practices, where concerns around risk to public health from such practices have prompted calls for tighter control over the industry (Anderson, 2006; Noah, 2006). This debate, however, is arguably more complex than simply reflecting upon the association between tattooing and body piercing activities and the risk of infection. This is the second in a three-part series of articles on the topical issue of tattooing and body piercing. It highlights and discusses additional key factors that have been influential, either explicitly or implicitly, within the debate to determine the need for tighter controls over the tattooing and body piercing industry.
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Affiliation(s)
- Claire Chalmers
- University of the West of Scotland, Hamilton Campus, Almada Street, Hamilton ML3 0JB,
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