Tattoo removal by non‐professionals – medical and forensic considerations

Abstract

Tattoos are common phenomena in the western world and the demand for their removal has become widespread in the recent years. The introduction of quality-switched lasers has provided an effective removal method that is increasingly being exploited by tattoo studios themselves. Dermatologists, however, are frequently confronted with complications and side effects of tattoo removals that were performed by non-professionals. The objective of this study is to assess potential risks and pitfalls of laser tattoo removal when performed by medical laymen. The methods followed are systematic and evidence-based review of the literature. Four major problem areas were identified: rare but potentially severe allergic or toxic effects of decomposition products of the tattoo pigments; bodily harm caused by out-of-specification usage of the laser devices; malignant disease that is obscured within the area of a tattoo and requires meticulous dermatological diagnosis; and insufficient pre-operative consultation of patients about the risks, side effects and realistic expectations on the therapeutic outcome. We came to a conclusion that tattoo laser removal by medical laymen is unacceptable from the point of view of patient safety and the laws need to ban this practice swiftly.

Classification of Tattoo Complications in a Hospital Material of 493 Adverse Events

“…Indeed, acute allergic reactions including anaphylactic reaction as well as delayed flare up of allergic reactions of the treated tattoos have been reported during or shortly after laser removal of tattoos [32][33][34] . The use of laser equipment by an inexperienced layperson (cosmetologist, tattooist, or private person) can result in numerous complications [35] . Treating doctors and tattooists should constantly develop their knowledge and skills.…”

Skin Care in the Tattoo Parlor: A Survey of Tattoo Artists in New York City

“…In New York State, laser tattoo removal is considered a medical procedure and may only be performed by licensed medical professionals, so we did not ask NYC tattoo artists about their experiences with laser removal. Studies suggest that laser removal by nonmedical professionals may be dangerous as they may not be equipped to manage complications of the procedure [22]. Further research in regions where laser tattoo removal by nonmedical professionals is legal is needed to understand laser removal practices of tattoo artists.…”

Behandlungsfehler durch medizinische Laien bei Laser‐ und IPL‐Anwendungen: Ergebnisse einer bundesweiten Erhebung

“…Vordergründig legalisiert wird dieses Vorgehen durch die Aussage, dass keine Behandlung von Krankheiten vorgenommen werden würde. Infolge dessen, so die Argumentationskette, könne auch eine ärztliche Diagnostik entfallen und eine Durchführung der Maßnahmen von angelernten Hilfskräften vorgenommen werden [3].…”

“…Am pro-blematischsten ist die Entstehung von Pseudomelanomen (postinterventionell) sowie das Lasern pigmentierter Hautveränderungen unklarer Dignität ohne vorherige Diagnostik oder histologischer Kontrolle. Eventuell bestehende Melanome könnten durch den Pigmentverlust unentdeckt fortschreiten und metastasieren [3][4][5][6][7][8][9][10].…”

“…nicht mehr durchführbar. Die Diagnostik einer beispielsweise durch Tätowierungen kaschierten bösartigen Hautveränderung kann selbst für einen erfahrenen Dermatologen schwierig sein und liegt defi nitiv außerhalb der Kompetenz eines Laien [2,3,15]. Darüber hinaus ist nach der AWMF-Leitlinie "Melanozytäre Nävi" die Anwendung von Laser-und IPL-Geräten bei melanozytären Nävi kontraindiziert [16].…”