Tattoos are defined as the introduction of exogenous pigments into the dermis in order to produce a permanent design. This process may occur unintentional or may be deliberately administered for cosmetic or medical reasons.
Tattoos have been around for over 5000 years and over time have evolved to represent a common cosmetic practice worldwide. Currently, adverse reactions are relatively rare and generally unpredictable and predominantly include immune-mediated reactions and skin
infections. Along with better healthcare standards and more stringent public health mandates such as the provision of disposable needles, major infectious complications related to
hepatitis and human retroviral
infections have decreased significantly. When they do occur, skin
infections are most frequently associated with Staphylococcus aureus or Streptococcus pyogenes. The aim of this study is to review the types and rates of medical complications of permanent
tattoos. PubMed search and search dates were open ended. Acute local
inflammation is the most common complication, but
infections,
allergic contact dermatitis, and other inflammatory or immune responses that are not well-characterized may occur. As many patients with immune reactions to
tattoos do not react on skin or patch testing, it is postulated that the
antigens contained in
dyes or pigments are such small molecules that they need to be haptenized in order to become immunogenic. Red ink is associated more frequently with long-term reactions, including granulomatous and pseudolymphomatous phenomena or
morphea-like lesions and
vasculitis. Exacerbation of preexisting
psoriasis,
atopic dermatitis, and
pyoderma gangrenosum may occur after
tattooing. There is no well-defined association between
cancer and
tattoos. The treatment of
tattoo-related complications may include local destructive measures (
cryotherapy, electro-surgery,
dermabrasion, chemical destruction, ablative
laser destruction), surgical excision, and thermolysis of the pigment using
Q-switched laser therapy.