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

Background/Aims: Tattooing is a global trend. Clinical knowledge of complications is based on case reports collected over a century. Larger cohorts reflecting complications associated with contemporary trends are lacking. Methods: The study was a retrospective review of a consecutive cohort of patients with tattoo complications diagnosed in the “Tattoo Clinic“ of Bispebjerg University Hospital in Copenhagen, Denmark, from 2008 to 2015, based on patient history and systematic clinical examination. Results: A total of 493 tattoo complications in 405 patients were studied. Overall, 184 (37%) presented allergic reactions with plaque elevation in 32.2%, excessive hyperkeratosis in 3.7%, and ulceration in 1.4%, predominantly observed in red tattoos and nuances of red; 66 (13%) presented papulo-nodular reactions, mainly observed in black tattoos (considered non-allergic) and due to pigment agglomeration; 53 (11%) had bacterial infections; 46 (9%) were psycho-social complications; 144 (30%) belonged to several specific diagnostic entities, including photosensitivity, pain syndrome, and lymphopathy. We found no cases of cutaneous or other malignancies. Sarcoidosis was primarily seen in black tattoos and was a common associated disease, found in 23 reactions (5%), compared to the background population. Conclusion: The study introduces a new concept of classification of tattoo complications based on simple tools such as patient history and objective findings supplemented with histology. The study reflects complications originating from presently used tattoo inks, often with organic pigments. The introduced classification has been submitted to the World Health Organisation (WHO) as a proposal to the 11th revision of the International Classification of Diseases.

[1]  C. McBride,et al.  Association Between Causal Beliefs and Shoe Wearing to Prevent Podoconiosis: A Baseline Study. , 2016, The American journal of tropical medicine and hygiene.

[2]  A. Luch,et al.  A medical-toxicological view of tattooing , 2016, The Lancet.

[3]  J. Serup,et al.  Histopathology and immune histochemistry of red tattoo reactions , 2015, Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging.

[4]  H. Wulf,et al.  Black tattoos protect against UVR‐induced skin cancer in mice , 2015, Photodermatology, photoimmunology & photomedicine.

[5]  Y. Murata,et al.  Natural course of keratoacanthoma and related lesions after partial biopsy: Clinical analysis of 66 lesions , 2015, The Journal of dermatology.

[6]  J. Serup,et al.  Patients with tattoo reactions have reduced quality of life and suffer from itch , 2015, Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging.

[7]  C. Thum,et al.  Inflammatory Complications Related to Tattooing: A Histopathological Approach Based on Pattern Analysis , 2015, The American Journal of dermatopathology.

[8]  H. Westh,et al.  Tattoos - health, risks and culture: with an introduction to the 'seamless prevention strategy' , 2015 .

[9]  W. Bäumler,et al.  Tattooed Skin and Health , 2015 .

[10]  J. Serup Seamless prevention of adverse events from tattooing: integrated strategy emphasising the customer-tattooist interaction. , 2015, Current problems in dermatology.

[11]  L. Bonadonna Survey of studies on microbial contamination of marketed tattoo inks. , 2015, Current problems in dermatology.

[12]  M. Shinohara,et al.  Complications of Decorative Tattoos: Recognition and Management , 2014, American Journal of Clinical Dermatology.

[13]  J. Serup,et al.  Patch test study of 90 patients with tattoo reactions: Negative outcome of allergy patch test to baseline batteries and culprit inks suggests allergen(s) are generated in the skin through haptenization , 2014, Contact dermatitis.

[14]  J. Serup,et al.  Photosensitivity and photodynamic events in black, red and blue tattoos are common: A ‘Beach Study’ , 2014, Journal of the European Academy of Dermatology and Venereology : JEADV.

[15]  N. Kluger Sarcoidosis on tattoos: a review of the literature from 1939 to 2011. , 2013, Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG.

[16]  J. Serup,et al.  High prevalence of minor symptoms in tattoos among a young population tattooed with carbon black and organic pigments , 2013, Journal of the European Academy of Dermatology and Venereology : JEADV.

[17]  N. Jacobsen,et al.  Black tattoo inks induce reactive oxygen species production correlating with aggregation of pigment nanoparticles and product brand but not with the polycyclic aromatic hydrocarbon content , 2013, Experimental dermatology.

[18]  M. Landthaler,et al.  Adverse Reactions after Tattooing: Review of the Literature and Comparison to Results of a Survey , 2013, Dermatology.

[19]  J. Serup,et al.  Microbial status and product labelling of 58 original tattoo inks , 2013, Journal of the European Academy of Dermatology and Venereology : JEADV.

[20]  M. Shinohara,et al.  The histopathologic spectrum of decorative tattoo complications , 2012, Journal of cutaneous pathology.

[21]  U. Wollina Severe Adverse Events Related to Tattooing: An Retrospective Analysis of 11 Years , 2012, Indian journal of dermatology.

[22]  V. Koljonen,et al.  Tattoos, inks, and cancer. , 2012, The Lancet. Oncology.

[23]  N. Kluger [Cutaneous infections related to permanent tattooing]. , 2011, Medecine et maladies infectieuses.

[24]  L. Magee,et al.  Hyperalgesia After Volar Wrist Tattoo: A Case of Complex Regional Pain Syndrome? , 2011, Journal of clinical neuromuscular disease.

[25]  N. Kluger [Cutaneous infections related to permanent tattooing]. , 2011, Medecine et maladies infectieuses.

[26]  A. Baumgartner,et al.  Hygienic-microbiological quality of tattoo- and permanent make-up colours , 2011, Journal für Verbraucherschutz und Lebensmittelsicherheit.

[27]  N. Kluger Cutaneous complications related to permanent decorative tattooing , 2010, Expert review of clinical immunology.

[28]  M. Landthaler,et al.  Incidence of Health Problems Associated with Tattooed Skin: A Nation-Wide Survey in German-Speaking Countries , 2010, Dermatology.

[29]  B. Balme,et al.  Cutaneous lymphoid hyperplasia (pseudolymphoma) in tattoos: a case series of seven patients , 2010, Journal of the European Academy of Dermatology and Venereology : JEADV.

[30]  C. Raulin,et al.  Tattoo removal by non‐professionals – medical and forensic considerations , 2009, Journal of the European Academy of Dermatology and Venereology : JEADV.

[31]  H. Maibach,et al.  Cutaneous allergic reactions to tattoo ink , 2009, Journal of cosmetic dermatology.

[32]  M. Landthaler,et al.  Photochemical cleavage of a tattoo pigment by UVB radiation or natural sunlight , 2007, Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG.

[33]  N. Tsankov,et al.  Tattoos: dermatological complications. , 2007, Clinics in dermatology.

[34]  M. Landthaler,et al.  Tattoo Pigments are Cleaved by Laser Light—The Chemical Analysis In Vitro Provide Evidence for Hazardous Compounds¶ , 2004, Photochemistry and photobiology.

[35]  Ronald W. England,et al.  Immediate cutaneous hypersensitivity after treatment of tattoo with Nd:YAG laser: a case report and review of the literature. , 2002, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[36]  J. Post,et al.  Tattoo-related brachial plexopathies with adjacent muscle atrophy. , 2001, Annals of internal medicine.

[37]  L. Rickman,et al.  Infectious complications of tattoos. , 1994, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.