Identification of pigments related to allergic tattoo reactions in 104 human skin biopsies

Abstract

Background Red tattoos are prone to allergic reactions. The identity of the allergen(s) is mostly unknown. Objectives Chemical analysis of human skin biopsies from chronic allergic reactions in red tattoos to identify culprit pigment(s) and metals. Material and methods One hundred four dermatome biopsies were analyzed by matrix‐assisted laser desorption/ionization tandem mass spectrometry (MALDI‐MS/MS) for identification of commonly used organic pigments. Metal concentrations were assessed by inductively coupled plasma (ICP)‐MS and x‐ray fluorescence (XRF). Fourteen patients had cross‐reactions in other red tattoos. Results In total, the identified pigments were mainly azo Pigment Red (P.R.) 22 (35%), P.R. 210 (24%), P.R. 170 (12%), P.R. 5 (0.9%), P.R. 112 (0.9%), and Pigment Orange (P.O.) 13 (11%). P.R. 122 (0.9%) and Pigment Violet (P.V.) 23 (8%) were also common. P.R. 22, P.R. 170, and P.R. 210 also dominated in patients with cross‐reactions. In 22% of the biopsies, no red pigment was detected. Element analysis indicated the presence of the sensitizers nickel and chromium. Conclusions P.R. 22, P.R. 170, and P.R. 210 were identified as the prevailing pigments behind chronic allergic reactions in red tattoos. The epitope causing the reaction might be a pigment‐degradation product. Metal contamination may derive from different sources, and its role in red tattoo allergy cannot be ascertained.

Keratoacanthomas and Squamous Cell Carcinomas on Tattoos: A Review of 42 Cases

“…P.R. 170 is not the most prevailing pigment found in skin biopsies from chronic red allergic reactions, but it is still found in 12% of the cases [20]. In our experience, we had 1 patient with a lichenoid reaction to red associated with KA, but we failed to find similar cases in our review.…”

High‐frequency (20 MHz) high‐intensity focused ultrasound: New ablative method for color‐independent tattoo removal in 1‐3 sessions. An open‐label exploratory study

“…The department has a specialized Tattoo Clinic treating tattoo complications, and a laser section which on special indications performs Nd:YAG-laser removal of tattoos. [29][30][31][32] The surgical unit has special experience in removal of tattoos with allergic reactions to red azo pigment by dermatome shaving. 10…”

Safety of tattoos and permanent make-up: a regulatory view

“…Also, the poor penetration of the test substance into the skin may lead to a false-negative readout (Steinbrecher et al 2004). Recently, the analysis of skin biopsies of patients with allergic reactions against tattoos allowed the identification of organic pigments as well as metal ions with most frequent abundance (Serup et al 2019). Among the organic pigments, azo class pigments were found in most of the biopsies analyzed.…”