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SEPTEMBER 1903
TATTOOS--". The practice has been defined by Maurice Berchon as 'that strange and
very ancient custom which consists in the introduction under the cutaneous epidermis, at
different depths, of coloring matter, in order to produce some design which will be of
very long duration.'
Source: Scientific American, Sep2003, Vol. 289 Issue 3, p22, 1p
Abstract Tattoos are placed for different reasons. A technique for tattoo removal which
produces, with minimal risk of scarring, is needed. Nonspecific methods have a high
incidence of
scarring, textural, and pigmentary alterations compared with the use of Q-switched lasers.
With new advances
in Q-switched laser technology, tattoo removal can be achieved with minimal risk of
scarring and permanent
pigmentary alteration.
There are five types of tattoos:. Amateur tattoos
require less treatment sessions than professional multicolored tattoos. Other factors to
consider when evaluating
tattoos for removal are: location, age and the skin type of the patient.
Treatment should begin by obtaining a pre-operative history. Since treatment with the Qswitched lasers is
painful, use of a local injection with lidocaine or topical anaesthesia cream may be used
prior to laser treatment.
Topical broad-spectrum antibacterial ointment is applied immediately following the
procedure.
Three types of lasers are currently used for tattoo removal: Q-switched ruby laser
(694nm), Q-switched
Nd:YAG (Neodymium-doped Yttrium Aluminum Garnet) laser (532nm, 1064nm),
and Q-switched alexandrite laser (755nm). The Q-switched ruby and alexandrite
lasers are useful for removing black, blue and green pigments. The Q-switched
532nm Nd:YAG laser
can be used to remove red pigments and the 1064nm Nd:YAG laser is used for
removal of black and blue
pigments.
The most common adverse effects following laser tattoo treatment with the Q-switched
ruby laser include
textural change, scarring, and pigmentary alteration. Transient hypopigmentation and
textural changes have
been reported in up to 50 and 12%, respectively, of patients treated with the Q-switched
alexandrite laser.
Hyperpigmentation and textural changes are infrequent adverse effects of the Qswitched Nd:YAG laser and
the incidence of hypopigmentary changes is much lower than with the ruby laser.
The development of localized
and generalized allergic reactions is an unusual complication following tattoo
removal with the Q-switched
ruby and Nd:YAG lasers.
Since many wavelengths are needed to treat multicolored tattoos, not one laser
system can be used alone to
remove all the available inks and combination of inks. While laser tattoo removal is
not perfect, we have come
a long way since the advent of Q-switched lasers. Current research is focusing on
newer picosecond lasers,
which may be more successful than the Q-switched lasers in the removal of the new
vibrant tattoo inks.
REVIEW ARTICLE Am J Clin Dermatol 2001; 2 (1): 21-25
1175-0561/01/0001-0021/$22.00/0
© Adis International Limited. All rights reserved.
Tattoos are placed for different reasons:[1]
• cultural (tribal and gang-related);
• medical (delineating a radiation port);
• cosmetic (lip, eyebrow, and eyeliner and flesh tones);
• recreational;
• traumatic.
A technique which produces selective removal of each tattoo
pigment, with minimal risk of scarring, is needed. Nonspecific
methods, such as surgical excision, dermabrasion, and carbon dioxide
laser vaporization, as well as salabrasion, electrosurgery, and
cryosurgery have a much higher incidence of scarring, textural,
and pigmentary alterations than the Q-switched lasers.[2-7]
Our ability to treat tattoos has been enhanced by the development
of the Q-switched ruby, Q-switched Nd:YAG, and Qswitched
alexandrite lasers. This article will summarize the traditional
and modern methods for laser tattoo removal.
In 1964, Dr Leon Goldman development the first laser for
tattoo removal, a normal mode ruby laser. However, this technique
for tattoo removal was soon abandoned. Interest was reawakened
in the 1980s and 1990s. In the 1980s, in Scotland, Reid and coworkers[
8] reported that the Q-switched ruby laser was useful for
the removal of both amateur and professional blue-black tattoos
with minimal cutaneous adverse effects. Amateur tattoos were
found to clear in 4 to 6 sessions, while professional tattoos required
1 to 3 more additional sessions.[9] Eighty percent of amateur
and 65% of professional tattoos were found to lighten considerably
after 6 to 8 treatments.[10]
Researchers have compared the carbon dioxide laser and the
argon laser for tattoo removal. The carbon dioxide laser is a continuouswave laser that emits light at 10 600nm. Its main chromophore
is water. The argon laser is also a continuous-wave laser
emitting blue-green light at 488 to 514nm. Since these modalities
cause nonspecific thermal injury, there is a high potential for scarring.
The argon laser was shown to be less injurious than the
carbon dioxide laser to the surrounding tissue, but thermal damage
caused by the long exposure time still led to scar formation
in many cases.[11]
In 1983, Drs Rox Anderson and John Parrish described the
theory of selective photothermolysis.[12] Selectivity is achieved
by choosing a laser wavelength that is maximally absorbed by the
cutaneous chromophore. Then damage can be confined to that
target by limiting the pulse duration to less than the thermal relaxation
time of the cutaneous chromophore. The thermal relaxation
time is the time that it takes for the target tissue to lose 50%
of its incident heat without conducting heat to the surrounding
tissue. Thermal relaxation time varies directly with the square of
the diameter. This is determined only by the size of the chromophore,
that is, the larger the size, the longer the thermal relaxation
time.[7] Since there is only minimal absorption by the surrounding
tissue, peripheral injury is limited.[12] In tattoos, the target chromophore
is the exogenous tattoo ink.
The mechanism of tattoo clearance has been analyzed and
studied extensively. Prior to treatment, tattoo pigment is found in
membrane bound granules in fibroblasts, macrophages, and mast
cells, which are located perivascularly.[9] The photoacoustic effect,
produced by the Q-switched laser, ruptures these pigment
containing cells, sending a ‘shock wave’ throughout the tissue. A
neutrophilic response occurs shortly thereafter and the altered tattoo
pigment is repackaged in fibroblasts, macrophages, and mast
cells while some is taken to the lymphatic spleen. This accounts
for some lightening. In addition, some pigment is eliminated by
transepidermal migration. The tattoo pigment that remains may
also be less visible due to change in its optical properties.
1. Treatment
A pre-operative history should be obtained in all patients. It
should include a history of keloidal scarring, treatment with isotretinoin
in the past year, and allergies to antibacterial ointments.
Written information regarding the procedure is useful and should
be given to the patient preoperatively. Representative before and
after photographs are also helpful. The patients should be advised
that many treatments will be required and total removal of tattoo
pigment may not be possible. Patients should also be advised that
if they think they will be unsatisfied with only partial removal of
their tattoo that it may not be wise to pursue treatment.
Since treatment with the Q-switched lasers is painful, many
patients request local injection with lidocaine (xylocaine) prior to
laser treatment. For some patients topical anaesthesia using
‘EMLA’ cream (eutectic mixture of lidocaine-prilocaine) may be
adequate. Topical broad-spectrum antibacterial ointment is applied
immediately following the procedure. Postoperative wound
care consists of normal saline or hydrogen peroxide 3% used to
gently clean the wound and the application of a topical antibacterial
ointment, twice daily, until the wound has reepithelialized.
Strict sun avoidance and sunblock is advised to minimize hyperpigmentation.
However, if it does occur, hydroquinone therapy
with sunblock is started twice daily until resolution occurs.[13]
There are many issues that are important in evaluating the
candidate for successful tattoo removal. Several generalizations
can be made that are useful in this process. Amateur tattoos require
less treatment sessions compared with professional multicolored
tattoos. Tattoos that are distally located are more difficult
to remove which may be related to lymphatic drainage. The age
of the tattoo is also relevant since over time the body slowly disperses
the ink via lymphatic drainage. In general, older tattoos are
easier to remove and require fewer treatments. Patients with
darker skin types have a higher risk of pigmentary alteration and
possible scarring. For these patients, longer wavelength lasers
may be more appropriate because there is less interference with
melanin.[13]
1.1 Type of Tattoo
The laser surgeon must consider the type of tattoo to be removed
because this will affect the clearance and complication
rates. The 5 major types of tattoos are amateur, professional, cosmetic,
medicinal, and traumatic.
1.1.1 Decorative Amateur Tattoos
Some examples include those placed by tribal and gang
members. The amateur tattoo usually consists of black India ink.
Since these tattoos are placed unevenly and superficially in the
dermis, they respond well to laser treatment, with fewer treatments
and more complete clearance.
1.1.2 Professional Tattoos
In the past, these types of tattoos were commonly seen in
military men and bikers. However, with today’s changing trends
people of all ages and socioeconomic strata are obtaining professional
tattoos. Unfortunately, these tattoos do pose difficulties for
the laser surgeon. These tattoos are placed more deeply in the
dermis with a greater density of pigment. The colors are very
vibrant and diverse in shade. Since there is no government regulation
on tattoo pigment or control over the adulteration of the
pigments, the tattoo artist may mix or even overlay the inks so
that it is difficult to identify which pigments have been utilized.
Therefore, it is complex, not only to identify the multiple color
combinations, but also to choose the appropriate lasers for these
colors. Black pigment is best treated with Q-switched Nd:YAG,
ruby, or alexandrite lasers. Red pigment responds to Q-switched
Nd:YAG 532nm; blue and green is best treated by Q-switched
alexandrite and Q-switched ruby.[14]
1.1.3 Cosmetic Tattoos
Cosmetic tattoos are applied for a variety of reasons including
disguising scars, broadening lips, eye and lip liners, covering
periorbital pigmentation, or providing rosy cheeks. The colors
that are used most frequently are off-white, reddish-brown, red,
flesh tones (skin-colored), or dull orange. Many of these cosmetic
tattoos are made with iron pigments. Iron has 2 different oxidation
states: as ferrous oxide which is black, and ferric oxide which
is a red-brown color. Upon exposure to the Q-switched laser energy
the ferric oxide undergoes a reduction reaction to become
ferrous oxide, a black pigment. The adverse effect known as ‘paradoxical
darkening’ was first described by Anderson et al.[15]
While it can occur following Q-switched laser treatment of any
tattoo with brown, white, or flesh-tone colors, it is usually seen
with cosmetic tattoos. A test treatment of all cosmetic tattoos
should be performed since this gray-black color will then require
many more treatments for removal.[16-18]
1.1.4 Medicinal Tattoos
These types of tattoos are often placed to designate a radiation
port during cancer therapy. After patients are in remission,
they are often anxious to remove these signs of illness. Fortunately,
these India ink blue-black tattoos are often easily removed
in 1 to 2 sessions.
1.1.5 Traumatic Tattoos
Traumatic tattoos can occur following different types of injury
to the skin. This method of introducing tattoo pigment can
occur following abrasion or explosion. Gunpowder and particulate
matter following motorcycle and bicycle accidents are examples
of these types of tattoos.
1.2 Types of Laser
Three lasers are currently used for tattoo removal: Qswitched
ruby laser (694nm), Q-switched Nd:YAG laser (532nm,
1064nm), and Q-switched alexandrite laser (755nm). The wavelength,
pulse duration, and colors for each laser system are shown
in table I.
1.2.1 Q-switched Ruby Laser
The Q-switched ruby is composed of a ruby crystal (aluminum
oxide), which has a crystal lattice with a chromium impurity
inside of it. The crystal is surrounded by a helical flashlamp. In
the Q-switched mode, very high power is achieved by allowing
the energy to build up inside the optical cavity. The laser has a
wavelength of 694nm, a 28 to 40 nsec pulse width (over 108
W/cm2), and injures to a depth of about 1mm into skin. The laser
has a mirrored articulated arm and a choice of two spot sizes
(5mm and 6.5mm) and has a frequency of 1Hz. Treatment of
tattoos is usually started at 6 to 8 J/cm2 with a 5mm spot size and
performed ideally with 10% overlap of pulses. The ideal tissue
response is whitening without epidermal injury. This whitening
is due to high temperatures generated causing the accumulation
Table I. Summary of characteristics of lasers used for tattoo removal[14]
Laser Wavelength Pulse duration Tattoo colors that
can be treated
Alexandrite 755nm (Q-switched) 50-100ns Black, blue, green
Ruby 694nm (Q-switched) 28ns Black, blue, green
Nd:YAG 532nm (Q-switched) 10ns Red
1064nm 10ns Black, blue
Laser Tattoo Removal 23
of water vapor in the skin. If tissue perforation occurs, then the
fluence may need to be lowered. The 694nm wavelength is well
absorbed by melanin, blue-black and green tattoo pigment. When
Levine and Geronemus[19] compared the Q-switched ruby with
the Q-switched Nd:YAG lasers, they concluded that both lasers
were effective in removing black amateur and professional tattoos.
The Q-switched Nd:YAG was less effective in removing
green pigment.
1.2.2 Q-switched Nd: YAG Laser
The Q-switched neodymium: yttrium-aluminum-garnet
(QSNd:YAG) laser was developed in 1989. It is a solid state, high
fluence laser containing a crystal rod of yttrium-aluminum-garnet
doped with 1 to 3% neodynium ions. Its emission is in the near
infrared range at 1064nm, with a pulse duration of 10 to 20 nsec.
The laser emission can be doubled in frequency by placing a
potassium-titanyl-phosphate (KTP) crystal inside the laser cavity
and focusing the beam through the crystal, producing a green light
at 532nm. The laser has a mirrored articulated arm; spot sizes vary
according to the exact model from 0.8 to 8mm and fluences from
1 to 12 J/cm2. Treatment is performed with 10% overlap of pulses.
At a wavelength of 532nm fluences of 2 to 4 J/cm2 are used to
treat red tattoos. When the 1064nm wavelength is used, fluences
of 5 to 6 J/cm2 (3 to 4mm spot size) are appropriate.[13] The 1064nm
option is best suited to black and blue-black tattoos, and the
532nm wavelength is used for red pigment.
Given its longer wavelength, this laser does not have as high
an affinity for melanin as does the Q-switched ruby laser. It may
be more useful in the treatment of tattoos in darker skinned individuals.
Gravelink et al.[20] performed a small comparative study
using the Q-switched ruby laser and Q-switched Nd:YAG laser
in the treatment of tattoos in patients with Fitzpatrick skin types
V and VI. They showed the Q-switched Nd:YAG laser to be
superior in pigment removal with a lower risk of hypopigmentation.
1.2.3 Q-switched Alexandrite Laser
The Q-switched alexandrite laser (755nm, pulse duration
from 50 to 100nsec) delivers its energy via a flexible fibreoptic
arm. Target chromphores include blue, black, and green tattoo
pigments.
Fitzpatrick and Goldman[21] used the Q-switched alexandrite
laser (3mm spot size, fluences from 4 to 8 J/cm2) to treat 17
patients with professional, and 8 patients with amateur tattoos.
More than 95% of the tattoo pigment was removed in an average
of 8.9 sessions. Alster[22] examined the Q-switched alexandrite in
conjunction with a 510nm pulsed dye laser. 24 multicolored professional
tattoos and 18 blue-black amateur tattoos were treated
with the 755nm, 100nsec Q-switched alexandrite; the 510nm laser
was used to treat the red tattoos. Removal of amateur tattoos
required 4.6 treatments, professional tattoos required 8.5, and red
tattoos required 2 treatments. No adverse sequelae were noted.
2. Adverse Effect Profiles
The most common adverse effects following laser tattoo
treatment with the Q-switched ruby laser include textural change,
scarring, and pigmentary alteration. Since the wavelength of
694nm is well absorbed by melanin, the most common adverse
effect reported is hypopigmentation. While it is usually transient,
it may be permanent. Depigmentation is much rarer. This is particularly
important when treating patients with Fitzpatrick types
IV and V skin.[21] Textural changes have also been noted with
both the Q-switched ruby and Nd:YAG lasers.[23] While higher
fluences may be successful in tattoo pigment removal, the risk of
adverse effects is greater.
The development of localized and generalized allergic reactions
is an unusual complication following tattoo removal with
the Q-switched ruby and Nd:YAG lasers. Ashinoff et al.[24] reported
2 women were treated with both laser systems simultaneously
and developed delayed, pruritic reactions. One of the
patients was biopsied revealing spongiotic dermatitis consistent
with an id reaction. The reactions responded to treatment with
antihistamines and topical and/or systemic corticosteroids. In patients
experiencing such reactions, an alternative treatment
should probably be implemented, since it cannot be predicted
when a more severe systemic reaction might occur.[24]
While the etiology of these allergic reactions is unknown, it
is known that since tattoo pigment has an intracellular location
prior to laser treatment, it is therefore in an immune protected site.
Following laser treatment when the pigment becomes extracelluar,
it can now be recognized by the immune system as a
foreign antigen.
The safety profile of Q-switched Nd:YAG laser and ruby
lasers is very similar although the incidence of hypopigmentation
is much lower, with the Q-switched Nd:YAG laser.[19,23] Hyperpigmentation
and textural changes are infrequent adverse effects
of the Q-switched Nd:YAG laser.
Transient hypopigmentation in as much as 50% of patients
and a 12% incidence of textural changes has been reported with
the Q-switched alexandrite laser.[21]
3. Conclusion
Since many wavelengths are needed to treat multicolored
tattoos, not one laser system can be used alone to remove all the
available inks and combination of inks. While laser tattoo removal is not perfect, we have come a long way since the advent
of Q-switched lasers.
Since the newer vibrant tattoo colors can be quite resistant to
all Q-switched lasers currently available, current research is focusing
on newer picosecond lasers, which may be more successful
in the removal of these tattoo inks.[25]
TattooedCouple.jpg
Source: National Review, 06/05/2000, Vol. 52 Issue 10, p55, 2p
Who in the rainbow can draw the line where the
violet tint ends and the orange tint begins? Distinctly
we see the difference of the colors, but
where exactly does the one first blendingly enter
into the other?
H. Melville, Billy Budd, Sailor
The word "tattoo" (from the Polynesian tatau, from ta, meaning to strike or collide with)
became part of the English vocabulary in 1769, when James Cook visited the Pacific
island of Tahiti on his first voyage around the world. "Both sexes," he wrote, "paint their
bodys Tattow as it is called in their language, this is done by inlaying the Colour of black
under their skins in such a manner as to be indelible. Some have ill design'd figures of
men birds or dogs, the women generaly have this figure Z simply on ever joint of their
fingures and toes."
Source: Natural History, Nov99, Vol. 108 Issue 9, p80, 2p
The Maoris began tattooing as early as the 11th century, using chisels made of bone
and a mixture of water or fat and charcoal for ink. Women were tattooed on the lips
and chin, while men were often marked all over the face. (Unlike needle tattooing,
chisel tattooing makes a grooved scar in the skin in addition to the pattern.)
In the 18th century, Capt. James Cook, astounded by the detailed blue patterns
inscribed on the faces of the Maoris, brought their word "tattow" back to Europe,
where it evolved into the English "tattoo."
Source: Civilization, Jul/Aug95, Vol. 2 Issue 4, p27, 1p
ABSTRACT
Background. The use of lasers has assumed an increasingly important role in the
treatment of a variety of cutaneous lesions over the past few decades. Because of their
effectiveness, physicians from a variety of specialties have incorporated lasers into their
practices. Unfortunately, widespread availability of lasers and the public's fascination
with their potential uses have created extraordinary, often unrealistic, expectations.
Methods. We review the laser systems most frequently used to treat skin conditions.
Results. We discuss lasers with specificity for vascular malformations and pigmentary
disorders as well as for tattoos and scars. Also, we review the latest techniques for
cutaneous laser resurfacing with carbon dioxide and erbium: YAG lasers. Last, we briefly
outline future uses of lasers and ongoing investigations, including laser treatment of leg
veins and laserassisted hair removal.
Conclusions. Lasers, when properly used, offer clear advantages when compared with
older, traditional approaches. Laser technology is clearly at its best when the
characteristics of selectivity and specificity apply. Significant improvement and even
elimination of many cutaneous lesions can now be accomplished with reduced risks to
the patient when proper patient selection and laser treatment parameters are chosen.
As LASER TECHNOLOGY continues to evolve, treatment options for a variety of
cutaneous lesions expand and improve. The advent of new lasers with innovative
technology will continue to set high standards in the treatment of vascular, pigmented,
tattooed, and scarred lesions. We review the different lasers available for use in various
cutaneous conditions.
LASER BASICS
The first laser was developed in 1959, 32 years after Einstein had proposed the concept of
stimulated emission. In 1963, dermatologist Leon Goldman was the first physician to test
this prototype ruby laser in human skin.(n1)
Laser, an acronym for light amplification by stimulated emission of radiation, has
several therapeutically physical properties: (1) monochromaticity--the ability to
selectively target chromophores with an appropriately single wavelength; (2)
coherence--the proper alignment of light waves, allowing high intensity to be
focused over a small area; (3) compressibility--the use of ultra short pulses that
delivers localized energy; and (3) collimation--the transmission of parallel rays of
light without divergence or loss of intensity as the distance increases, thus creating a
spot size that is maintained over a wide distance. Selective target destruction occurs if
the laser wavelength is appropriate and the light exposure time (pulse duration) is shorter
than the time it takes for heat to diffuse from the target (thermal relaxation time).(n2,n3)
This theory of "selective photothermolysis" is important when treating small cutaneous
targets to prevent unnecessary tissue damage that could lead to scarring or unwanted
pigmentary changes.
LASER TYPES
Continuous wave (CW) lasers (argon, krypton, older Nd:YAG and CO2 lasers) emit
a constant beam of light in contrast to the pulsed lasers (510 and 585 nm pulsed dye,
Q-switched or QS ruby, QS Nd:YAG, QS alexandrite) that produce interrupted
bursts of high energy light. In general, selective photothermolysis of various cutaneous
lesions is better achieved using pulsed laser technology because of the short thermal
relaxation times of cutaneous chromophores such as hemoglobin and melanin. Each laser
system has different clinical applications, depending on its wavelength and pulse duration
(Table 1).,
PIGMENT LASERS
Q-Switched Ruby Laser (694 nm)
The ruby laser was the first to be shown effective in the treatment of dermal pigmentation
without scarring. Quality or "Q"-switching of the laser light permitted the production of
energy densities (fluences) of up to 10 J/cm2, thereby improving tissue heating and
destruction. Because melanin absorbs light well in the deep red portion of the
electromagnetic spectrum, the 694 nm wavelength of the ruby laser with a 20 to 40
nanosecond (ns) pulse duration is perfect for selective absorption by melanosomes.
Another benefit of this laser is the greater dermal depth of penetration of its long
wavelength, being particularly useful for the treatment of deep pigmented lesions such as
nevus of Ota.
The laser-irradiated skin shows immediate and transient whitening, lasting up to 30
minutes, followed by erythema and swelling for 30 to 60 minutes. Vesiculation may
occur in 24 to 36 hours, and healing is complete by 10 to 14 days.
The ruby laser is successfully used for the treatment of solar lentigines (5 to 6J/cm2, 1 to
2 treatments) and ephelides,(n4) isolated labial lentigos or in association with PeutzJeghers syndrome,(n1,n5,n6) nevus of Ota (5 to 6J/cm2 4 to 6 treatments),(n7,n11) blue
nevi, as well as other melanocytic nevi.(n12,n13) Ruby laser irradiation of Becker's
nevus, nevus spilus, and cafe-au-lait lesions (5 to 6 J/cm2, 3 to 4 treatments) are
associated with a high rate of recurrence, usually seen within 6 to 12 months after
treatment.(n4,n14) Post-inflammatory hyperpigmentation and melasma are not typically
responsive to the ruby laser.(n15) Complications of treatment are temporary
hypopigmentation (lasting 2 to 6 months), transient hyperpigmentation (in 15% of cases),
and rarely permanent depigmentation. The incidence of scarring or epidermal atrophy is
< 5%.
Q-Switched Alexandrite Laser (755 nm)
The Q-switched alexandrite laser emits red light at a slightly longer wavelength (75.5
nm) and pulse duration (50 to 100 ns) than the ruby laser. Treatment is usually initiated at
a thence of 6.0 to 6.5 J/cm2 with a 3 mm spot size. Repeat treatments are delivered at 6to 8week intervals to allow for adequate tissue healing. As with the ruby laser, the Qswitched alexandrite laser can also be used to treat epidermal and dermal pigmented
lesions, such as solar lentigines (Fig 1), benign melanocytic nevi, and nevus of
Ota.(n16,n17) Similar to other pigment-specific lasers, recurrence of cafe-au-lait macules
has been reported after treatment. Transient hypopigmentation after treatment is not as
commonly observed as after ruby irradiation.
Q-Switched Nd:YAG Laser (1,064 nm, 532 nm)
The Nd:YAG laser emits an infrared light at 1,064 nm with a pulse duration of 10 ns.
Frequency doubling of the 1,064 nm wavelength will result in a 532 nm visible green
light. The shorter 532 nm wavelength is better used for the treatment of lentigines, cafeaulait macules, and other epidermal pigmented lesions,(n18,n20) whereas the longer
1,064 nm wavelength is used for treatment of deep dermal pigment, such as in nevus of
Ota and other melanocytic nevi. Typically, 2 to 5 treatments are required at an average
fluence of 8 J/cm2 with a 3 mm spot size to effect the desired degree of lightening.(n19)
Complications include hypopigmentation or hyperpigmentation and transient textural
changes at higher fluences.
Pigmented Lesion Dye Laser (510 nm)
The pigmented lesion dye laser emits a green light at 510 nm with a 300 ns pulse
duration. It is proven effective in the treatment of epidermal pigmented lesions, including
cafe-au-lait spots and solar lentigines.(n21-n26) Unlike solar lentigines, which clear after
1 to 2 treatments at 2.5 J/cm2, cafe-au-lait macules usually require multiple laser sessions
(6 to 8 treatments) at 2-month intervals, using fluences of 2.5 to 3.5 J/cm2. Transient
pigmentary changes are observed in 15% of treated cafe-au-lait lesions.
Copper Vapor Laser (578 nm)
The copper vapor laser emits a green light at 510 nm and a yellow beam at a wavelength
of 578 nm. Brief 20 ns pulses are delivered with 67 Mu s intervals between pulses. The
ability of this laser to emit pulses at a high repetition rate (15,000 pulses/sec = 15 kHz)
qualifies this system as a quasi-CW laser. At 510 nm, lentigines, cafe-au-lait macules,
and dermatosis papulosa nigra can be successfully treated, whereas at 578 nm, vascular
lesions such as telangiectasias can be targeted.(n27) Because of the quasi-CW nature of
this laser system, nonspecific tissue thermal damage may occur with increased risk of
pigmentary and textural skin changes.
TATTOO LASERS
Before laser technology, exogenous pigment was treated with more damaging techniques
such as dermabrasion and excision, resulting in scar formation or pigmentary changes.
Lasers have revolutionized the treatment of tattoos, offering acceptably desirable results.
The older laser systems, such as the CW CO2 and argon lasers, also led to scarring due to
excessive thermal injury of normal skin. The Q-switched lasers that produce ultra short
pulses of high energies literally shatter tattoo ink particles without destruction of the
surrounding tissue. The resultant injury is followed by phagocytosis, lymphatic
transportation, and/or transepidermal extrusion of the fragmented ink particles.
Professional tattoos are more difficult to treat than the amateur variety, because they are
comprised of multicolored organometallic dyes that are placed deeper and more densely
packed in the skin. Amateur tattoos often require 4 to 6 laser treatments, whereas
professional ones require 8 or more sessions.
All previously described pigment-specific Q-switched lasers can be used in the
treatment of tattoos with varying efficacy, depending on the ink color (Table 2). The
three Q-switched laser systems previously mentioned (ruby, alexandrite, Nd:YAG)
can all remove blueblack tattoo ink with equal efficacy(n28-n40) (Fig 2). Fluences of
6 to 8 J/cm2 are used, leading to immediate tissue whitening of the treated area. The
ruby laser is least effective in treating red ink; however, the alexandrite and 1,064
nm Nd:YAG lasers are also relatively ineffective. Red tattoos can be easily removed
within two to four sessions using green wavelength lasers (510 nm pulsed dye or 532
nm frequency-doubled Nd:YAG). Complications observed after Q-switched laser
irradiation of tattoos include hypopigmentation (due to concomitant melanin
destruction), systemic allergic reaction (due to release of extracellular ink particles
with high antigenicity, eg, chromium-containing red or yellow inks),41 and tattoo
ink darkening (due to Q-switched induced oxidation-reduction reaction of iron
oxide or titanium oxide-containing tattoos).(n42)
VASCULAR LASERS
The peak absorption wavelength of oxyhemoglobin occurs in the yellow portion of
the electromagnetic spectrum. In accordance with the principles of selective
photothermolysis, a pulse duration shorter than 1 ms is needed for targeting small
caliber blood vessels and effecting blood coagulation.
Flashlamp-pumped Pulsed Dye Laser (585 nm)
The initial reports on the vascular effect of the flashlamp-pumped pulsed dye laser used a
577 nm wavelength. However, subsequent research revealed that at a longer wavelength
of 585 nm tissue penetration could be increased without losing vascular specificity.
Furthermore, unwanted hypopigmentation was less frequently observed due to decreased
absorption of 585 nm light by melanin. Nonetheless, it is always important to remember
that since epidermal melanin interferes with absorption of the 585 nm pulsed dye laser
pulses, energy delivery will be lower through more deeply pigmented skin. Spot sizes
vary from 5 to 10 mm and fluences range from 4 to 9 J/cm2. By increasing the spot size,
deeper tissue penetration is obtained. If a smaller spot size is used, a higher fluence is
needed to produce the same clinical results.
The vascular-specific pulsed dye laser was developed primarily for the treatment of
portwine stains (6.0 to 7.0 J/cm2, spot size 5 to 7 mm),(n43-n47) but it is now considered
to be the standard for the treatment of several different vascular lesions, including
telangiectasias, spider angiomas, superficial hemangiomas, and pyogenic
granulomas.(n48-n80) Purpuric macules develop immediately after treatment and
typically resolve within 1 to 2 weeks. Scaling (12%) and crusting (4%) may occur after
treatment. Blistering and scarring are complications reported in fewer than 1% of cases
and are associated with delivery of excessive heat energy to a particular area.
Quasi-continuous Wave Lasers
Although these lasers have less vascular specificity, their use may be preferable in some
patients because of the lack of post-irradiation purpura produced. Thus, patients with
discrete areas of facial telangiectasias (rather than diffuse) are often considered to be
good treatment candidates for quasi-CW lasers.
Argon-pumped Tunable Dye Laser (5 77 nm, 585 nm). In essence, this laser differs from
its CW predecessor by the ability of the light beam to be pulsed using a robotized scanner
device. The appropriate technique requires the use of a spot size as small as 0.1 mm to
trace each blood vessel. Good clinical results have been obtained using this system in
telangiectasias and, to a lesser extent, port-wine stains.(n61,n62)
KTP Laser (532 nm). The KTP (Potassium Titanyl Phosphate) laser produces a 532 nm
light beam in millisecond pulses that can be used to successfully treat telangiectasias
despite its lower vascular-specificity. Using fluences of 15 to 20 J/cm2 at these longer
pulse durations effects elimination of telangiectasias without purpura in 1 to 3 treatment
sessions (Fig 3).(n63-n65)
Copper Vapor or Copper Bromide Laser (5 78 nm). Clinical results using the copper
vapor system for facial telangiectasias are comparable with those obtained with the
argon-pumped tun able dye laser.(n66,n67) A small 150 Mu m spot is advanced along the
vessels to effect blanching. Mild swelling and minimal crusting occurs within the
irradiated areas with resolution within 1 week. Repeated treatments are delivered at
bimonthly intervals.
Krypton Laser (568 nm). Small vascular lesions such as telangiectasias are generally
treated using a 1 mm spot and 0.7 to 0.9 watts power with a 0.2 second pulse.(n68)
Similar to the other quasi-CW laser systems, mild cutaneous erythema and edema result
from treatment.
LASERS FOR HYPERTROPHIC SCARS AND KELOIDS
Initially, various CW lasers (argon, Nd:YAG, carbon dioxide) were used to treat
hypertrophic scars and keloids; however, recurrences within 2 years were uniformly
observed.(n69-n75) In the past decade, the vascular-specific 585 nm pulsed dye laser has
been shown in several studies to successfully treat the erythematous component of
hypertrophic scars and keloids (Fig 4).(n76-n84) Furthermore, improvement has been
observed in scar texture, pliability, thickness, and symptoms, after pulsed dye laser
irradiation.(n79,n84) Selective destruction of the capillaries entrapped in these
abnormally proliferative scars and an observed increase in tissue mast cell number in
postlaser irradiated scars appear to influence collagen turnover and deposition.(n79)
EPIDERMAL (KERATOTIC) AND DERMAL (PAPULAR) LESION LASERS
Various keratotic lesions, including verruca vulgaris, actinic cheilitis, seborrheic
keratoses, and epidermal nevi can be treated with CO2 laser vaporization.(n85,n87)
Verrucae have also been successfully eliminated through selective destruction of the
nurturing blood vessels by 585 nm pulsed dye laser irradiation.(n88-n90) Dermal lesions
such as trichoepitheliomas, sebaceous hyperplasia, xanthelasma, and syringomas are most
responsive to CO2 laser vaporization.(n87,91-n93)
CUTANEOUS RESURFACING LASERS
Pulsed C02 (10,600nm) and Erbium:YAG (2,940nm)
Continuous wave CO2 lasers had significant limitations due to heat transmission to nontarget tissue, with subsequent scarring and hypopigmentation.(n94) In recent years,
noteworthy advances in CO, laser technology have now permitted successful skin
resurfacing to be achieved without these undesirable complications.
Pulsed CO, lasers have been developed to achieve the desired amount of tissue ablation
necessary for successful cutaneous resurfacing. High energy, short-pulsed, or scanned (<
1 ms) CO2 laser systems can deliver up to 500 m of energy per pulse to vaporize tissue so
quickly and completely that transmission of heat to non-target tissues does not occur.
These pulsed or scanned CO2 lasers can be used to resurface skin with rhytides (Fig 5)
and/or atrophic scars.(n95-n102) The most significant drawback to the use of these lasers
is prolonged erythema (lasting 2 to 4 months). Newer short-pulse erbium:YAG
(2,940nm) laser systems have recently entered the cutaneous resurfacing treatment arena
and have been shown to produce less skin redness because of reduced residual thermal
damage. Because of the limited thermal effect on tissue and decreased collagen
contraction, however, the clinical results obtained with erbium:YAG laser resurfacing is
often less dramatic than with the pulsed CO2 systems.(n104-n106) The cutaneous
resurfacing lasers can also be used in conjunction with blepharoplasties, facelifts, and
hair transplantation to reduce intraoperative bleeding and postoperative recovery
time.)(n107-n111)
NEW TRENDS
Photodynamic therapy has been used to treat cutaneous malignancies and psoriasis
unresponsive to conventional therapy. It involves using lasers in conjunction with
exogenous photosensitizers.(n112) Long-pulse ruby, alexandrite, and Nd:YAG
lasers are being used to target terminal hair for the purpose of achieving prolonged
hair removal after multiple successive laser sessions.(n118-n119) Early
(erythematous) striae atrophicae have shown favorable clinical response to 585 nm
pulsed dye laser irradiation when compared with CO2 laser vaporization.(n120n121) Infraorbital dark circles have been improved with the use of pigmentspecific(n122,n123) and resurfacing lasers.(n124) Photothermolysis of lower
extremity telangiectasia is under investigation(n125) and is already a useful adjunct
to current sclerotherapy techniques.
A wide range of lasers is now available for dermatologic treatment. Future developments
and advances in laser technology will continue to expand therapeutic options, improve
clinical outcomes, reduce complications, and offer a more efficacious way of treating a
variety of skin conditions.
TABLE 1. Different Lasers and Their Applications
Laser Type
Wavelength
Applications
Ruby (Q-switched) (Long-pulsed)
694 nm
Pigment, dark tattoo, hair
Alexandrite (Q-switched) (Long-pulsed)
755 nm
Pigment, dark tattoo, hair
Nd:YAG (Q-switched) (Long-pulsed)
1,064 nm
Pigment, dark tattoo, hair
Frequency-doubled Nd:YAG
532 nm
Superficial pigment, red tattoo
Pulsed dye
510 nm
585 nm
Superficial pigment, red tattoo
Vascular, scars, warts, striae
Potassium titanyl
532 nm
Pigment, vascular phosphate (quasi-CW)
Copper vapor/bromide
510 nm
578 nm
Pigment (quasi-CW)
Vascular
Tunable dye argon
577/585 nm
Vascular (quasi-CW)
Erbium:YAG (pulsed)
2,940 nm
Skin resurfacing(*)
CO2
10,600 nm
Actinic cheilitis, verrucae (continuous wave)
CO2
10,600 nm
Skin resurfacing(*), (high-energy, pulsed)
(*) Rhytides, atrophic scars, epidermal/dermal lesions.
TABLE 2. Laser Treaatment of Different Color Tattoo Inks
Laser Type
Black
Green
Red
Tan
Ruby/694
Alexandrite/755 nm
Nd: YAG/1,064 nm
Frequency-doubled Nd:YAG/532 nm
+++
+++
+++
-
++
+++
+
-
+++
Darkening
Darkening
Darkening
Darkening
Flashlamp-pumped pulsed dye/510 nm
-
-
+++
Darkening
Source: Southern Medical Journal, Sep98, Vol. 91 Issue 9, p806, 9p
What’s In Tattoo Ink?
The vast majority of tattoo pigments are derived from metals, which makes them a potential source for developing a skin reaction.
Some pigments do have non-metallic options for those who have concerns or a past history of allergic reactions to these compounds.
Red is the color most commonly associated with reactions within a tattoo. Mercury is the base metal in red tattoo dye, and may be
known by the names mercury sulphide, cinnabar, vermillion and red cinnabar.
Reactions within the tattoo may be eczematous or granulomatous. These reactions are often seen several years from the time the tattoo
is placed and may be associated with exposure to cross reactants. These include such chemicals as thimerasol (a widely used
preservative), mercurochrome and some vaccines that also contain thimerasol. For those with known thimerasol allergies who are set
upon having red within their tattoos, there are a variety of non-metallic pigments that lend a red color to the skin such as carmine
(derived from dried insect carcasses) and scarlet lake, sandalwood and brazilwood which are organic red pigments.
Another option, cadmium red is related to the metal family and may have potential reactivity and cadmium sulfide may be a byproduct
within some red dyes which may result in a phototoxic swelling of the area when exposed to light.
Black is most commonly achieved from carbon. Sensitivity to carbon is rare. Other sources of black tattoo color may be found in
black ink and logwood. Neither of these are metal derivatives, however, the black waterproof ink contains phenol solution in which
charcoal particles are suspended and may be the source of other reactions.
Yellow is achieved from the use of Cadmium and is a common cause of reactions within tattoos. Not only may cadmium produce
local or generalized eczematous reactions; it has also been associated with phototoxic reactions when exposed to light. Cadmium
sulfide is the most common material used in yellow tattoo ink.
Blue dyes are derived from a variety of Cobalt salts and is notorious for deep granulomas as well as causing localized hypersensitivity
reactions and a few reported cases of uveitis (an inflammation of the eyes). Light blue colors are also derived from cobalt and may
again cause granulomas. Watch for the names cobalt blue and cobaltous aluminate that are terms for this blue pigment.
Green comes from Chromium and is a common cause of eczematous reactions both within the tattoo, as well as generalized
eczematous reactions on the body. Chromium oxide has a variety of names including Chrome green, Casalic green and Guignet’s
green. These variations while mixed in different suspensions may all cause such significant and long term itching and other
eczematous reactions that complete removal of the tattoo may be required. The allergic reaction may arise several years after the tattoo
has been placed. Other shades of green such as emerald green are formed from another type of chromium salt called chromium
sesquioxide (aka veridan) or copper salt derivatives.
Purple is derived from the metal Manganese which may cause the formation of tattoo granulomas.
Violet again comes from Manganese and may also result in granulomas.
Brown dye may be formed via the use of either Venetian Red which is derived from Ferric Oxide or from Cadmium salts, associated
with phototoxic swelling upon exposure to sunlight.
White tattoos are achieved usually from titanium or zinc oxide or from the use of lead carbonates. These may have the potential to
contain metallic derivatives.
New trendy colors I have seen in tattoos such as “hot” turquoise, pink, coral, etc. may also be potential allergens, depending upon the
compounds mixed to achieve these colors. I have seen patients who are allergic to fluoroscene used to give some highlighter colors a
neon appearance and this may also be used in some tattoo dyes, so take this into account as well. Should you have a past history of a
tattoo reaction, make sure you discuss the chemical make-up of the specific dye your artist uses before you go ahead with your tattoo.
There may be other pigment options available to you.
Since most tattoo inks contain metal, MRI exams may cause tattoos to have a burning or stinging sensation. Redness may even occur.
This should be temporary and the presence of a tattoo is not a contraindication to having an MRI.
http://www.dermadoctor.com/pages/newsletter113.asp?AID=1067
Body Painting
Body painting can transform a person into a spirit, a work of art, another gender or even a map of a sacred place. It can
emphasize visual appeal, express allegiance or provide a protective and empowering coating. Protective body paints often
feature in initiation rituals, weddings and funerals -- all occasions of transition and of spiritual danger. People everywhere
adorn the living, and some also treat the dead, with body paint. To make body paint, pigments composed of plant extracts or
mineral clays and powders can be mixed with vegetable oil or animal fat. Throughout history, the substances used for body paint have
been important trade items. Ochre, camwood, cinnebar, and kaolin were traded throughout Asia, Africa and Europe.
Henna, used as a temporary skin dye, was widely traded in the Muslim world along with patterns and designs used to apply it.
Commercially manufactured body paints, now available in a wider palette, may be adopted for their visual appeal but they rarely take
on the symbolic significance of natural paints and dyes.
Henna
The crushed leaves of the henna plant, when mixed with other natural ingredients, yields a thick, fragrant paste used for painting hands
and feet. The olive green, dried henna powder, once mixed with such ingredients as black tea and coffee, cloves and tamarind,
turns dark. Once the paste is applied on the skin, it is allowed to dry, sometimes overnight. The dried henna is scrapped off the
skin resulting in a maroon-red stain. Henna has traditionally also been used for hair conditioning and dyeing, skin antiseptic
and tonic, and as cloth and leather dye. Henna is a cosmetic and a medicine, but most importantly, it is a marker of beauty,
auspiciousness and celebration.
Henna painting is considered a woman's art form, often to mark special events in a woman's life, especially marriage. The painted
bride is denoted special by the intricate, elaborate henna patterns on her hands and feet, attesting to the liminal occasion in which she
is transported from one stage of life to another. Henna designs add beauty and decoration to the parts of the body that are in view,
namely hand and feet, but patterns usually extend towards the elbows and knees, causing erotic curiosity for the concealed parts.
Designs vary with each culture, and even within cultures. Generally speaking, Arabic Swahili women's designs consists of large, bold
floral patterns, whereas Moroccan Berber women paint geometric, linear designs. In India, Hindu women prefer paisleys, vines and
birds such as peacocks. Muslim women do not paint figurative images due to the Islamic prohibition on representational art.
In the past decade, henna painting has experienced an immense popularity in the United States. Although ethnic communities residing
in the West have always practiced the art of henna, the acceptance of this form by Westerners, especially celebrities, is a relatively
new phenomenon. Popularly called "temporary tattoo," henna painting does function like tattoos. People who are reluctant to acquire a
real tattoo, test out a location and design by first having an ephemeral henna version of what will eventually become a permanent part
of their skin. Also like tattoo, henna designs in the US resemble "tribal" bracelets and anklets, belts and rings. The practice of wearing
henna as jewelry was born in the West.
Kaolin
White clay used as body paint. Among various African groups it used for healing, for protecting a newborn and its mother;
and to help a healer communicate with spirits in the "other world."
Moko
The art of tattoo as practiced by the Maori of New Zealand. Worn by both men and women, moko was a sign of distinction,
reserved for those who were the most noble and accomplished.
Pigment
A dry substance that when mixed with liquid does not dissolve, but becomes a paint, ink, or other coloring agent.
Tattooing
Tattoo involves puncturing the skin with a sharp instrument and inserting pigment through the outer layer, the epidermis,
into the second layer, the dermis. Tattoos are intended to be permanent; only recently have expensive laser techniques allowed
people to remove them. Tattoo patterns and techniques have varied with different cultures. Traditional Polynesian tattooists tap
a needle with a small hammer, while the Japanese work with bundles of needles set in wooden handles. In the West, the electric tattoo
machine has revolutionized tattooing, expanding the ease of application and the range of colors and designs. Besides being decorative,
tattoos send important cultural messages: a commitment to some group, an emblem of a rite of passage, even a fashion statement.
Tattooing has been used to indicate high rank in some societies, rebellion and low status in others. Despite numerous religious and
social injunctions, tattooing has been a popular form of body art throughout the world.
http://www.amnh.org/exhibitions/bodyart/glossary.html
1) Teens, tattoos and body piercing
Journal of Pediatric and Adolescent Gynecology, Volume 17, Issue 3, June 2004, Pages
215-216
Angela Nicoletti
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2) Venous lakes of the vermillion lip treated by infrared coagulation
British Journal of Oral and Maxillofacial Surgery, Volume 42, Issue 3, June 2004,
Pages 251-253
A. Ah-Weng, S. Natarajan, S. Velangi and J. A. A. Langtry
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3) Paleodermatoses: lessons learned from mummies*1
Journal of the American Academy of Dermatology, Volume 50, Issue 6, June 2004, Pages
919-936
Eve Judith Lowenstein
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4) Surgical pearl: the use of methylene blue temporary tattoos for tissue orientation
in Mohs micrographic surgery*1
Journal of the American Academy of Dermatology, Volume 50, Issue 4, April 2004,
Pages 640-641
Norma S. Magee and Richard F. Wagner, Jr
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5) Abstracts
European Journal of Surgical Oncology, Volume 30, Issue 2, March 2004, Pages 119-165
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6) Q-switched laser management of an explosion tattoo
Journal of the American Academy of Dermatology, Volume 50, Issue 3, March 2004,
Pages 479-480
Douglas N. Naversen and J. David Igelman
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7) Clinical facts & curios
Current Problems in Pediatric and Adolescent Health Care, Volume 34, Issue 2, February
2004, Pages 114-118
James A. Stockman, III
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8) Temporary henna tattooing--a risky procedure: Case report and literature review
Burns, Volume 29, Issue 8, December 2003, Pages 866-867
M. Jindal and B. Davis
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9) "Girl talk": gender, equity, and identity discourses in a school-based
computer culture
Women's Studies International Forum, Volume 26, Issue 6, November-December 2003,
Pages 561-573
Jennifer Jenson, Suzanne de Castell and Mary Bryson
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10) Traumatic tattooing of the skin and ocular surface
Journal of Cataract & Refractive Surgery, Volume 29, Issue 9, September 2003,
Pages 1845-1846
Michael Ehrenhaus, Richard Najac, Laurence Weissman and Cono Grasso
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11) Lasers in dermatology: Four decades of progress*1
Journal of the American Academy of Dermatology, Volume 49, Issue 1, July 2003, Pages
1-31
Elizabeth L. Tanzi, Jason R. Lupton and Tina S. Alster
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12) Tattoos and body piercings: marks and markers?: Carroll ST, Riffenburgh RH,
Roberts TA, Myhre EB. Tattoos and body piercings as indicators of adolescent risk-taking
behaviors. Pediatrics 2002;109:1021\N7
Journal of Midwifery & Women's Health, Volume 48, Issue 3, May-June 2003, Page
235
T. A. Roberts and S. A. Ryan
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13) Temporary tattoo dermatitis
The Journal of Pediatrics, Volume 142, Issue 5, May 2003, Page 586
Robert J. Leggiadro, Jeffrey R. Boscamp and Allen N. Sapadin
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14) Tattooing ears--a simple method
British Journal of Plastic Surgery, Volume 56, Issue 3, April 2003, Page 312
I Al-Basri and V. Rose
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15) FROM MY PERSPECTIVE: The future of clothing
Technological Forecasting and Social Change, In Press, Corrected Proof, Available
online 26 March 2003
Joseph F. Coates
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16) Tattoo as an additional tool for diagnosing of mental and behavioral disorders
associated with psychoactive substance use
European Neuropsychopharmacology, Volume 13, Supplement 1, March 2003, Page S18
A. Borokhov, R. Y. A. Bastiaans and V. Lerner
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17) Festival as creative destination
Annals of Tourism Research, Volume 30, Issue 1, January 2003, Pages 7-30
Richard Prentice and Vivien Andersen
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18) Sensitisation to red tattoo pigment
British Journal of Plastic Surgery, Volume 56, Issue 1, January 2003, Page 73
Mairi Macarthur and Michaela Davies
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19) African aromatherapy: past, present and future applications
International Journal of Aromatherapy, Volume 13, Issue 4, 2003, Pages 185-195
Stephanie Rose Bird
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20) Got you under my skin
The Lancet, Volume 360, Issue 9331, 10 August 2002, Page 495
Kelly Morris
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21) Successful treatment of an allergic reaction in a red tattoo with the Nd-YAG
laser
British Journal of Plastic Surgery, Volume 55, Issue 5, July 2002, Page 456
R. Dave and P. J. Mahaffey
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22) Lipstick and pearls
Surgery, Volume 131, Issue 6, June 2002, Pages 663-664
Nancy D. Perrier
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23) Oral pigmented lesions
Clinics in Dermatology, Volume 20, Issue 3, May-June 2002, Pages 286-288
Giovanni M. Gaeta, Rocco A. Satriano and Adone Baroni
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24) Surgical Pearl: Removing skin-colored cosmetic tattoos with carbon dioxide resurfacing
lasers
Journal of the American Academy of Dermatology, Volume 46, Issue 5, May 2002, Pages
764-765
Iltefat Hamzavi and Harvey Lui
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25) Patch testing over tattoos
American Journal of Contact Dermatitis, Volume 13, Issue 1, March 2002, Pages 19-20
Joseph F. Fowler and M. Kathleen McTigue
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26) Clinical picture: An unexpected tattoo
The Lancet, Volume 359, Issue 9307, 23 February 2002, Page 649
Jonathan C R Bowling and Richard Groves
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27) "Tooth worms", poverty tattoos and dental care conflicts in Northeast
Brazil
Social Science & Medicine, Volume 54, Issue 2, January 2002, Pages 229-244
Marilyn K. Nations and Sharm�nia de Ara�jo Soares Nuto
http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6VBF-44HTGB46&_origin=SDEMFRASCII&_version=1&md5=433238b17d3ca39813ca8c4f20553832
28) Induced transmittance in alexandrite laser eye-protectors--a survey of different
types of laser filters
Optics & Laser Technology, Volume 33, Issue 5, July 2001, Pages 359-362
A. Schirmacher and E. Sutter
http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6V4H-43G3M5GH&_origin=SDEMFRASCII&_version=1&md5=1244c70a5b0d2e1a9bf5edd1b87123f5
29) Examination of Tattoos on Mummified Tissue using Infra-red Reflectography
Journal of Archaeological Science, Volume 28, Issue 4, April 2001, Pages 395-400
Annalisa Alvrus, David Wright and Charles F. Merbs
http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6WH8-45BT6MHW&_origin=SDEMFRASCII&_version=1&md5=e180ef8aa92524b5c1465c04c5af3645
30) Tattoo pigment masquerading as secondary malignant melanoma
British Journal of Plastic Surgery, Volume 53, Issue 4, June 2000, Page 359
H. Hannah, S. Falder, P. R. M. Steele and S. K. Dhital
http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6WC6-45FCCYK3X&_origin=SDEMFRASCII&_version=1&md5=b693fb076d48ec3ec5469ece6c217e00
31) Pulsed dye laser treatment of port-wine stains in pigmented skin
Journal of the American Academy of Dermatology, Volume 42, Issue 4, April 2000,
Pages 667-671
Sabine Sommer and Robert Alexander Sheehan-Dare
http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6WM8-4C0KM4K20&_origin=SDEMFRASCII&_version=1&md5=3a0b2638d7389c261c4de9e73b7e78a6
32) Colour shift following tattoo removal with Q-switched Nd-YAG laser (1064/532)
British Journal of Plastic Surgery, Volume 52, Issue 6, September 1999, Pages 482-487
A. H. S. Peach, K. Thomas and J. Kenealy
http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6WC6-45M2SBJ14&_origin=SDEMFRASCII&_version=1&md5=a9e6ddd88d42afd7594249f6f7ccb7db
33) P079 Tattoos: Sala-microdermabrasion with radiobistury
Journal of the European Academy of Dermatology and Venereology, Volume 9, Supplement
1, September 1997, Page S172
Claudio Comacchi and Torello Lotti
http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6T92-3Y5FY4Y1X&_origin=SDEMFRASCII&_version=1&md5=c00e7059b23142a228fd5f3aed734ccb
34) FC086 Lichenoid tattoo reaction
Journal of the European Academy of Dermatology and Venereology, Volume 9, Supplement
1, September 1997, Page S135
H. E. Gore, D. J. Eedy and J. Somerville
http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6T92-3Y5FY4Y78&_origin=SDEMFRASCII&_version=1&md5=9e8b4610b9377396895e8b3fa7392620
35) WS092 A review of treatment of pigmented lesions and tattoos
Journal of the European Academy of Dermatology and Venereology, Volume 9, Supplement
1, September 1997, Page S98
S. W. Lanigan
http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6T92-3Y5FY4YDR&_origin=SDEMFRASCII&_version=1&md5=1e43da7b7bf7d05e46dc12c55cd6418e
36) 1311 Corneal tattoo: Ultrastructural and immunohistochemical observations of
a case
Vision Research, Volume 35, Supplement 1, October 1995, Page S67
Sekundo W.
http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6T0W-4B7GR1F23&_origin=SDEMFRASCII&_version=1&md5=856a23bb9a41fd35f6e3eb2711b14076
Most will agree that permanent makeup has been in existence since the Ice Age, when
crude natural substances were used to create color and instruments for placing colorful
art in the skin. Cleopatra is believed to have been adorned with permanent makeup and
Egyptian mummies have been recovered with face and body tattoos intact. The ancient
Japanese art of Tebori boasts full-body tattooing intricately done by hand.
http://www.lastingmakeup.com/History%20of%20Permanent%20Makeup.htm
You on a motorcycle. Shades. Sleeve rolled up over your bicep.
That screamin' eagle tattoo says you are ready to rumble.
Of course, 15 years later maybe you don't want to rumble.
With tattoos making a big impression on young people, doctors with laser treatments are making
big bucks taking the impressions off. Young women, especially, later regret the permanent
reflection of their adolescence marked in living color on their shoulders and hands.
Laser treatments can permanently remove up to 95 percent of a tattoo, but they are very
expensive and take several treatments. The laser works by shooting short bursts of light
into the tattoo pigment. The laser breaks up the pigment and the tiny pigment particles are
removed by the body's immune system.
With laser treatments, tattoo ink color matters. Black is the easiest to remove since it
absorbs the most of the laser wavelengths. Green is harder to remove. Research has created
lasers specifically designed to remove various tattoo colors, but, the more obscure the
colors in your tattoo, the harder the tattoo will be to remove.
If laser treatment doesn't work, the other permanent options are more invasive. The tattoo can
be sanded off (dermabrasion), cut off (surgery) with or without skin grafting, or burned off
(chemical peels).
No method is painfree. All are expensive.
http://halife.com/living/health/maytattoo.html
Tattoo Pigments: Throughout history, diverse materials have been used as tattoo pigment,
most notably carbon particles (as in soot), plant derived pigments, and various metal oxides
and salts. Aetius of Amida published a recipe for tattoo pigment consisting of Acacia wood,
gall, and vitriol (sulphuric acid) mixed with ground corroded bronze treated with vinegar,
which was rubbed in over a pattern pricked by needles. In contrast to drugs and cosmetics,
tattoo pigments have never been controlled or regulated in any way, and the exact
composition of a given tattoo pigment is often kept a "trade secret" by the manufacturer.
In most cases, neither the tattoo artist nor the tattooed patient have any idea of the
composition of the tattoo pigment.
"Traditional" Tattoo Pigments: Until recently, most coloring agents in tattoo pigment were
inorganic heavy metal salts and oxides, many of which were also used in paints and dyes.
Cadmium, Chromium, Cobalt, Iron, Lead, and Mercury all figured prominently in these
pigments, with a high incidence of allergic and phototoxic reactions, as well as scarring.
Compostion of "Traditional" Tattoo Pigments
Compostion of "Traditional" Tattoo Pigments
Color
Materials
Black Iron Oxide (Fe3O4)
Comment
occurs in nature as magnetite crystals
Iron Oxide (FeO)
Jet Black powder, wustite
Carbon
Bone Black; amorphous carbon from combustion; soot, as in
indian ink
Logwood
Heartwood extract from Haematoxylon campechisnum, of
Central America and the West Indies
Brown ochre
Iron Oxides mixed with clay; raw ochre is yellowish-heating
causes reddening through dehydration; used since ancient
times
Red
Cinnabar
Mercury sulfide (HgS)
Cadmium Red
Cadmium selenide (CdSe), cadmium seleno-sulfide (orange)
Iron Oxide (Fe2O3)
common rust; Dried Fe2O3 is intense red
Yellow Cadmium yellow
Cadmium sulfide (CdS), cadmium zinc sulfide (CdZnS)
various ochres
see ochre
Curcuma yellow
Derived from plants of the ginger family; aka tumeric or
curcurmin
Chrome Yellow
Lead Chromate (PbCrO4), often mixed with lead sulfide
Green Chromium Oxide
Aka Casalis Green, Anadomis Green
(Cr2O3)
Copper Carbonate Hydroxide derived from the mineral
Malachite (Cu2(CO3)(OH)2); Malachite Green is an aniline
dye with a similar color also used as a fungicide/bacteriocide
Malachite
Ferrocyanides and
Ferricyanides
Blue
Azure Blue
Cobalt Blue
Various admixtures, such as Potassium Ferrocyanide (yellow
or red), Ferric Ferrocyanide (Prussian Blue)
Various, including copper(II) carbonate (azurite), sodium
aluminum silicate (lapis lazuli), calcium copper silicate
(Egyptian Blue)
cobalt aluminum oxides, chromium oxides
Violet Manganese Violet
Manganese ammonium pyrophosphate, also used in paints
and cosmetics
White Lead White
Lead Carbonate (2 Pb(CO3)2 · Pb(OH)2); used since antiquity
as a white pigment
Titanium dioxide
(TiO2)
Barium Sulfate
(BaSO4)
Flesh
Derived from anatase or rutile; may be used as a primary
pigment or to dilute or modify color of other pigments
Often used to dilute or modify color of other pigments
various ochres
see ochre
NB: This list is by no means inclusive-almost anything that can be used as a pigment, HAS been
used as a pigment!
Because of the potential toxicity of heavy metal -containing pigments, there has been a shift in
recent years away from these agents, and toward industrial organic pigments, especially azo- and
polycyclic compounds. These pigments are considered safer and well tolerated by the skin,
although allergic reactions and phototoxicity can and do occur. With laser treatment, these
complex molecules may be cleave into smaller molecules, some of which are considered possible
carcinogens.
Composition of Organic Tattoo Pigments
Composition of Organic Tattoo Pigments
color
chemical structure
Peak
Absorption
Comment
red
Napthol-AS pigment
yellowish-red
Napthol-AS pigment
500-540nm Aka Napthol reds, synthesized from Naptha.
Used mainly in printing inks and interior paints.
500-540nm
reddish-yellow
disazodiarylide
410-440nm Formed from the condensation of 2 monoazo
yellowishorange
yellow
disazopyrazolone
disazodiarylide
greenish-yellow Monoazo pigment
green
410-440nm pigment molecules. Large molecular size with
excellent thermal stability and color fastness.
Primarily used as a coloring agent in plastics and
410-440nm paints.
410nm
600-725nm
bluish-green
Cu/Al
phthalocyanine
Cu-phthalocyanine
blue
Cu-phthalocyanine
600-725nm
magenta
Quinacridone
530nm
purple
Dioxazine/carbazole
650nm
600-725nm
NB: This list is by no means all-inclusive! Many tattoo colors are mixtures of 2 or more individual pigments, and
colors may be modified or lightened by adding inorganic fillers such as TiO2 or BaSO4
NB: This list is by no means all-inclusive! Many tattoo colors are mixtures of 2 or more
individual pigments, and colors may be modified or lightened by adding inorganic fillers such as
TiO2 or BaSO4
As with paints and dyes, 2 or more individual pigments may be mixed to make different
colors. For Q-Switched Laser treatment to be effective, the absorption peak of the pigment
must match the wavelength of the laser energy. Similar colors may contain different
pigments, with different responses to a given laser wavelength, and not all pigments absorb
the wavelengths of currently available medical lasers.
For more information on industrial organic pigments and their properties, click here
Recent market analysis identified 41 trade colors from 16 chemical entities.
Similar colors may contain different pigments
not all pigments absorb laser wavelengths well
694nm well absorbed by Cu-pthalocyanine (blue), Cu-hexadecachloro pthalocyanine (blue
green)
1064/532 not well absorbed by monoazo pigment (greenish yellow), diazopyrazolone (yellow
orange), Cu-hexadecachloro pthalocyanine (blue green)
532 is well absorbed by azo pigment (yellow red) but not quinacridone (blue red)
http://www.shorelaser.com/LaserTattooDet.html
check out 5 .gif line charts
http://www.shorelaser.com/IndOrgPigments.html
The choice of design is a matter of personal taste. You should make your decision with care and
forethought and remember, the tattoo you get will be with you for the rest of your life. When
picking your design think in terms of ten, twenty or fifty years from now.
You can check out different designs and styles by viewing our gallery. We have provided both a
historical look at design styles as well as a general gallery of tattoos.
Here are the various tattoo styles;
Black & Gray Wash - This style uses black ink and various shades of black to 'round' out
the design. Strong light source and subtle shading is used to render the tattoo and will
usually hold up well over time. This is the preferred method for portraits (which should be
done by someone adept at portrait rendering).
New School - Bright colors and bold outlines give this style its distinctive look. Based on
graffiti art, New School tends to have exaggerated poses and proportions and contrasting
color hi-lites. This is a very 'trendy' tattoo style.
Old School (Traditional) - Taking its roots from the early days of tattoos, this style uses
simple lines and flat shading with a minimum of colors. The traditional colors are black,
red, green, yellow and blue. These are the tattoos of your grandfather's time.
Irezumi - Otherwise known as 'Japanese' or 'Oriental' tattoos. The theme usually defines
an Irezumi tattoo and include such things as koi fish (carp) swimming in 'finger' waves,
oriental dragons, buddhas, samurais and geishas, kabuki masks and other traditional
oriental icons and images. The colors are bright and simple with a conscientious use of
black areas.
Tribal - A very popular style, tribal work tends to be decorative lines and shapes that
invoke a 'feel' rather than depict an object. Usually rendered in solid black but can be done
with a mixture of color or shading for interesting variations. The term 'tribal' is also often
misused. The term originally refered to any tattoo design taken from indigenous people
from other parts of the world, in particular from the Pacific Islands and Africa. Today it is
often used to refer to any solid black decorative design having a 'tribal' feel. Some artists
refer to this variation as 'neo-tribal'.
Celtic Knotwork - Taken from the old Celtic manuscripts from Ireland this style can be as
complex or as simple as you like. Celtic knotwork requires skill in rendering it properly
and should be done by an artist that specializes in this art form. Usually done just in black
but can use solid, bright primary colors for interest.
Bio-mechanical - This style became popular through the work on the 'Alien' movies by
Swedish artist H.R.Geiger. This style combines anatomical flesh intertwined with some sort
of mechanical parts. This style requires some rendering skill by the artist and should be
done by someone who specializes in this art form.
Fine Line - A more contemporary style of tattooing, this style relies on thin tines and finer
detail than the old traditional forms. Fine line is particullarly good for small, feminine
tattoos and realistic tattoos where line as well as form help create a more natural
rendering.
http://www.msu.edu/~krcmari1/individual/gallery.html
***
Origins
Believe it or not, some scientists say that certain marks on the skin
of the Iceman, a mummified human body dating from about 3300
B.C., are tattoos. If that’s true, these markings represent the earliest
known evidence of the practice. Tattoos found on Egyptian and
Nubian mummies date from about 2000 B.C., and classical authors
mention the use of tattoos in connection with Greeks, ancient
Germans, Gauls, Thracians and ancient Britons.
Oops
One busy physician who
specializes in tattoo removal
estimates that 50 percent of
people who get tattoos later
regret them. We discuss the
implications of getting tattooed
Tattooing was rediscovered by Europeans when exploration brought as well as the tattoo removal
them into contact with Polynesians and American Indians. The word process in the article How
tattoo comes from the Tahitian word tattau, which means "to mark," Tattoo Removal Works.
and was first mentioned in explorer James Cook’s records from his
1769 expedition to the South Pacific. Because tattoos were considered so exotic in European and
U.S. societies, tattooed Indians and Polynesians drew crowds at circuses and fairs during the 18th
and 19th centuries.
Meaning
The practice of tattooing means different things in different cultures. In early practice, decoration
appears to have been the most common motive for tattooing, and that still holds true today. In some
cultures, tattoos served as identification of the wearer’s rank or status in a group. For example, the
early Romans tattooed slaves and criminals. Tahitian tattoos served as rites of passage, telling the
history of the wearer’s life. Boys reaching manhood received one tattoo to mark the occasion, while
men had another style done when they married. Sailors traveling to exotic foreign lands began to
collect tattoos as souvenirs of their journeys (a dragon showed that the seaman had served on a
China station), and tattoo parlors sprang up in port cities around the globe.
This Tahitian tattoo tells about rights of passage in the
wearer's life.
Thousands of tattoo designs, or "flash," are available.
Custom tattooing (like freehand drawing without a stencil) is increasingly popular with customers,
especially those with multiple tattoos.
Tattoo artists enjoy creating custom designs like this one.
Tattoo artists say they like the custom work -- that it’s more challenging and artistically satisfying to
create something new rather than using a stencil to reproduce a time-worn image such as a rose or
an eagle.
Early Tattooing Methods
An amazing variety of tattooing methods developed in different cultures. In North and South
America, many Indian tribes routinely tattooed the body or the face by simple pricking, and some
tribes in California introduced color into scratches.
Many tribes of the Arctic and Subarctic, mostly Inuit, and some people in eastern Siberia, made
needle punctures through which a thread coated with pigment (usually soot) was drawn underneath
the skin. In Polynesia and Micronesia, pigment was pricked into the skin by tapping on a tool shaped
like a small rake.
The Maori
The Maori people of New Zealand, who are world famous for their tattooing, applied their wood
carving technique to tattooing. In the moko style of Maori tattooing, shallow, colored grooves in
distinctive, complex designs were produced on the face and buttocks by striking a small bonecutting tool (used for shaping wood) into the skin. After the Europeans arrived in the 1700s, the
Maori began using the metal that settlers brought for a more conventional style of puncture tattooing.
The Maori had a custom of preserving the heads of their tattooed leaders after death as precious
family possessions. Over time, they began to trade some of the heads to collectors for firearms and
iron tools. This practice, which is why there are some of these heads in European museums, was
short-lived because of the fighting and political turmoil it caused.
Modern Tattooing
Today, tattoos are created by injecting ink into the skin. Injection is
Thanks to Sean Beck
done by a needle attached to a hand-held tool. The tool moves the
HowStuffWorks would like to
needle up and down at a rate of several hundred vibrations per
thank Sean Beck of the Naked
minute and penetrates the skin by about one millimeter.
Art tattoo parlor (located in
Raleigh, NC) for his help in
What you see when you look at a tattoo is the ink that's left in the
skin after the tattooing. The ink is not in the epidermis, which is the creating this article.
layer of skin that we see and the skin that gets replaced constantly,
but instead intermingles with cells in the dermis and shows through the epidermis.
The tattoo needle inserts ink into the skin's dermal layer.
The cells of the dermis are remarkably stable, so the tattoo's ink will last, with minor fading and
dispersion, for your entire life!
None of the 50-plus colors and shades of pigment used in tattooing are currently regulated by the
U.S. Food and Drug Administration.
http://missourifamilies.org/features/adolescentsarticles/adolesfeature6.htm
Revising scars with lasers is very much dependent on the height and the size of the scar. In most
instances, it is the carbon dioxide, or erbium laser that is used to smooth scars. But, whenever a
scar is revised, whether a laser is used or scalpel surgery, you trade the original scar in for
another. Sometimes it's an improvement, sometimes it is not. If the scar that the person is talking
about is a small round scar and he/she wants it to be more of a lined scar instead of a circular,
round bump, in most instances, that is better revised with scalpel surgery than a laser. It seems
'lower tech' but is often a better choice because it creates a narrower scar.
With regard to the solar keratosis, that is another word for a sun damaged spot or a "precancer."
People that have solar keratoses are at somewhat higher risk for skin cancer because they are a
reflection of long-term sun exposure in the past. Sun exposure is the main risk factor for getting
skin cancer. Now, a single solar keratosis does not increase the person's risk dramatically.
However, if there are many solar keratoses, the risk goes up, especially if there has been a prior
history of skin cancer in that person. The cost depends on the region of the country, whether
inpatient or outpatient setting, a whole host of factors that come into play with regards to the
cost. Typically this would be in the hundreds of dollars (not thousands of dollars), lots of
different factors are involved (how many sutures, inpatient, outpatient).
Lasers are not typically used to treat melanomas. However, with regard to melanoma, the chance
of recurrence is most dependent on the thickness of the cancer at the time of diagnosis. This
thickness is typically described in millimeters. Lasers can be used to treat a variety of skin
conditions, most commonly they are used to treat broken blood vessels or reddish birth
marks/skin lesions, excess hair or unwanted hair, tattoos and some brown or tan birth marks, and
wrinkles and other surface signs of photoaging.
Traditional scalpel surgery, or topical therapy, among other forms of therapy, should also be
considered when a person seeks care for these conditions. Laser surgery is not always the answer
for every skin condition, a person should leave their options open and realize that lasers are one
tool used by the doctor to treat these conditions and that a thorough discussion with their health
care provider, their dermatologic surgeon, would give them additional information as to whether
laser surgery might be helpful for them. The inks used in tattoos and permanent makeup (also
known as micropigmentation) and the pigments in these inks are subject to FDA regulation
as cosmetics and color additives. However, FDA has not attempted to regulate the use of
tattoo inks and the pigments used in them and does not control the actual practice of
tattooing. Rather, such matters have been handled through local laws and by local
jurisdictions. But with the growth in popularity of tattooing and permanent makeup, FDA
has begun taking a closer look at related safety questions.
Among the issues under consideration are tattoo removal, adverse reactions to tattoo
colors, and infections that result from tattooing. Another concern is the increasing variety
of pigments and diluents being used in tattooing -- more than fifty different pigments and
shades, and the list continues to grow. Although a number of color additives are approved
for use in cosmetics, none is approved for injection into the skin. Using an unapproved
color additive in a tattoo ink makes the ink adulterated. Many pigments used in tattoo inks
are not approved for skin contact at all. Some are industrial grade colors that are suitable
for printers' ink or automobile paint.
Nevertheless, many individuals choose to undergo tattooing in its various forms. For some, it is
an aesthetic choice or an initiation rite. Some choose permanent makeup as a time saver or
because they have physical difficulty applying regular, temporary makeup. For others, tattooing
is an adjunct to reconstructive surgery, particularly of the face or breast, to simulate natural
pigmentation. People who have lost their eyebrows due to alopecia (a form of hair loss) may
choose to have "eyebrows" tattooed on, while people with vitiligo (a lack of pigmentation in
areas of the skin) may try tattooing to help camouflage the condition. Of course if the skin
around this permanent makeup lightens or darkens to changing the sun conditions the results will
still be unsatisfactory.
(information resources include ... www.burnsurvivor.com and www.aad.org)
http://www.colortration.com/keratosis.htm
methods.A 48-year-old woman requested removal of permanent makeup (cosmetic tattoos) of
her eyebrows and around her lips. Physical examination revealed a brown tattoo of both
eyebrows and dark red lip liner around both lips. A test area was performed on the red tattoo of
the lips. A frequency-doubled Nd:YAG laser (532 nm, 2.0 J/cm2, 2 mm spot size) was used for
the lip area, while the same laser at 1064 nm, 3.9 J cm2, 2 mm spot size was utilized for the
eyebrows. The lip area immediately turned black. The patient returned for follow-up 1 month
later; the black ink on the lip was treated with the same laser at 1064 nm, 3 mm spot size, 4.2
J/cm2, with satisfactory resolution in two monthly treatments. Both brown eyebrow turned bright
orange and were treated with 532 nm, 3 mm, 3.0 J/cm2. One month later the eyebrows were a
mixture of yellow ink and dark green. The yellow area was treated with 532 nm, 3 mm, 2.3
J/cm2, while the dark green was treated with the 1064 nm, 3 mm spot size, 4.2 J/cm2. One
month later little improvement was noted, so Q-switched ruby laser at 694 nm, 6 mm spot size,
16 J/cm2 was utilized. An additional four monthly treatments were given utilizing a combination
of both ruby and 532 nm ND:YAG lasers for green and yellow pigment, respectively.
http://www.blackwell-synergy.com/links/doi/10.1046/j.1524-4725.2002.00161.x/abs/
ARE THERE GLOW-IN-THE-DARK INKS OR FLUORESCENT INKS?
Fluorescent ink is not the same as glow-in-the-dark ink. Fluorescent
inks glow under ultraviolet light. Phosphorescents glow after being
exposed to light, and glow-in-the-dark things that glow without any
outside stimulus are almost unknown.
There are *no* glow-in-the dark inks.
There are *no* phosphorescent inks.
For a brief time around 1991, some tattoo artists experimented with
fluorescent inks that glow under UV light. At the time, it was
thought that these could be used to make tattoos that would only be
visible under UV light. As it turned out, these inks did not perform
as expected. They were not invisible under normal light, and in some
cases turned brown. At the same time, many people reported skin
irritation problems. As a result, we are not currently aware of any
tattoo artists still using these inks.
There is a collection of information about these inks at:
http://www.bme.freeq.com/spc/experiences/glow/
WHAT COLORS ARE AVAILABLE?
There are a lot more colors available now than just "Popeye green and
red." Just about every color imaginable can be obtained for your design.
If your artist does not have a pre-mixed color, s/he will mix the colors
on the spot for you. It is not an exaggeration to say that you could
specify your design by Pantone color, especially since many artists have
fine arts degrees and are familiar with the various Pantone shades
[Pantone shades are used by professional artists and are standard
numbered colored].
ARE THERE GOLD OR SILVER INKS FOR TATTOOS?
While there are some metallic inks available, these are very rare and a
general answer to this question is a simple "no." If you have a design
that needs to look metallic, a good artist can use other colors to make
it look metallic without actually using gold or silver ink.
My understanding is that artists shy away from metallic colors because
of their toxic properties under the skin.
CAN I GET A WHITE INK TATTOO?
Most artists use white ink to highlight certain parts of your tattoo
design. However, white ink is a special color that requires your artist
to work closely with you. The effect of white ink differs greatly among
clients, and its visibility and retention on the skin has much to do
with the natural coloration of your skin.
White ink seems to work best on very light-skinned people.
Unfortunately, this means people with dark skin would not able to get a
white ink tattoo on their skin to have a "photo negative effect" that
looks like a negative of a dark colored tattoo on light skin. This is
because the ink sits under your skin, and the layer of skin over the ink
is tinted with your natural skin color. So if you have very dark skin,
the white will be overwhelmed with your natural melanin.
Those who have very light skin however, may use white ink exclusively to
get tattoo designs that are very difficult to discern at first glance.
This might be an interesting option for ankle or wrist tattoos, or other
areas where a regular non-white tattoo would show up too easily and
possibly cause problems for the wearer.
Researchers at Texas A&M are developing technology that will give diabetics a new way to
monitor their glucose levels. A "smart tattoo" that changes color intensity depending on glucose
levels is being developed by Gerard Cote, associate professor for the Department of Biomedical
Engineering at A&M.
The National Institute of Health states that more than 100 million people worldwide are afflicted
with diabetes, 17 million of whom are from the United States. About 19 percent of all deaths in
the United States are diabetes-related, making it the sixth leading cause of death among people
aged 25 years or older. Cote said he hopes his technology will help people manage their glucose
levels, effectively preventing the progression of diabetic complications such as eye, kidney, heart
and nerve disease.
"It is actually fluorescent particles that we hope to implant underneath the skin," Cote said.
The particles are polyethylene glycol beads that have a fluorescent coating. Glucose displaces the
fluorescent molecules, therefore when the glucose level is low, the fluorescence is high.
It is recommended that glucose levels be checked six or more times a day. Currently, diabetics
have to test their blood sugar level using finger-prick instruments. Because of the pain and
inconvenience of testing, many diabetics fall short of correctly monitoring their glucose levels.
The "smart tattoo" would eliminate the need for such invasive devices.
Nicole Parish, a 25-year-old Bryan High School teacher and 20-year diabetic, says she greatly
dislikes the current glucose monitoring methods.
"I hate, I hate, I hate checking my blood sugar. I hate pricking my finger all day long. For me it's
the hardest thing to deal with having this disease," Parish said.
But the days of finger-pricking may soon be coming to an end. Once the fluorescent beads are
implanted, according to Cote, the change in glucose levels would be detected noninvasively by
an external device that may be as small as a watch.
A sensor examines the light emitted from the tattoo. The higher the intensity of the light, the
higher the glucose level. Cote said he feels that the varying intensity of the displaced
fluorescence will be just as accurate as current monitoring devices.
The idea, Cote said, is that the particles, along with the external device after calibration, would
replace the finger-sticking instrument for the day-to-day readings.
One of the features of this technology that allows it to work is its fundamental difference from
common ink tattoos.
"A normal tattoo is made of ink particles that get taken up by the cells, and our particles are
intended to be in the interstitial space, not in the cells," Cote said.
The ink in standard tattoos is small enough to be absorbed into the cells of the skin, but the
fluorescent particles are much bigger. This allows the particles to occupy the interstitial fluid
surrounding the cells, which is important because the glucose levels in the interstitial fluid are
directly related to the levels in the blood.
Cote says the particles would last about one year before needing to be replaced and would need
to be injected in a part of the body where continuous exposure to the sun could be avoided.
Cote acquired his idea for this technology when he was attending a conference where a doctor,
who removes tattoos with lasers, joked that "it would be nice to have a tattoo that actually did
something."
"I was working in the glucose monitoring area and so I thought why not a glucose monitor," Cote
said. "We have since got funding from NSF-REU Interdisciplinary Chemistry Research Program,
Texas ARP (Advanced Research Program), and most recently NASA to further the idea."
In the end, it is up to the individual to decide what glucose monitoring method he or she prefers.
But as Parish said, compared to endless finger-pricking, "getting a little tattoo would be a small
price to pay."
http://www.thebatt.com/news/2003/09/18/Scitech/smart.Tattoo.Makes.Life.Easier-469164.shtml
Tattoo Removal at Mayo Clinic in Rochester
Tattoos may be accidental, caused by dirt or foreign material being driven into a wound, or
they may be purposely applied in either an amateur or professional setting by using
various inks and techniques.
Successful removal of a purposely applied tattoo depends on its cause, size, method of
placement, and type of pigment. A simple cutting out and closure often treat very small tattoos
that are seldom visible. A scar will result, but the scar is often less objectionable than the tattoo
itself.
Historically, physicians treated larger, multicolored, purposely applied tattoos in two ways:
dermabrasion and carbon dioxide laser. Dermabrasion sands the skin down below the level of the
tattoo ink. The carbon dioxide laser vaporizes the entire tattooed area. In most patients, these
treatments result in objectionable scars.
Treatment
Mayo physicians remove tattoos with a laser known as a Q-switched YAG laser. This laser
fires an intense beam of light, either invisible or green-colored, into the tattoo in a very
rapid burst. This heats the pigment within the tattoo and triggers its eruption from the
skin. The laser color depends on the color of the ink. Certain colors, like fluorescent yellow,
are extremely difficult to remove.
The procedure time varies from 15 to 45 minutes, depending on the tattoo size and the area
treated. Topical anesthesia is occasionally used depending on tattoo location, size and the
patient's tolerance for the brief burning discomfort associated with each laser burst. Oral or
intramuscular sedation can be used at the patient's request.
Following treatment, the wound may ooze small amounts of blood for several hours. The wound
must be covered with a dressing for 24 hours and maintained in a moist environment for seven to
10 days.
The risks of scarring with this treatment are low. However, complete removal of the tattoo is
rare. Although multiple treatments are usually required to obtain successive lightening of the
tattoo, final results depend on the depth of the tattoo pigment within the skin. On rare occasions,
certain uncommon tattoo inks react with the laser to form a darker-colored chemical, which is
untreatable.
http://www.mayoclinic.org/tattooremoval-rst/
Ink particles and colors
Tattoo particles are initially dispersed diffusely as fine granules in the upper dermis, as well as in
vertical foci at sites of injection, but they aggregate to a more focal, concentrated appearance
from days 7-13. In one study, black ink granules had a mean diameter of 4.42 mm, while Taylor
et al found black pigment granules in tattoos to be polymorphous and varying from 0.5-4.0 mm
in diameter. Turquoise and red pigment particles are approximately twice as large as black
granules. In both amateur and professional tattoos, the depth of the pigment ink varies greatly,
with a greater variability in size, shape, and location noted in amateur tattoos. Regardless of the
diverse origins of tattoo pigment, the light and electron microscopic appearance of all pigments
are similar, except for color.
Tattoo pigment granules are composed of 3 kinds of loosely packed particles, ranging from 2400 nm in diameter. The most common particle size is 40 nm, a particle size of 2-4 nm is less
common (slightly more electron dense), and a particle size of 400 nm is least common (very
electron dense with a crystalline structure). A study of freshly implanted eyeliner tattoo ink
revealed a particle size in the extracellular matrix of 0.1-1.0 mm, although the average particle
size in the pigment vial prior to implantation was 0.25 mm.
A prominent network of connective tissue surrounds each of the fibroblasts that contain ink
particles, effectively entrapping and immobilizing the cell. The life span of these fibroblasts is
unknown and may persist throughout the individual's life.
Although these studies provide considerable detail regarding the architectural morphology and
physiology, they do not fully explain the natural history of dermal tattoo ink. Commonly, a tattoo
appears duller, bluer, more indistinct, and blurred with time, presumably as a consequence of ink
particles moving deeper into the dermis through the action of mobile phagocytic cells. Random
biopsy samples of older tattoos demonstrate pigment in the deep dermis, in contrast to the more
superficial location of newer tattoos. Eventually, tattoo ink appears in the regional lymph nodes
of patients with tattoos.
Tattoo ink is remarkably nonreactive histologically, despite the frequent use of different
pigments of unknown purity and identity by tattoo artists. Amateur tattoo inks consist of simple,
carbon particles originating from burnt wood, cotton, plastic, or paper, or from a variety of inks,
including India ink, pen ink, and vegetable matter. Although it rarely occurs, red (mercury),
yellow (cadmium), green (chromium), and blue (cobalt) tattoo pigments have elicited a
persistent, localized allergic or photoallergic dermatitis and, more infrequently, systemic
reactions. Interestingly, the colors most commonly involved in allergic reactions (red and
yellow) often spontaneously disappear from a tattoo without clinical signs of a reaction.
TATTOO REMOVAL TECHNIQUES Section 4 of 9
Author Information Overview Histology Tattoo Removal Techniques Pulsed Laser Treatment Of
Tattoos Adverse Effects Comparative Studies Of Q-switched Lasers Laser Ablation Of Facial
Cosmetic Tattoos Bibliography
Over the centuries, different methods for tattoo removal have been explored. The earliest report
of removal was from Aetius, a Greek physician who described salabrasion in 543 AD. Less
modern tattoo removal techniques involve the destruction or removal of the outer skin layers by
mechanical, chemical, or thermal means, accompanied by inflammation. Transepidermal
elimination of pigment occurs through denuded skin and via an exudative phase that allows
tattoo pigment to migrate to the wound surface. The inflammatory response may also promote
macrophage activity, with increased phagocytosis enabling additional pigment loss during the
healing phase.
http://www.emedicine.com/derm/topic563.htm