Complications of tattoos and permanent makeup: overview and analysis of 308 cases

Abstract

Background: Worldwide 10-20% of the population is tattooed. However, tattoo complications can occur, such as allergic tattoo reactions, infections, and manifestations of autoimmune dermatoses. Despite the growing popularity of tattoos and changes in tattoo ink composition over the last decades, little is known about these complications, its clinical aspects, pathomechanism, and relative occurrence.Objective: The aim of this article is to describe the types and clinical aspects of dermatological tattoo complications, its relative occurrence and underlying conditions. Methods:We performed a retrospective cohort study enrolling all patients with tattoo complications from the Tattoo Clinic. Tattoo complications were categorized into infections, inflammatory tattoo reactions, neoplasms, or miscellaneous reactions and correlated to clinical data.Results: Of the total of 326 patients, 301 patients were included with 308 complications. The majority of the complications were chronic: 91.9%. Allergic red tattoo reactions and chronic inflammatory black tattoo reactions (CIBTR) accounted for 50.2% and 18.2%, respectively, of all tattoo complications. Of these CIBTR reactions, extracutaneous involvement was found in 21.4%, including tattoo-associated uveitis (7.1%) and systemic sarcoidosis (14.2%). Of all black tattoo reactions, systemic sarcoidosis was found in 7.8%. Conclusion:Tattoos can cause a wide range in complications that may start years after getting the tattoo. The most frequent tattoo reactions are allergic red tattoo reactions and chronic inflammatory black tattoo reactions, making these the most relevant for the dermatologist. CIBTR have a high percentage of multi-organ involvement, and therefore, screening for sarcoidosis, including ocular involvement, is advised.

Treatment of a refractory allergic reaction to a red tattoo on the lips with methotrexate and Q-switched Nd-Yag laser

“… 4 Allergic reactions to red tattoo ink are the most frequently encountered complications in dermatologic practice. 5 These reactions are characterized by chronic pain and itch associated with swelling and hyperkeratosis, sometimes leading to ulceration and crusting, which is sharply confined to the red-tattooed skin. 6 The histopathology is predominated by histiocytes, sometimes in granulomatous formation, and frequently in combination with an interface dermatitis.…”

Immediate and sustained effects of cobalt and zinc-containing pigments on macrophages

“…Moreover, the activation of CD11b, which is linked to the anti-tumor immune response [89], will be impossible in CD11b-negative cells, and may contribute to a lower anti-tumoral activity. Thus, the increase in the CD11b-negative population that we observed on pigment-treated cells, especially after the recovery period, may be linked to the observed inflammatory complications linked to tattoos [4,6,7]…”

“…Moreover, the activation of CD11b, which is linked to the anti-tumor immune response [89], will be impossible in CD11b-negative cells, and may contribute to a lower anti-tumoral activity. Thus, the increase in the CD11b-negative population that we observed on pigment-treated cells, especially after the recovery period, may be linked to the observed inflammatory complications linked to tattoos [4,6,7] Overall, the macrophages treated with zinc and cobalt-containing pigments appear less efficient against pathogens, may be less efficient against tumors and they also seem to have a more proinflammatory basal phenotype. Moreover, based on results, macrophages should be less efficient in their key role in tissue renewal (elimination of cellular debris and apoptotic cells via efferocytosis).…”

“…For example, red inks can induce a delayed type-IV allergy, black inks can induce chronic inflammations such as granulomatous inflammation or sarcoidosis. [6]. Blue pigments (suspected to contained cobalt) and other colors such as purple or white, could also be linked to sarcoidosis.…”

“…As a comparison, according to Agence Nationale de Sécurité du Médicament et des produits de santé (ANSM, the French drug regulatory agency), an adverse reaction to a product is considered to be frequent when it is found in 1 to 10% of people. It also appears that the effects vary depending on the colors used [4,[6][7][8].…”