An update on cutaneous complications of permanent tattooing

ABSTRACT

Introduction: Decorative tattooing involves the introduction of exogenous pigments and/or dyes into the dermis to produce a permanent design.

Areas covered: This review provides an overview of the current aspects of cutaneous complications associated with permanent tattooing and permanent make-up based on the previous reviews of interest, case series, and case reports of interest. References for this review were found through a search of PubMed by use of the terms ‘tattoo’, ‘tattoos’, or ‘tattooing’.

Expert opinion: Complications include primarily infections, allergy to tattoo pigments, benign, and sometimes malignant tumors arising on tattoos and the localization of various dermatoses to tattoos. Immunocompromised patients and individuals with chronic conditions should be able to discuss with their physician and ask advice before getting tattooed. Tattoo color allergy still remains an unsolved issue. The identification of current culprit failed. It is most likely a byproduct that appears in situ in the skin during the life of the tattooed bearer. Studies involving expert centers are warranted to establish the best treatments for tattoo allergy. The risk of tattoo associated cancers appears to this author as largely overstated. However, case controls studies on large on cohorts of individuals with or without tattoos could help to evaluate whether tattoos have a possible in role in cancers.

KEYWORDS:

• Allergy
• cancer
• tattoo
• infection
• ink
• pigment
• hypersensitivity reaction

Article Highlights

• Hypersensitivity reactions (or allergies) to tattoo inks are currently the most common complication on a tattoo, but they are unpredictable.

• Microscopic examination of a skin sample helps to distinguish various histopathological patterns such as eczematous, lichenoid, granulomatous, and pseudo-lymphomatous reactions.

• Epicutaneous patch tests are not reliable.

• Any granulomatous tattoo reaction, even restricted to one color, should prompt evaluation for sarcoidosis.

• Patients with a known cutaneous disease should be warned of a potential risk of localization of their disease to the tattoo.

• Skin cancers on tattoos are still considered so far as coincidental, except for keratoacanthomason red tattoos.

• Patients with chronic conditions and/or impaired immunity should discuss with their physician about the possibility and when to have a tattoo.

Declaration of interest

N Kluger has received honoraria for expertise from Bayer (2016), Beiersdorf (2018) and Bioderma (2019). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.