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Medical Complications of Tattoos: A Comprehensive Review

Abstract

Tattoos are defined as the introduction of exogenous pigments into the dermis in order to produce a permanent design. This process may occur unintentional or may be deliberately administered for cosmetic or medical reasons. Tattoos have been around for over 5000 years and over time have evolved to represent a common cosmetic practice worldwide. Currently, adverse reactions are relatively rare and generally unpredictable and predominantly include immune-mediated reactions and skin infections. Along with better healthcare standards and more stringent public health mandates such as the provision of disposable needles, major infectious complications related to hepatitis and human retroviral infections have decreased significantly. When they do occur, skin infections are most frequently associated with Staphylococcus aureus or Streptococcus pyogenes. The aim of this study is to review the types and rates of medical complications of permanent tattoos. PubMed search and search dates were open ended. Acute local inflammation is the most common complication, but infections, allergic contact dermatitis, and other inflammatory or immune responses that are not well-characterized may occur. As many patients with immune reactions to tattoos do not react on skin or patch testing, it is postulated that the antigens contained in dyes or pigments are such small molecules that they need to be haptenized in order to become immunogenic. Red ink is associated more frequently with long-term reactions, including granulomatous and pseudolymphomatous phenomena or morphea-like lesions and vasculitis. Exacerbation of preexisting psoriasis, atopic dermatitis, and pyoderma gangrenosum may occur after tattooing. There is no well-defined association between cancer and tattoos. The treatment of tattoo-related complications may include local destructive measures (cryotherapy, electro-surgery, dermabrasion, chemical destruction, ablative laser destruction), surgical excision, and thermolysis of the pigment using Q-switched laser therapy.

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Acknowledgments

The authors appreciate the expertise and advice, including use of photographs from Dr. Nejib Doss of Tunis and Dr. I. Mendez-Moguel of Belize.

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Correspondence to M. Eric Gershwin.

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Islam, P.S., Chang, C., Selmi, C. et al. Medical Complications of Tattoos: A Comprehensive Review. Clinic Rev Allerg Immunol 50, 273–286 (2016). https://doi.org/10.1007/s12016-016-8532-0

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Keywords

  • Pigment
  • Dye
  • Ink
  • Skin infection
  • Dermatitis
  • Cancer
  • Laser
  • Tattoo
  • Type IV hypersensitivity reaction
  • Delayed type hypersensitivity reaction
  • Granulomatous reactions
  • Skin prick testing
  • Patch testing