II. A short history of tattooing

Henna Tattoo: From Cosmetic Purposes to Dermatological Reactions

Introduction

Henna, commonly used as a hair dye, is also used for temporary tattoos. It is commonly mixed with para-phenylenediamine (PPD) to enhance color intensity, which may induce cutaneous sensitization.

Aim

This study aimed to describe the clinicodemographic features of patients with dermatological reactions to henna tattoos.

Materials and Methods

This cross-sectional study, included patients with dermatological reactions to henna tattoos. All the patients were subjected to entire medical history including clinicodemographic data and general and dermatological examinations.

Results

This study included 17 female patients with a mean age of 26.88 ± 6.6 years. Of these 17 patients; 41.2% were suburban residents, 58.8% were housewives, 70.6% were married, and 47.1% were middle socioeconomic class and 53% had type IV Fitzpatrick skin. All used black color and commercial henna for cosmetic purposes, 41.2% used market henna, and 35.3% used coiffeur henna. Many (70.6%) had localized reactions with 23.5% presenting with reaction of hands, 64.7% had acute eczematous reactions, and all had a progressive course. The mean duration of the reaction was 6.76 ± 2.6 days. The mean latency time of the reaction was 2.7 ± 0.85 days.

Conclusion

This study concluded that public awareness of possible cutaneous reactions to henna tattoos should be increased. The health authority legislation should control the use of black henna to minimize the consequences.

Tattoos in Psychodermatology

Tattooing is a permanent form of body art applied onto the skin with a decorative ink, and it has been practiced from antiquity until today. The number of tattooed people is steadily increasing as tattoos have become popular all over the world, especially in Western countries. Tattoos display distinctive designs and images, from protective totems and tribal symbols to the names of loved or lost persons or strange figures, which are used as a means of self-expression. They are worn on the skin as a lifelong commitment, and everyone has their own reasons to become tattooed, whether they be simply esthetic or a proclamation of group identity. Tattoos are representations of one’s feelings, unconscious conflicts, and inner life onto the skin. The skin plays a major role in this representation and is involved in different ways in this process. This article aims to review the historical and psychoanalytical aspects of tattoos, the reasons for and against tattooing, medical and dermatological implications of the practice, and emotional reflections from a psychodermatological perspective.

[Secondary surgical and medical treatment of scars]

The authors, through their experience, take stock of current secondary management of scars whether they are pathological (hypertrophic, cheloid) or dystrophic (enlarged, hypo- or hyper-pigmented, adherent) by presenting surgical or medical solutions.

Hypersensitivity reactions due to black henna tattoos and their components: are the clinical pictures related to the immune pathomechanism?

Hypersensitivity to para-phenylenediamine (PPD) and related compounds induced by temporary black henna tattoos has become a serious health problem worldwide. Different patterns of sensitization with various clinical aspects are described in literature due to PPD associated to henna tattoo and these manifestations are likely correlated with the immunological and dermatological pathomechanisms involved. Henna is the Persian name of the plant Lawsonia inermis, Fam. Lythraceae. It is a woody shrub that grow in regions of North Africa, South Asia, India and Sri Lanka. Nowadays it is rather frequent to see temporary "tattoos" performed with henna. To make tattoos darker and long-lasting PPD has been associated to henna in tattoo drawings mixtures, so obtaining "black henna". In these years there has been a rise of contact sensitization to PPD and in medical literature an increased number of cases have been reported on temporary henna tattoo application. Here we review the various clinical patterns related to PPD and henna tattoo, to investigate the possible link between clinic-morphological pictures and the immunological response to PPD and henna. The literature underlines that different clinical manifestations are related to black henna containing PPD, and its derivative products may cause delayed-type as well as immediate-type reactions. Further studies are needed to investigate the relationship between clinical and morphological aspects of PPD contact dermatitis and the T cell subsets predominance.

Growing trend of tattooing and its complications in Nigeria

Tattoo, a Polynesian word meaning 'to mark', is a form of body modification done by inserting indelible ink into the dermis to change its pigmentation. Tattoos are done for social, cultural, and religious purposes. It has been in existence since the 18th century and was associated with sailors, lower class individuals, and criminals. However, since the late 20th century, tattooing has undergone a redefinition and shifted to an acceptable form of expression all over the world, including Nigeria, cutting across almost all age groups and socioeconomic class. This review is aimed at highlighting the indication, complications arising from the procedure as well as removal, and how to manage them. The dermatological complications associated with tattoos can occur either during inking or attempts at removal. Most times, tattoos are obtained through unsafe means by unauthorized personnel, and this is associated with numerous health risks. Of particular importance to the dermatologists are the hypersensitivity reactions, granulomatous skin disease, and formation of both keloid and hypertrophic scars. Treatment options vary and include use of silicone gel and intralesional steroids for hypertrophic and keloid scars, topical medication for hyperpigmentation, and use of LASER for tattoo removal. In conclusion, the trend of tattooing has become a widely accepted form of social expression all over the world and is gradually gaining ground in Nigeria. Patients frequently present to the dermatologists and physicians for solutions to the complications. It is important to proffer solutions and educate patients on the various health risks associated with tattooing.

Tattoo Removal: Selecting the Right Alternative

Because an ideal method for removing tattoos still eludes us, a plethora of alternatives described in the literature is available. Selecting the right treatment modality requires familiarity with both the advantages and the disadvantages of each technique being considered. This paper attempts to summarize the attributes and pitfalls of commonly used methods of tattoo removal to assist the surgeon in choosing the most suitable method.

Prison tattoos as a reflection of the criminal lifestyle

The purpose of this study was to examine the relationship between prison tattoos and the criminal lifestyle and recidivism. Participants consisted of 81 male inmates with prison tattoos (i.e., prison-themed or prison-made tattoos), 75 inmates with nonprison tattoos (e.g., animal tattoos, tattoos of ethnic origin), 52 male inmates with no tattoos, and 66 college students with tattoos. Results indicated that inmates with prison tattoos differed from inmates with nonprison tattoos, inmates without tattoos, and college students with tattoos with regard to criminal thinking styles, were at increased risk of recidivism, and presented more institutional behavioral problems, resulting in more disciplinary infractions. There were no significant differences between inmate groups with regard to number of convictions; however, additional group comparisons indicated that inmates with visible tattoos and antisocial-themed tattoos were at greater risk for recidivism and received more disciplinary infractions than inmates without visible or antisocial-themed tattoos. Implications of these findings are discussed.

Medical applications of tattooing

Tattooing is an ancient procedure, practiced by humans from all parts of the world for a variety of reasons. However, relatively little is known by the medical audience of the numerous medical conditions where tattooing is employed as a therapeutic modality or a diagnostic method. Tattooing for cosmetic and medicinal purposes, referred to as either micropigmentation, dermatography, or medical tattooing, may ensure permanent camouflage in a wide range of dermatological diseases. It can be a valuable finishing step in several surgical procedures in the fields of craniofacial surgery, plastic and reconstructive operations, cosmetic surgery procedures, and breast reconstruction. Other fields of application of medical tattooing include radiation therapy, endoscopic surgery, and ophthalmology.

Response of mouse skin to tattooing: use of SKH-1 mice as a surrogate model for human tattooing

Tattooing is a popular cosmetic practice involving more than 45 million US citizens. Since the toxicology of tattoo inks and pigments used to formulate tattoo inks has not been reported, we studied the immunological impact of tattooing and determined recovery time from this trauma. SKH-1 hairless mice were tattooed using commercial tattoo inks or suspensions of titanium dioxide, cadmium sulfide, or iron oxide, and sacrificed at 0.5, 1, 3, 4, 7, or 14 days post-tattooing. Histological evaluation revealed dermal hemorrhage at 0.5 and 1 day. Acute inflammation and epidermal necrosis were initiated at 0.5 day decreasing in incidence by day 14. Dermal necrosis and epidermal hyperplasia were prominent by day 3, reducing in severity by day 14. Chronic active inflammation persisted in all tattooed mice from day 3 to 14 post-tattooing. Inguinal and axillary lymph nodes were pigmented, the inguinal being most reactive as evidenced by lymphoid hyperplasia and polymorphonuclear infiltration. Cutaneous nuclear protein concentrations of nuclear factor-kappa B were elevated between 0.5 and 4 days. Inflammatory and proliferative biomarkers, cyclooxygenase-1, cyclooxygenase-2, and ornithine decarboxylase protein levels were elevated between 0.5 and 4 days in the skin and decreased to control levels by day 14. Interleukin-1 beta and interleukin-10 were elevated in the lymph nodes but suppressed in the tattooed skin, with maximal suppression occurring between days 0.5 and 4. These data demonstrate that mice substantially recover from the tattooing insult by 14 days, leaving behind pigment in the dermis and the regional lymph nodes. The response seen in mice is similar to acute injury seen in humans, suggesting that the murine model might be a suitable surrogate for investigating the toxicological and phototoxicological properties of ingredients used in tattooing.

Lasers in dermatology

The use of dermatologic laser therapy is rapidly expanding. Thirty years of experience has produced advances in the technology, techniques, and therapeutic efficacy of dermatologic lasers. The original lasers have been improved and modified, and new types of lasers have expanded the dermatologist's therapeutic repertoire. Extensive research has provided a greater understanding of the skin's clinical and histologic response to laser treatment. This has allowed dermatologists to expand their therapeutic options and techniques and to improve clinical outcome.

Red tattoo reactions: X-ray microanalysis and patch-test studies

Eighteen patients who developed cutaneous reactions to red tattoos were studied to identify the chemicals responsible for the reactions to modern red tattoo pigments. Biopsies from the tattoos were examined histologically and the chemical composition of the red pigments was analysed by X-ray microanalysis. A variety of metallic elements including aluminium, iron, calcium, titanium, silicon, mercury and cadmium were detected. Patch tests were performed to the relevant chemicals in nine cases, and only one patient reacted to mercury. This study demonstrates that although reactions to mercury still occur, other red dyes containing a variety of inorganic pigments may provoke a cutaneous inflammatory response.

A superior method of tattoo removal using the Q-switched ruby laser

The Q-switched ruby laser was used to treat 101 amateur and 62 professional tattoos in 80 patients over a period of 22 months. Using a 5- to 8-mm spot size and energy fluences of 2-4 joules/cm2, an average of three retreatments resulted in complete pigment removal in four, nearly complete pigment removal in 84, significant pigment removal in 11, and minimal pigment removal in two amateur tattoos. Using identical parameters for professional tattoos, there was complete pigment removal in two, nearly complete pigment removal in five, significant pigment removal in 18, minimal pigment removal in 25, and very little pigment removal in 12. Professional tattoos with red, yellow, and green pigments faded, but required multiple retreatments. While transient hypopigmentation occurred in many patients, skin texture and hair growth returned to normal in all cases and no hypertrophic scarring was seen.

Tattoo removal using serial tangential excision and polyurethane membrane dressing

A technique using serial split-thickness tangential excisions and polyurethane membrane dressings for removal of decorative tattoos is described.

Significance of tattoos in male psychiatric patients

The study investigated the social background and current social stability of 45 tattooed males. Tattooed subjects compared to non-tattooed controls were more likely to report leaving home and school early, to report spending a period in a boys' institution and in prison, and showed greater current instability with regard to accommodation and employment. Tattoos were significantly associated with a current diagnosis of personality disorder and alcoholism and past treatment for drug abuse and parasuicide.