Les tatouages protègent du cancer !

C’est sous ce titre provocateur qu’un article de recherche danois a été publié en 2015 dans un journal international de photobiologie

Lerche CM, Sepehri M, Serup J, Poulsen T, Wulf HC. Black tattoos protect against UVR-induced skin cancer in mice. Photodermatol Photoimmunol Photomed 2015;31(5):261-268.

Cet article n’a fait l’objet d’aucune couverture médiatique, probablement car ni les auteurs, ni le journal n’ont jugé utile de le faire.

Ces chercheurs danois se sont intéressés au développement de cancers cutanés sur les tatouages en utilisant un modèle de souris tatouée (si, si, ca existe !).  Pour cela, ils ont pris des souris dites sans poils, mais avec un système immunitaire qui fonctionne normalement. Ils ont tatoués leur dos d’un large rectangle noir avec une encre noire connue pour contenir un carcinogène, le benzopyrène. Ils ont réparti ces souris en 2 groupes pour les comparer. Ils ont ensuite exposé la moitié de ces souris 3 fois par semaine à des ultra-violets (les UV étant connus pour être carcinogènes au long cours) tandis que l’autre moitié était laissée tranquille. Par ailleurs pour des besoins de comparaison, il y a avait également un 3ème groupe de contrôle non tatoué, et non exposé à des UV, ainsi qu’ un 4ème groupe de souris qui avaient été tatoués mais sans encre (ce qui permet de vérifier si l’acte de tatouer lui-même est un facteur de risque).  Les auteurs ont ensuite attendu tranquillement de voir et de comparer l’apparition de cancers cutanés sur ces souris.

Sans surprise toutes les souris bombardées d’UV (tatouées ou non) ont au final développé des cancers cutanés alors que celles que l’on avait laissé vivre tranquillement non. Mais le plus étonnant (ou interessant) est que la médiane de temps de développement des cancers cutanées pour la moitié des souris était plus longs chez les souris tatouées de près de 50 jours ! (de l’ordre de 210 à 240 jours contre 160 à 190 jours). Les auteurs concluaient sur un effet protecteur des tatouages et la non-confirmation qu’une seule de dose injectée de benzopyrène à un effet carcinologique comparable à une exposition répétée.

Une des explications physiopathologiques est tout bêtement que le noir dans le derme absorbe les UV et ces derniers ne sont pas réfléchi vers l’épiderme comme dans une peau blanche non tatouée.

On peut discuter l’emploi du terme protecteur ici car en terme de santé publique cela n’est pas très fin à une époque où l’on essaye de prévenir les cancers de peau et les mélanomes liés au soleil et aux cabines à UV en éduquant la population à justement éviter le trop de soleil…

Cette année, les mêmes danois ont récidivé avec une étude similaire mais avec du rouge avec une encre contenant de l’anisidine, un autre carcinogègne interdit actuellement.  

Lerche CM, Heerfordt IM, Serup J, Poulsen T, Wulf HC. Red tattoos, ultraviolet radiation and skin cancer in mice. Exp Dermatol. 2017 May 13. doi:10.1111/exd.13383.

 Le protocole était identique, mais cette fois ci les auteurs ont observé que le délai de survenue de cancers cutanés était identique dans les 2 groupes. En d’autres termes, l’effet co-carcinogène des tatouages contenant des carcinogènes semble négligeable cliniquement comparés aux effets d’une exposition solaire

Ajoutons que dans un 3ème article, la même équipe a montré qu’ils ne retrouvaient aucun cancers dans les organes internes de ces souris tatouées.

Sepehri M, Lerche CM, Hutton Carlsen K, Serup J. Search for Internal Cancers in Mice Tattooed with Inks of High Contents of Potential Carcinogens: A One-Year  Autopsy Study of Red and Black Tattoo Inks Banned in the Market. Dermatology. 2017;233(1):94-99.

 

On peut critiquer les méthodes, le modèle murin, ou qu’il ne s’agisse pas d’une étude sur les nanoparticules spécifiquement… Les résultats sont là, publiés et pour le moins rassurant. On notera l’absence complète de couverture de ces articles: Parce que ce sont des journaux moins connu que Nature, ou que les auteurs ou les journaux ne jugent pas utiles de faire le buzz?

 Quant à l’article dans Scientific reports que dit-il ? que l’on trouve des composés des tatouages dans les ganglions de drainage.

Schreiver I, Hesse B, Seim C, Castillo-Michel H, Villanova J, Laux P, Dreiack  N, Penning R, Tucoulou R, Cotte M, Luch A. Synchrotron-based ν-XRF mapping and μ-FTIR microscopy enable to look into the fate and effects of tattoo pigments in  human skin. Sci Rep. 2017 Sep 12;7(1):11395.

Certes, mais celà on le savait depuis longtemps. Déjà Variot et Morau écrivaient en 1887 (!)

Variot (G.);Morau (H.). Etude microscopique et expérimentale sur les tatouages européens. In: Bulletins de la Société d’anthropologie de Paris, III° Série. Tome 10, 1887. pp. 730-736.

« Les travaux antérieurs de Follin et Virchow ont amplement démontré qu’un certain nombre de fragments colorés étaient charriés par les vaisseaux lymphatiques jusqu’aux ganglions »

Depuis plus d’une vingtaine d’années sont rapportés des cas de ganglions pigmentés véritablement tatoués. Ils sont de découverte fortuite lors d’une intervention chirurgicale, obligeant cependant à faire une biopsie et une analyse microscopique pour éliminer un mélanome.

De fait, si des pigments visibles à l’oeil nu ou au microscope sont passés dans les ganglions lymphatiques, on peut de fait anticiper que des particules de toute petite taille comme des nanoparticules (qui par définition on une taille < 100 nm) pouvaient passer. On sait depuis 2008 qu’il existe des nanoparticules également dans les encres de tatouages.

Je ne reviendrais pas sur les techniques et le contenu de l’article.  

Je souhaite pointer du doigt que dans cette étude les chercheurs n’avaient aucune information sur les personnes (décédées), qui ont donné leur peau et ganglions. On ne sait rien d’elles (sexe,  âge, métier, expositions à divers toxiques dans leurs vies, problèmes de santé etc) et même pas quelle est l’ancienneté des tatouages analysés !

Y a t-il encore une quelconque pertinence d’analyser des tatouages vieux de 50 ans alors qu’une législation européenne est active depuis 2008 et que des taux limites d’impuretés en sels métalliques est fixé ?

Enfin, j’insisterai sur la toxicologie du tatouage qui est particulière avec un mode d’exposition spécifique (l’introduction dans la peau d’une dose donnée de produit). Elle ne peut pas être mise sur le même plan que d’autres expositions (comme une exposition alimentaire ou respiratoire continue et quotidienne). 

Non loin de nier l’intérêt de cette étude, intéressante et utile, car elle confirme définitivement ce que l’on suspectait intuitivement à savoir le passage possible de ces derniers dans la circulation.

Maintenant fallait-il faire un communiqué de presse auprès du grand public, alors que d’autres études rassurantes ne font pas l’objet d’un battage ? non, d’autant que la pertinence clinique aujourd’hui de ces résultats n’est pas établie.

Publicités

Invitation for tattoo professionals to a meeting during the EADV congress in Geneva, 14 September 2017

 

Dear All,

Together with the Media and PR Committee of the EADV (European Academy of Dermatology and Venerology), we are delighted to invite you to our meeting organised during our upcoming EADV Congress in Geneva, Switzerland.

The aim is to explore future collaborations with tattooists, body art professionals and trainers.

When: Thursday 14 September 2017 from 14.30-16.00 hrs Where: Starling Hotel Geneva (walking distance from the PalExpo Congress Venue) 34 Route François Peyrot, 1218 Le grand Saconnex, Geneva, Switzerland

Registration: Free; no reimbursement of travel or hotel costs

Target group: Professional tattooists/tattoo organisation leaders/trainers

Presenters: Nicolas Kluger MD (15 min), Christa De Cuyper MD (15 min), Jens Bergström Professional tattooist/trainer (15 min)

Topics:  Tattoos and skin diseases: Risks and contraindications and specific measures to be taken  Wound care  The role of the tattooist in skin cancer detection  CEN hygiene standards for tattooists  Plus plenty of time for Q&A…

For further information and registration please contact christa.decuyper@outlook.be

Looking forward to meeting you in Geneva,

Christa De Cuyper, on behalf of the EADV Media & PR Committee

Official letter: Tattooists letter Geneve sept14

EADV (Headquarters) – Via S. Balestra 22B – 6900 Lugano, Switzerland Phone: +41 91 973 45 20 – Fax: +41 91 973 45 30 – Email: office@eadv.orghttp://www.eadv.org EADV (Succursale Belge) – Avenue Général de Gaulle 38 – 1050 Brussels, Belgium Phone: +32 2 650 00 90 – Fax: +32 2 650 00 98 – Email: office@eadv.orghttp://www.eadv.org

The 2017 Summary of Published Medical Journal Articles Involving Body Piercing, Modifications, & Tattooing on 8/28/17

IMG_0980.jpg

Here is a 2017 Summary of Published Medical Journal Articles Involving Body Piercing, Modifications, & Tattooing
Submitted to the APP et al on 8/28/17

All articles and abstracts summary was performed by Scott L. DeBoer RN,MSN,EMT-P

Founder: Pedi-Ed-Trics Emergency Medical Solutions
Transport Nurse: MedEx Chicago

List & Summaries of 1/1/17-8/25/17 Published Medical Articles on Body Art

This list is reproduced with the explicit authorization of Scott DeBoer. All credits for this work goes to him.

The articles are classified by the family name of the first author from A to Z
Adatto, M., et al. (2017). New and Advanced Picosecond Lasers for Tattoo Removal. Curr Probl Dermatol. 52. 113-123.
– Early methods of tattoo removal ultimately resulted in unacceptable cosmetic outcomes. While the introduction of laser technology was an improvement over the existing chemical, mechanical, and surgical procedures, the use of nonselective tattoo removal with carbon dioxide and argon lasers led to scarring. Q-switched lasers with nanosecond (10-9) pulse domains were considered to have revolutionized tattoo treatment, by selectively heating the tattoo particles, while reducing the adverse sequelae to adjacent normal skin. Theoretical considerations of restricting pulse duration, to heat tattoo particles to higher temperatures, proposed the use of sub-nanosecond pulses to target particles with thermal relaxation times lower than the nanosecond pulses in Q-switched lasers. Initial studies demonstrated that picosecond (10-12) pulses were more effective than nanosecond pulses in clearing black tattoos. Advances in picosecond technology led to the development of commercially available lasers, incorporating several different wavelengths, to further refine pigment targeting.

Ahn, K., et al. (2017). Simulation of laser-tattoo pigment interaction in a tissue-mimicking phantom using Q-switched and long-pulsed lasers. Skin Res Technol. 23(3). 376-383.
– A Q-switched (QS) neodymium-doped yttrium aluminum garnet laser was used at settings of 532-, 660-, and 1064-nm wavelengths, single-pulse and quick pulse-to-pulse treatment modes, and spot sizes of 4 and 7 mm. Most of the laser-tattoo interactions in the experimental conditions formed cocoon-shaped or oval photothermal and photoacoustic injury zones, which contained fragmented tattoo particles in various sizes depending on the conditions. In addition, a long-pulsed 755-nm alexandrite laser was used at a spot size of 6 mm and pulse widths of 3, 5, and 10 ms. The finer granular pattern of tattoo destruction was observed in TM phantoms treated with 3- and 5-ms pulse durations compared to those treated with a 10-ms pulse.
– We outlined various patterns of laser-tattoo pigment interactions in a tattoo-embedded TM phantom to predict macroscopic tattoo and surrounding tissue reactions after laser treatment for tattoo removal.
Ahn, K., et al. (2017). Pattern analysis of laser-tattoo interactions for picosecond- and nanosecond-domain 1,064-nm neodymium-doped yttrium-aluminum-garnet lasers in tissue-mimicking phantom. Sci Rep. 7(1). 1533.
– During laser treatment for tattoo removal, pigment chromophores absorb laser energy, resulting in fragmentation of the ink particles via selective photothermolysis. The present study aimed to outline macroscopic laser-tattoo interactions in tissue-mimicking (TM) phantoms treated with picosecond- and nanosecond-domain lasers. Additionally, high-speed cinematographs were captured to visualize time-dependent tattoo-tissue interactions, from laser irradiation to the formation of photothermal and photoacoustic injury zones (PIZs). In all experimental settings using the nanosecond or picosecond laser, tattoo pigments fragmented into coarse particles after a single laser pulse, and further disintegrated into smaller particles that dispersed toward the boundaries of PIZs after repetitive delivery of laser energy. Particles fractured by picosecond treatment were more evenly dispersed throughout PIZs than those fractured by nanosecond treatment. Additionally, picosecond-then-picosecond laser treatment (5-pass-picosecond treatment + 5-pass-picosecond treatment) induced greater disintegration of tattoo particles within PIZs than picosecond-then-nanosecond laser treatment (5-pass-picosecond treatment + 5-pass-nanosecond treatment).

Aktas, A., et al. (2017). Monitoring of Lawsone, p-phenylenediamine and heavy metals in commercial temporary black henna tattoos sold in Turkey. Contact Dermatitis. 76(2). 89-95.
– To determine the presence of, and quantify, Lawsone, PPD and heavy metal contaminants (cobalt, nickel, lead, and chromium) in commercial temporary black henna tattoo mixtures (n = 25) sold in Turkey.
– Our results suggest that commercial temporary black henna mixtures containing PPD levels up to 51.6% pose a risk of contact sensitization and severe allergic contact dermatitis among users. It is important to identify both the additives and metallic contaminants of black henna tattoo products; the significance of metal contaminants has still to be assessed.
Allen, D. (2017). Moving the Needle on Recovery From Breast Cancer: The Healing Role of Postmastectomy Tattoos. JAMA. 317(7). 672-674.
Amadori, F., et al. (2017). Oral mucosal lesions in teenagers: a cross-sectional study. Ital J Pediatr. 43(1). 50.
– Adolescence is a period of transition to adulthood. Little is known about oral mucosal lesions (OMLs) in teenagers, in which the emergence of new habits, unfamiliar to children, could affect the type of lesions. The aim of this study was to evaluate the distribution of oral mucosal lesions (OMLs) in a wide sample of adolescents.
– A retrospective cross-sectional study was carried out examining all medical records of adolescents (aged 13-18 years) treated at the Dental Clinic of the University of Brescia (Italy) in the period from 2008 to 2014.
RESULTS:
– … piercing-related lesions (4%)…
– The prevalence of OMLs in adolescents are different from those in children and, in some conditions, it could increase with age.
Ayanlowo, O., et al. (2017). Growing trend of tattooing and its complications in Nigeria. Int J Dermatol. 56(7). 709-714.
– However, since the late 20th century, tattooing has undergone a redefinition and shifted to an acceptable form of expression all over the world, including Nigeria, cutting across almost all age groups and socioeconomic class. This review is aimed at highlighting the indication, complications arising from the procedure as well as removal, and how to manage them. The dermatological complications associated with tattoos can occur either during inking or attempts at removal. Most times, tattoos are obtained through unsafe means by unauthorized personnel, and this is associated with numerous health risks.
– In conclusion, the trend of tattooing has become a widely accepted form of social expression all over the world and is gradually gaining ground in Nigeria. Patients frequently present to the dermatologists and physicians for solutions to the complications. It is important to proffer solutions and educate patients on the various health risks associated with tattooing.
Bareket, L., et al. (2017). Corrigendum: Temporary-tattoo for long-term high fidelity biopotential recordings. Sci Rep. (7).
Baumler, W. (2017). Laser Treatment of Tattoos: Basic Principles. Curr Probl Dermatol. 52. 94-104.
– Tattooing has become very popular worldwide during the past decades, and millions of people have one or many tattoos at different anatomical sites. The color of tattoos is mainly black, followed by red, green, blue, and other colors. A part of the tattooed people regret tattooing or have permanent problems with tattoos and therefore seek for tattoo removal.
– Laser therapy is most effective in black tattoos and less effective for colored tattoos. The rate of side effects is low due to the selectivity of the treatment. Laser light may change the chemistry of the tattoo pigments and hence provoke toxic decomposition products.
Bellaud, G., et al. (2017). Bacterial chondritis complications following ear piercing. Med Mal Infect. 47(1). 26-31.
– We conducted a retrospective study of patients presenting with post-piercing chondritis in the infectious disease department of Tenon Hospital, Paris, France.
RESULTS:
– We included 21 patients. Fifteen bacteriological cultures were positive (7 Pseudomonas aeruginosa, 5 Staphylococcus aureus, and three other).
– Transcartilaginous ear piercing may lead to infectious complications or deformity. In case of chondritis, early administration of an antibiotic therapy active against P. aeruginosa and S. aureus is recommended.
Biesman, B. & Costner, C. (2017). Evaluation of a transparent perfluorodecalin-infused patch as an adjunct to laser-assisted tattoo removal: A pivotal trial. Lasers Surg Med. 49(4). 335-340.
– Laser-assisted treatment of tattoos is well recognized to produce opaque epidermal whitening that prevents multiple sequential passes during a single treatment session. The amount of epidermal whitening produced in association with the procedure can be minimized by topical application of perfluorodecalin (PFD), which is an optical clearing agent. This pivotal trial assessed the ability of a transparent PFD-infused patch used in conjunction with a Q-switched nanosecond laser in the treatment of tattoos to permit multiple laser passes during a single 5 minute treatment session in comparison to the number of passes that could be completed using conventional treatment of the tattoo with the laser alone.
– Significantly more laser passes could be made on average using the PFD patch compared with treatment using the laser alone (3.7 passes vs. 1.4 passes; P < 0.001). AEs were limited to those expected during laser removal of tattoos. The proportions of subjects with transient edema and erythema were lower in the PFD patch treatment group (36.7% vs. 63.3% and 33.3% vs. 70.0%, respectively); all AEs were transient and resolved quickly. No patient in either group exhibited dyschromia (hypo- or hyperpigmentation) in the treatment area at the 1-month post treatment visit. Additionally, when surveyed at the 1-month follow-up visit, all subjects (30/30) preferred to continue laser-assisted tattoo removal with the PFD patch.
– An average of 3.7 laser passes were made in a defined 5-minute treatment session when using the transparent PFD-infused patch, which is significantly more than was possible with the laser alone (average of 1.4 passes). Use of the PFD patch was associated with improved tolerability compared with conventional treatment, with subjects experiencing fewer and less severe AEs related to epidermal injury.
Bircher, A., et al. (2017, July 4). Allergic contact dermatitis caused by a new temporary blue-black tattoo dye – sensitization to genipin from jagua (Genipa americana L.) fruit extract. Contact Dermatitis.
– Temporary tattoos made with an extract of the jagua fruit (Genipa americana L.) are becoming increasingly popular. It is claimed that it is ‘dermatologically tested’ and does not contain p-phenylenediamine.
– A 39-year-old female who repeatedly applied ‘completely natural and 100% safe’ Earth Jagua® tattoo, obtained via the internet, to her left hand developed allergic contact dermatitis within 6 weeks. Analysis of the dye showed the presence of geniposide and genipin.
– We report an extensively evaluated case of allergic contact dermatitis caused by a temporary Earth Jagua® tattoo. The allergen identified is genipin, a substance that is increasingly used for tattoos and as a therapeutic agent in medicine. This could result in an increase in the number of allergic reactions in the future.
Boulart, L., et al. (2017). Dealing with tattoos in plastic surgery. Complications and medical use. Ann Chir Plast Esthet. 62(2). e23-329.
– Not only has tattooing been socially performed for thousands of years, but it has also been part and parcel of medical practice since antiquity. In our day and age, plastic surgeons are ever more frequently compelled to deal with tattooing, whether in terms of its medical application or its complications. While the process itself may appear harmless, it is not without risk and necessitates use of suitable tools and management by expert hands.
Burlingame, B. (2017). Clinical Issues-January 2017. AORN J. 105(1). 110-116.
Caccavale, S., et al. (2017). Herpes compuctorum: a cutaneous infection related to permanent tattoo. Int J Dermatol. 56(7). e148-e149.
Calderia, S., et al. (2017). Tattoo or no tattoo? A contemporary ethical issue in nursing education. Nurs Ethics. 24(5). 626-628.
Calogiuri, G., et al. (2017). Hypersensitivity reactions due to black henna tattoos and their components: are the clinical pictures related to the immune pathomechanism? Clin Mol Allergy. 15(8).

– Here we review the various clinical patterns related to PPD and henna tattoo, to investigate the possible link between clinic-morphological pictures and the immunological response to PPD and henna. The literature underlines that different clinical manifestations are related to black henna containing PPD, and its derivative products may cause delayed-type as well as immediate-type reactions.
Chheda, K., et al. (2017). The tattoo removal ethical conundrum: Should a physician be part of a minor patient’s punishment? J Am Acad Dermatol. 77(2). 385-387.
Cobb, H., et al. (2017). Systemic contact dermatitis to a surgical implant presenting as red decorative tattoo reaction. JAAD Case Rep. 3(4). 348-350.
– Up to 5% of orthopedic implant patients suffer metal-related cutaneous complications caused by delayed-type hypersensitivity reactions, most commonly to nickel, cobalt, and chromium. Both generalized and remote site dermatitis to orthopedic implants are uncommon.
– Traditional and decorative tattoos have been given for thousands of years around the world and remain a popular practice in modern times, with as many as 3 in 10 adults reporting having 1 or more tattoos. As more people get tattoos, the rate of complications, which may be as high as 2%, is likely to increase. Adverse tattoo reactions are common and predominantly affect red pigmented areas. Although reactions were often caused by an allergy to particular metals within pigments in the past, with the shift toward the use of azo dyes, the mechanism is unclear.
– A 57-year-old woman with diabetes mellitus and an unremarkable dermatologic history underwent placement of a first metatarsophalangeal joint hemi implant with cobalt chromium hardware coated with titanium plasma and hydroxyapatite. The patient reported that within 2 weeks of surgery, the red-containing areas of her tattoos, which were previously flat and uninflamed, became raised and pruritic. Oral antihistamines and emollients resulted in only partial symptom relief. Her symptoms temporarily resolved after a combination of intralesional injections with triamcinolone suspension (10 to 40 mg/mL) at intervals of every 1 to 2 months and triamcinolone 0.1% cream only to recur several weeks after each injection.
– With the frequency of tattooing and surgery involving metallic implants both increasing, it seems inevitable that adverse tattoo reactions possibly related to metallic implants will also increase. This case exemplifies the need for clinicians to be able to recognize and diagnose these cutaneous complications and be aware of treatment options available.
Colbert, S. & Brennan, P. (2017). Tattoos: could they be used to advantage as a medical alert in oral and maxillofacial surgery? Br J Oral Maxillofac Surg. 55(3). 300-301.
– Many publications have addressed the medical complications of tattoos, but to our knowledge there are no reports of their use to alert people in our field of potentially dangerous conditions. We present a new way to inform oral and maxillofacial colleagues about patients with a history of malignant hyperthermia (or any other life-threatening medical problem) and discuss the potential advantages and disadvantages of medical alert tattoos.

Conti, R., et al. (2017). Pseudoepitheliomatous hyperplasia in a tattoo. G Ital Dermatol Venereol. 152(1). 71-72.
Coppola, N., et al. (2017). Hepatitis B virus infection in undocumented immigrants and refugees in Southern Italy: demographic, virological, and clinical features. Infect Dis Poverty. 6(1). 33.
– The data on hepatitis b virus (HBV) infection in immigrants population are scanty. The purpose of this study was to define the demographic, virological, and clinical characteristics of subjects infected with HBV chronic infection in a cohort of immigrants living in Naples, Italy.
– Of the 1,212 immigrants screened, 116 (9.6%) were HBsAg positive, 490 (40.4%) were HBsAg negative/anti-HBc positive, and 606 (50%) were seronegative for both. Moreover, 21 (1.7%) were anti-human immunodeficiency virus positive and 45 (3.7%) were anti-hepatitis C virus positive. The logistic regression analysis showed that male sex, Sub-Saharan African origin, low level of schooling, and minor parenteral risks for acquiring HBV infection (acupuncture, tattoo, piercing, or tribal practices, were independently associated with ongoing or past HBV infection.
Cornelissen, A., et al. (2017). Breast Implant Infection After Nipple Piercing. Aesthet Surg J. 37(1). NP3-NP4.
Corso, G., et al. (2017, July 15). Axillary blue sentinel lymph node: an unusual tattoo? Eur J Nucl Med Mol Imaging.
Cozzi, S., et al. (2017). Tattoo removal with ingenol mebutate. Clin Cosmet Investig Dermatol. 10. 205-210.
– An increasing number of people are getting tattoos; however, many regret the decision and seek their removal. Lasers are currently the most commonly used method for tattoo removal; however, treatment can be lengthy, costly, and sometimes ineffective, especially for certain colors. Ingenol mebutate is a licensed topical treatment for actinic keratoses. Here, we demonstrate that two applications of 0.1% ingenol mebutate can efficiently and consistently remove 2-week-old tattoos from SKH/hr hairless mice.
Crowther, A., et al. (2017). Exploring the motivations for body piercing: A pilot study. Issues Ment Health Nurs. 38(8). 682-683.
Cunningham, R., et al. (2017). Another Tattoo Reaction Pitfall: A Pink Lamb in Wolf’s Clothing. JAMA Dermatol. 153(5). 463-464.
de Cuyper, C., et al. (2017, August 9). Are metals involved in tattoo-related hypersensitivity reactions? A case report. Contact Dermatitis.
– Allergic reactions to tattoos are not uncommon. However, identification of the culprit allergen(s) remains challenging.
– We present a patient with papulo-nodular infiltration of 20-year-old tattoos associated with systemic symptoms that disappeared within a week after surgical removal of metal osteosynthesis implants from his spine. We aimed to explore the causal relationship between the metal implants and the patient’s clinical presentation.
– Nickel (Ni) and chromium (Cr) as well as high levels of titanium (Ti) and aluminium were detected in both the skin biopsy and the implants. XRF analyses identified Cr(III), with Cr(VI) being absent. Patch testing gave negative results for Ni and Cr. However, patch tests with an extract of the implants and metallic Ti on the tattooed skin evoked flare-up of the symptoms.
– The patient’s hypersensitivity reaction and its spontaneous remission after removal of the implants indicate that Ti, possibly along with some of the other metals detected, could have played a major role in this particular case of tattoo-related allergy.
Escudero-Gongora, M., et al. (2017). Reactive perforating collagenosis on a tattoo. J Eur Acad Dermatol Venereol. 31(2). e87-e89.
Fania, L., et al. (2017). Tattoo and warts: efficacy of topical immunotherapy. Eur J Dermatol. 27(3). 322-323.
Flynn, A., et al. (2017). Image Gallery: Systemic sarcoidosis presenting within the black pigment of a cosmetic tattoo. Br J Dermatol. 176(1). e2.
Friedmann, D., et al. (2017). Localized Cutaneous Argyria From a Nasal Piercing Successfully Treated With a Picosecond 755-nm Q-Switched Alexandrite Laser. Dermatol Surg. 43(8). 1094-1095.
Friedmann, D., et al. (2017). Keloidal Scarring From the At-Home Use of Intense Pulsed Light for Tattoo Removal. Dermatol Surg. 43(8). 1112-1114.
Garve, R., et al. (2017). Labrets in Africa and Amazonia: medical implications and cultural determinants.Trop Med Int Health. 22(2). 232-240.
– The custom of wearing labrets has a long tradition. Labrets appeared independently several thousand years ago in various culture groups in Asia, Europe, Africa and the Americas. Today, apart from diverse body modifications as increasingly practiced in western civilisations, lip plates and plugs are found among a small number of tribal groups only in Africa and Amazonia. We summarise the history of labrets in different societies, describe medical consequences of wearing lip plates and plugs for jaws and teeth and address relevant cultural issues.
Grannan, S. (2017). Understanding patient perceptions and risk for hepatitis C screening. J Viral Hepat. 24(8). 631-635.
– The specific aims were to identify specific themes and barriers to viral hepatitis C (HCV) testing and to determine if testing rates increased when patients self-identify their risk factors and were offered testing.
– The typical participant (N=111) was female (74%), Baby Boomer (1945-1965) generation (45%), white (86%), and uninsured (54%). Top 6 self-identified risks were tattoo and/or body piercings (47.7%), Baby Boomer (36%), multiple sex partners (18%), work-related exposure (8.1%), non-injection drug use (8.1%), and injection drug use (7.2%). Only 78% of Baby Boomers identified being a Baby Boomer as a risk. Eighty-one percent of participants did not want to test.
– Main reasons not to test were « I do not have any risk factors » (30.2%), concerned with cost (15.1%), tested in the past (15.1%), other reasons (9.3%), not feeling well (5.8%)
Greveling, K., et al. (2017). Non-invasive anaesthetic methods for dermatological laser procedures: a systematic review. J Eur Acad Dermatol Venereol. 31(7). 1096-1110.
– Pain is a common side-effect of dermatological laser procedures. Non-invasive anaesthetic drugs and anaesthetic procedures can be used to provide pain relief and increase patient satisfaction and treatment efficacy. However, it remains unclear which method provides the best pain relief. The objective of this systematic review was therefore to assess the efficacy and safety of non-invasive anaesthetic methods during dermatological laser procedures.
– All of the studies had an unclear or high risk of bias, and the overall quality of evidence was rated as low. In general, active non-invasive anaesthetic methods seemed to provide favourable results compared to placebo or no anaesthesia, and topical anaesthetic drugs and pneumatic skin flattening (PSF) seemed to result in a better pain reduction than skin cooling. However, the current evidence is insufficient to provide recommendations for daily clinical practice.
– There is a need for more high-quality (head-to-head) RCTs. Future studies should also evaluate sex differences in pain perception, have uniformity with regard to validated pain measurement scales and address clinically significant differences in pain reduction besides statistically significant differences.

Greveling, K., et al. (2017). Comparison of lidocaine/tetracaine cream and lidocaine/prilocaine cream for local anaesthesia during laser treatment of acne keloidalis nuchae and tattoo removal: results of two randomized controlled trials. Br J Dermatol. 176(1). 81-86.
– To compare the efficacy of lidocaine/tetracaine cream and lidocaine/prilocaine cream in reducing self-reported pain during deeper dermal laser treatment of acne keloidalis nuchae (AKN) and tattoos.
– We conducted two randomized, double-blind, controlled clinical trials with intrapatient, split-lesion designs: study A included patients with AKN (n = 15); study B included patients with black tattoos (n = 15). The primary end point was the patients’ self-reported pain on a 10-cm visual analogue scale (VAS). Secondary objectives were the percentage of patients with adequate pain relief, willingness to pay €25 for the cream that provided the best pain relief and safety of the creams.
– In both studies, VAS scores were lower for lidocaine/prilocaine cream, with a mean VAS difference in study A of 1·9 and in study B of 0·6. In study A, adequate pain relief was achieved in 13% (n = 2) with lidocaine/tetracaine cream vs. 73% (n = 11) with lidocaine/prilocaine cream (P = 0·004), and in study B in 53% (n = 8) vs. 80% (n = 12), respectively (P = 0·289). In study A, 47% (n = 7) were willing to pay an additional €25 vs. 73% (n = 11) in study B. No serious adverse events occurred.
– Lidocaine/prilocaine cream under plastic occlusion is the preferred topical anaesthetic during painful laser procedures targeting dermal chromophores.
Heinen, E., et al. (2017). Do long-term tongue piercings affect speech quality? Logopedics Phoniatrics Vocology. 42(3). 126-132.
– … we analyzed the effect of tongue piercing on speech in a perception experiment. Samples of spontaneous speech and read speech were recorded from 20 long-term pierced and 20 non-pierced individuals (10 males, 10 females each). The individuals having a tongue piercing were recorded with attached and removed piercing. The audio samples were blindly rated by 26 female and 20 male laypersons and by 5 female speech-language pathologists with regard to perceived speech quality along 5 dimensions: speech clarity, speech rate, prosody, rhythm and fluency.
– We found no statistically significant differences for any of the speech quality dimensions between the pierced and non-pierced individuals, neither for the read nor for the spontaneous speech. In addition, neither length nor position of piercing had a significant effect on speech quality. The removal of tongue piercings had no effects on speech performance either. Rating differences between laypersons and speech-language pathologists were not dependent on the presence of a tongue piercing.
– People are able to perfectly adapt their articulation to long-term tongue piercings such that their speech quality is not perceptually affected
Hendren, N., et al. (2017, May 27). Vibrio vulnificus septic shock due to a contaminated tattoo. BMJ Case Rep.
– We present a case of Vibrio vulnificus septic shock and cellulitis in a patient with chronic liver disease that occurred after obtaining a leg tattoo with subsequent seawater exposure in the Gulf of Mexico.
– Despite aggressive initial treatment, the patient developed septic shock and died. This case highlights the association of chronic liver disease and high mortality associated with infections of V. vulnificus.

Henley, J. & Ramsey, M. (2017, June 30). Tattoo Lasers. Stat Pearls.
– Laser tattoo removal was first used in the late 1960s following the creation of the first laser, but removal often led to suboptimal results due to significant surrounding tissue destruction and scarring. It was not until the description of the theory of selective photothermolysis in the 1980s that exogenous tattoo pigment could be selectively targeted as a chromophore at specific wavelengths. According to this theory, the target chromophore must be heated quickly before it can cool. For optimal destruction, the pulse durations need to be shorter than the thermal relaxation time of the tattoo particle or the time that is required for the target to lose 50% of its heat. Due to the small size of the tattoo particles, rapid pulses of high heat at very short pulse durations in the nanosecond to picosecond range are required to prevent cooling of the particles. The thermal relaxation time of tattoo particles is thought to be less than ten nanoseconds. Lasers with Q-switched technology are capable of producing light pulses of short duration but with a peak power that is much higher than is achievable with continuous wave output. More recently, lasers of even shorter pulse duration have been developed, potentially offering better targeting of chromophores with less damage to surrounding tissue. Laser Devices: The type of laser and wavelength chosen for removal largely depends on the patient’s tattoo color and skin type. Q-switched (QS) lasers such as the QS Ruby, QS Nd: YAG, and QS Alexandrite until recently were the most effective devices for tattoo removal. However, picosecond lasers have quickly become the mainstay of treatment due to their superior efficacy and decreased treatment durations. Now there are picosecond 532-nm, 694-nm, 755-nm, and 1064-nm devices available to target a wide array of tattoo pigments. Patients with Fitzpatrick IV-VI (darker) skin types should be treated cautiously due to increased risk for hypopigmentation following treatment. Lasers that penetrate deeper into the dermis, such as the Nd: YAG 1064-nm laser, are associated with a decreased risk of epidermal damage and hypopigmentation in this patient population. Some chromophores for various laser wavelengths include: 532 nm – red, orange, yellow, brown. 694 nm – black, blue, green. 755 nm – black, blue, green. 1064 nm – black, blue. Colors that respond best to laser removal are black, brown, dark blue, and green, while the most difficult colors to remove are red, orange, yellow, and light blue.

Hutton, K., et al. (2017). Laser Surgeon, Client Education, and Satisfaction with Tattoo Removal. Curr Probl Dermatol. 52. 124-131.
– Studies of satisfaction with tattoo removal outcomes by laser, rated by clients themselves, including qualitative aspects, are sparse. We studied long-term results and client satisfaction with tattoo removal by Q-switched YAG laser.
– Client-surgeon interaction during the full laser treatment course is a major determinant of client satisfaction. The client is in a dynamic state of mind and undergoes a change of opinion during a laser treatment course as a result of his/her experiences. In this continuous process of learning, expectations are changed from a state of high expectation before treatment to a more realistic state with acceptance of outcome. The laser surgeon shall be aware of his/her role as a tutor and prepare the client for a situation, where outcomes can be acceptable albeit not ideal.
Hutton, K., et al. (2017). Tattoo removal by Q-switched yttrium aluminium garnet laser: client satisfaction. J Eur Acad Dermatol Venereol. 31(5). 904-909.
– Tattoo removal by Q-switched yttrium aluminium garnet (YAG) lasers is golden standard; however, clients’ satisfaction with treatment is little known.
– One hundred and fifty-four tattoo removal clients who had attended the private clinic ‘Centre for Laser Surgery’, Hellerup, Denmark, from 2001 to 2013 completed a questionnaire concerning outcome expectations, level of pain experiences and satisfaction with tattoo removal. The laser surgeon and his team were blinded from data handling. The study design included a minimum 2-year postlaser treatment observation period from 2013 to 2015.
– Overall, clients were satisfied with their laser treatment; 85% assessed their treatment and results to be acceptable to superb, while 15% assessed their treatment and results to be inferior to unacceptable. Effectiveness relative to colour of tattoo on a scale from 0 (no effect) to 10 (complete removal) scored a mean of blue 9.5, black 9.4, yellow 8.9, red 8.8 and green 6.5. Clients were dissatisfied with green pigment remnants, which could mimic bruising. One hundred and twenty-nine clients (84%) experienced moderate to extreme pain during treatment. Twenty-eight (20%) developed minor scarring. There were many reasons for tattoo removal; e.g. stigmatisation (33%), conspicuousness (29%) and poor artistic quality (22%). One hundred and two clients had expected complete removal of tattoos without a blemish, expectations that were only partly fulfilled. During the treatment period, clients adjusted expectations and adapted more realistic views of outcomes.
– The majority of clients were satisfied with Q-switched YAG laser removal of tattoos despite high pretreatment expectations which were only partly met. The study supports YAG lasers for tattoo removal as acceptable therapy of today, with room for new approaches.

Imbernon-Moya, A., et al. (2017, February 23). Three-Dimensional Strawberry Tattoo. Actas Dermosifiliogr.
Imrigha, N., et al. (2017, May 2). Photobiomodulation therapy on wound treatment subsequent to Q-switched Nd: YAG laser tattoo removal in rat model. J Biophotonics.
– Q-switched Nd: YAG laser is the most effective laser for tattoo removal. Photobiomodulation (PBM) therapy is an alternative method applied to accelerate the wound healing. This paper investigated the effects of PBM therapy using 808 nm diode laser on tattooed skin after laser tattoo removal. Forty-five rats were selected and tattooed with black ink on their dorsal, and then distributed into three groups. G0 was received non-laser irradiation. G1 was treated by laser tattoo removal using 1064 nm with energy density of 3.4 J/cm2 without PBM therapy, while G2 was treated daily with PBM therapy using 808 nm diode laser of 5 J/cm2 after a single session of laser tattoo removal. The effects of tattoo removal and healing progress of the wound were analyzed using histological studies. Findings showed 808 nm laser promotes the healing process through enhancing epithelialization and collagen deposition. Moreover, PBM therapy stimulated immune cells to improve phagocytosis process for removing the tattoo ink fragments effectively. The PBM therapy treated group was capable of improving the healing process and increasing the quality of skin following the laser tattoo removal. It was also found that stimulation of cellular function by PBM therapy increased tattoo clearance efficiency.
Isik, S., et al. (2017). Severe Neck and Face Edema in an Adolescent-Delayed Hypersensitivity Reaction to Hair Dye. Pediatr Emerg Care. 33(6). 422-423.
– Here, a 15-year-old girl is presented, who developed a hypersensitivity reaction after first exposure to hair dye. She was found to have been sensitized to PPD before, through application of black henna tattoo.
Jakus, J. & Kailas, A. (2017). Picosecond Lasers: A New and Emerging Therapy for Skin of Color, Minocycline-induced Pigmentation, and Tattoo Removal. J Clin Aesthet Dermatol. 10(3). 14-15.
Jashnani, K., et al. The tattoo dilemma: Reading in between the ink. Indian J Pathol Microbiol. 60(1). 141-142.
Jibreal, H,., et al. (2017, June 28). Necrobiosis lipoidica following Q-switched laser tattoo removal. Australas J Dermatol.
Jones, M., et al. (2017). Advancing Keloid Treatment: A Novel Multimodal Approach to Ear Keloids. Dermatol Surg. 43(9). 1164-1169.
– Retrospective analysis of 49 patients treated with extralesional surgical excision of keloids localized to the ear followed by the application of autologous platelet-rich plasma (PRP) to wound site and postoperative in-office superficial radiation therapy (SRT).
– Fifty ear keloids were treated with this method, age from 15 to 66 of which 14 were male and 35 female. Almost 30% of patients acknowledged the source of injury that led to the development of the keloid was ear piercing. Treatment protocol achieved a 94% success rate with 3 patients who reported recurrence.
– Surgical excision combined with intraoperative PRP, adjuvant postoperative in-office SRT achieved a 94% nonrecurrence rate on follow-up over a 2-year period. Outcomes provide preliminary, albeit, strong evidence to support this multimodal method as a viable alternative in the management of keloids localized to the ear.
Junco, P. (2017, March 20). Educational intervention about oral piercing knowledge among dental students and adolescents at schools. Int Dent J.
– Oral piercing can lead to complications and dentists are in a unique position to detect such complications. The purpose of this study was: (i) to assess the immediate and the long-term effects, on dental students, of a training programme about oral piercing knowledge; and (ii) to assess the immediate effect, on adolescents, of a single educational intervention session about oral piercing.
– Oral piercing educational intervention had a favourable impact on adolescents and dental students, particularly among those who were more involved in the learning process.

Karsai, S. (2017). Removal of Tattoos by Q-Switched Nanosecond Lasers. Curr Probl Dermatol. 52. 105-112.
– Tattoo removal by Q-switched nanosecond laser devices is generally a safe and effective method, albeit a time-consuming one. Despite the newest developments in laser treatment, it is still not possible to remove every tattoo completely and without complications. Incomplete removal remains one of the most common challenges. As a consequence, particular restraint should be exercised when treating multicoloured tattoos, and patients need to be thoroughly informed about remaining pigment. Other frequent adverse effects include hyper- and hypopigmentation as well as ink darkening; the latter is particularly frequent in permanent make-up. Scarring is also possible, although it is rare when treatment is performed correctly. It is becoming more widespread for laser operators to encounter allergic reactions and even malignant tumours in tattoos, and treating these conditions requires a nuanced approach.
Keester, D. & Sommerich, C. (2017). Investigation of musculoskeletal discomfort, work postures, and muscle activation among practicing tattoo artists. Appl Ergon. 58. 137-143.
– Tattoo artists are an understudied worker population with respect to investigation of work-related musculoskeletal (MSK) discomfort and associated risk factors. Results from one discomfort survey has been published; no analysis of worker biomechanics has been published. As such, a study was conducted to begin exposure assessment of tattoo artists to work factors that could result in MSK discomfort. Consistent with the prior survey, the current study showed an elevated prevalence of MSK discomfort. Twelve month discomfort prevalence exceeded 50% in the neck, shoulders, hands/wrists, and upper and lower back (range: 53-94%). Seventy-one percent of postures evaluated during 16 h of observation had total RULA scores of 5, 6, or 7 (investigation and changes are required soon or immediately). Static muscle activity levels in the left, right, or both upper trapezius muscles in each study participant exceeded the 2-5% MVE limit recommended in the literature.

Kim, Y., et al. (2017, April 24). Mohs Micrographic Surgery for a Red Tattoo Reaction. Dermatol Surg.

Kim, H., et al. (2017). Primary Cutaneous Aspergillosis after Tattoo Removal Using a 1,064-nm Q-Switched Nd:YAG Laser in an Immunocompetent Patient. Ann Dermatol. 29(2). 241-243.

Klement, K., et al. (2017). Extreme rituals in a BDSM context: The physiological and psychological effects of the « Dance of Souls. » Culture, Health, & Sexuality: An International Journal for Research, Intervention and Care. 19(4). 453-469.
– Participation in extreme rituals (e.g., fire-walking, body-piercing) has been documented throughout history. Motivations for such physically intense activities include religious devotion, sensation-seeking and social bonding. The present study aims to explore an extreme ritual within the context of bondage/discipline, dominance/submission and sadism/masochism (BDSM): the ‘Dance of Souls’, a 160-person ritual involving temporary piercings with weights or hooks attached and dancing to music provided by drummers. Through hormonal assays, behavioural observations and questionnaires administered before, during and after the Dance, we examine the physiological and psychological effects of the Dance, and the themes of spirituality, connectedness, transformation, release and community reported by dancers. From before to during the Dance, participants showed increases in physiological stress (measured by the hormone cortisol), self-reported sexual arousal, self-other overlap and decreases in psychological stress and negative affect. Results suggest that this group of BDSM practitioners engage in the Dance for a variety of reasons, including experiencing spirituality, deepening interpersonal connections, reducing stress and achieving altered states of consciousness.
Klimova, A., et al. (2017.) Tattoo-associated uveitis. Cesk Slov Ofalmol. 73(1). 30-33.
– The clinical case of tattoo-associated uveitis was first described by Lubeck and Epstein in 1952. Uveitis is accompanied by induration and hyperemia of tattoo skin, which can precede, follow or manifest simultaneously with uveitis. T
– Tattoo-associated uveitis should be remembered in differential diagnosis due to the growing interest in tattoo.
Kluger, N. & Bosonnet, S. (2017). Keloid occurring in a tattoo. Ann Dermatol Venereol. 144(6-7). 455.
Kluger, N. & Armingaud, P. (2017). Herpes simplex infection on a recent tattoo. A new case of « herpes compuctorum ». Int J Dermatol. 56(1). e9-e10.
Kluger, N. (2017). Tattooing and immunodepression: Caution is warranted also in organ transplant patients. Transpl Infect Dis. 19(3).
– Letter to editor with nicely worded summary as to previously reported life-threatening issues with body art and transplant/immunosuppressed patients
– Recommends patients discuss desire for new tattoos (especially if already tattooed & likely to get another one) with physician to determine best time for « green light » for new body art
– Also indicates recommendations for tattoo artists when dealing with patients of this type

Kluger, N. (2017). Body piercing and tattooing among French patients with bleeding disorders. Presse Med. 46(5). 538-540.
– Nice summary of a survey of patients with bleeding disorders (hemophilia, etc.) and their experiences with physicians, body artists, and preparations/complications
– Interestingly, a high percentage of people did not inform the body artist about their bleeding tendencies before tattooing or piercing
– Recommends discussion with physician and body artist pre-procedure to optimize chance for success and minimize complications
Kluger, N., et al. (2017). Tattooing and psoriasis: a case series and review of the literature. 56(8). 822-827.
– Koebner phenomenon (KP) affects from a quarter to a third of the patients with psoriasis and can occur on tattoos
– Six men and one woman with a median age of 36 ± 6.4 years old were included. Five disclosed a KP in a recent tattoo within days to 1 month after its completion. Fifteen additional cases were collected from the literature (8 men, median age 22 ± 8.2 years old). The delay of psoriasis flare-up after tattooing was rather short, from a few weeks to several months. We found a high variability in the clinical presentation with five clinical subtypes/profiles of psoriasis on tattoos. A possible confusion between « genuine » KP on tattoos and the coincidental occurrence of psoriasis patches on tattoos is possible in some cases of the literature.
– Koebner phenomenon on tattoos may occur in patients with psoriasis under various forms. The evolution is benign, and psoriasis is not a contraindication for tattooing, but patients need proper counseling before getting tattooed.

Kluger, N. (2017). Cutaneous Complications Related to Tattoos: 31 Cases from Finland. Dermatology. 233(1). 100-109.
– Thirty-one patients (16 men and 15 women, mean age 37.8) were included from 9 cities, mainly from Helsinki. Fifty-two percent (16/31) presented with an allergic tattoo reaction mainly against the red colour (75%, 12/16). Reactions were clinically polymorph ranging from scattered papules or nodules to complete infiltration of a colour. Lesions were itchy and sometimes painful. The reactions were lichenoid, granulomatous, pseudolymphomatous or less specific with a dermal lympho-histiocytic or plasmocytic infiltrate. Other diagnoses included tattoo blow-out (13%), melanoma within a tattoo, naevi within a tattoo (10% each), lichen planus (6%), granulomatous reaction with uveitis, sarcoidosis and dermatofibroma (3% each).

Kluger, N. (2017). National survey of health in the tattoo industry: Observational study of 448 French tattooists. Int J Occup Med Environ Health. 30(1). 111-120.
– The data regarding the health of professional tattooists is inexistent. Tattooists are usually heavily tattooed and exposed daily to body fluids and skin-to-skin contacts with customers, tattoo inks, solvents, allergens, irritants, and work for hours often in inadequate positions using vibrating tattoo machines. We analyzed the health status of active French professional tattooists.
– An observational self-reported Internet survey was performed among 448 tattooists who were members of the French Tattoo Union in November 2013.
– The main physical complaints were musculoskeletal: back pain (65%), finger pain (41.5%) and muscular pain (28.8%). Finger pain, back pain, muscular pain and carpal tunnel symptoms/tingling sensations on the fingers occurred among 88%, 61.5%, 68% and 84% of the cases after having started their activity (p < 0.001). Other chronic diseases, autoimmune diseases and cancers remained at a low level here.
– Professional tattooists have a high prevalence of musculoskeletal complaints about back pain due to repetitive movements, awkward postures and use of a vibrating tattoo machine. Tattooists have a unique environment that imply developing intervention and preventive strategies for them.
Lagrelius, M., et al. (2017, July 4). A population-based study of self-reported skin exposures and symptoms in relation to contact allergy in adolescents. Contact Dermatitis.
– 3115 adolescents questionaire concerning various skin exposures and related skin symptoms. Of these, 2285 were patch tested.
– The prevalences of self-reported piercing (55.4%), hair dyeing (50.1%) and related skin symptoms were high, particularly in girls. Piercing and itchy rash after contact with metal items were associated with increased risks of nickel.
– Adolescents are exposed to skin-sensitizing substances, for example because of piercing, hair dyeing, and tattooing. Such early-life skin exposure may lead to lifelong contact allergy and future allergic contact dermatitis and hand eczema.

Lambertini, M., et al. (2017). ‘Scaly’ tattoo reactions: is treatment mandatory? Clin Exp Dermatol. 42(3). 347-348.

Lee, H,. et al. (2017, May 31). Does the Sequence of Tattooing and Nipple Reconstruction Affect Nipple Projection? Ann Plast Surg.
– In nipple reconstruction, the maintenance of adequate projection is one of the most important and challenging aspects. However, no reports have evaluated whether tattooing after nipple reconstruction affects nipple projection. This study aimed to test our hypothesis that tattooing after reconstruction adversely affects nipple projection.
– These findings showed that the sequence of nipple reconstruction and tattooing had no significant effect on the projection of the reconstructed nipple. It is easier to tattoo homogeneously before nipple reconstruction because of the flat surface but more difficult to make a smooth areolar peripheral margin and circular areolar shape when reconstructing the nipple. The sequence of tattooing and nipple reconstruction can be determined according to esthetic and clinical considerations.

Lerche, C., et al. (2017, May 13). Red tattoos, ultraviolet radiation and skin cancer in mice. Exp Dermatol.
– Ultraviolet radiation (UVR) induces skin cancer. The combination of UVR and red tattoos may be associated with increased risk of skin cancer due to potential carcinogens in tattoo inks. This combination has not been studied previously.
– In conclusion, no spontaneous cancers were observed in skin tattooed with a red ink containing 2-anisidine. However, red tattoos exposed to UVR showed faster tumor onset regarding the third tumor, and faster growth rate of the second and third tumor indicating red ink acts as a cocarcinogen with UVR.

Lim, H. & Shin, H. (2017). Sensitive Determination of Volatile Organic Compounds and Aldehydes in Tattoo Inks. J Chromatogr Sci. 55(2). 109-116.
– As the popularity of body art including tattoo ink has increased, the safety associated with it has become an important interest. In this study, twenty volatile organic compounds (VOCs) and two aldehydes in tattoo inks were identified and quantified.
– Our analytical results represent solvents used intentionally or non-intentionally in tattoo inks, and thus they may provide important information for national regulation.

Lorgeou, A., et al. (2017, July 31). Comparison of two picosecond lasers to a nanosecond laser for treating tattoos: a prospective randomized study on 49 patients. J Eur Acad Dermatol Venereol.
– Q-switched nanosecond lasers demonstrated their efficacy in treating most types of tattoos but complete disappearance is not always achieved even after performing numerous laser sessions. Picosecond lasers are supposed to be more efficient in clearing tattoos than nanosecond lasers but prospective comparative data remain limited.
– A total of 49 patients were included. Professional tattoos represented 85.7%, Permanent makeup 8.2% and non-professional tattoo 6.1%. The majority were black or blue and 10.2% were polychromatic.
– A reduction of 75% or more of the color intensity was obtained for 33% of the tattoos treated with the picosecond lasers compared to 14% with the nanosecond laser (p=0.008). An improvement superior to 75% was obtained in 34% monochromic black or blue tattoos with the picosecond lasers compared to 9% for the nanosecond laser. Only 1 of the 5 polychromic tattoos achieved more than 75% of improvement with the two types of laser.
– Our results show a statistically significant superiority of the picosecond lasers compared to the nanosecond laser for tattoo clearance. However, they don’t show better efficacy for polychromic tattoos and the difference in terms of side effects were also minimal with a tendency of picosecond lasers to be less painful.

Lu, C., et al. (2017). Bilateral diffuse lamellar keratitis triggered by permanent eyeliner tattoo treatment: A case report. Exp Ther Med. 14(1). 283-285.
– Diffuse lamellar keratitis (DLK) is a sterile inflammation of the cornea, which may occur after laser-assisted in situ keratomileusis (LASIK) surgery. Little is known about the association of DLK with permanent eyeliner tattoo. The present case report describes the case of a 37-year-old Chinese woman who developed severe foreign body sensation in both eyes 1 week after receiving bilateral permanent eyeliner tattoo treatment. The patient had received bilateral LASIK surgery 10 years previously.
– To our knowledge, this is the first case report describing a case of late-onset of DLK that was triggered by permanent eyeliner tattoo. Doctors should be aware of the diagnosis and treatment of this complication associated with the application of permanent eyeliner tattoo as the popularity of this cosmetic procedure increases.

Luetkemeier, M., et al. (2017). Skin Tattoos Alter Sweat Rate and Na+ Concentration. Med Sci Sports Exerc. 49(7). 1432-1436.
– The purpose of this study was to compare the sweat rate and sweat Na concentration of tattooed versus nontattooed skin.
– Tattooed skin generated less sweat and a higher Na concentration than nontattooed skin when stimulated by pilocarpine iontophoresis.

Malca, N., et al. (2017). Dealing with tattoos in plastic surgery. Tattoo removal. Ann Chir Plast Esthet. 62(2). e15-e21.
– Not only has tattooing been socially performed for thousands of years, but it has also been part and parcel of medical practice since antiquity. In our day and age, plastic surgeons are ever more frequently compelled to deal with tattooing – and with tattoo removal procedures, as well. While the process itself may appear harmless, it is not without risk and necessitates use of suitable tools and management by expert hands.

Malki, S., et al. (2017). Cutaneous T pseudolymphoma on the red pigmented areas of a tattoo. Int J Dermatol. 56(8). e172-e173.
Millan-Cavetano, J., et al. 92017, May 17). Treatment of red tattoo reaction using CO2 laser. Lasers Med Sci.
Mitchell, L., et al. (2017, January 19). Tattoo Trouble. BMJ. 356.
Mori, W., et al. (2017). Tattoo Artists’ Approach to Melanocytic Nevi. JAMA Dermatol. 153(4). 328-330.
Moulton, L. & Jernigan, A. (2017, February 19). Management of Retained Genital Piercings: A Case Report and Review. Case Rep Obstet Gynecol.
– The prevalence of genital piercing among women is increasing. As the popularity increases, the number of complications from infection, injury, and retained jewelry is likely to rise. Techniques to remove embedded jewelry are not well described in the literature. The purpose of this report was to describe a case of a patient with a retained clitoral glans piercing, discuss a simple technique for outpatient removal, and review current evidence regarding associated risks of clitoral piercings. A 24-year-old female presented to the emergency department with an embedded clitoral glans piercing. Local anesthetic was injected into the periclitoral skin and a small superficial vertical incision was made to remove the ball of the retained barbell safely. In conclusion, among patients with retained genital piercing, outpatient removal of embedded jewelry is feasible. While the practice of female genital piercing is not regulated, piercing of the glans of the clitoris is associated with increased injury to the nerves and blood supply of the clitoris structures leading to future fibrosis and diminished function compared to piercing of the clitoral hood.
– While retained or embedded jewelry is reported as a known complication of genital piercings, there is little published information about patients who are at risk and management strategies. To our knowledge, this is the first report detailing the removal of an embedded clitoral piercing.
– Retained jewelry is a known complication of genital piercings, but there is a paucity of published information on how to manage this problem. The best removal method in these delicate and sensitive areas must be tailored to the patient, the embedded object, and the physician’s skill set. In this case, removal was performed safely in an outpatient setting avoiding the morbidity of general anesthesia and the expense of operative management. As the popularity for genital piercings increases, clinicians should be prepared to handle the potential complications.

Muller, C., et al. (2017). Socio-epidemiologic aspects and cutaneous side effects of permanent tattoos in Germany – Tattoos are not restricted to a specific social phenotype. Dermatoendocrinol. 9(1).
– More and more people of all age classes have a tattoo. Intriguingly, there are multiple prejudices in the general population and published data that concern tattooed persons, such as being criminals, having a low education, being alcohol or drug abusers, or more risky in their life style.
– We interviewed 426 participants with already existing tattoos and 20 participants just before getting a new tattoo by using an online questionnaire. The participators were asked about socio-epidemiologic aspects of tattoos in general and special aspects of their own tattoo(s) in particular.
– Tattoos are interesting for people seeking popular body art, esp. university graduates and financially-secure individuals. 446 persons participated in this study. Most of the persons were female with a mean age of 35…. 93.5% of the participants did not want a tattoo removal. Intriguingly, most of the participants experienced no career problems related to the tattoo(s).
– The present data shows that common tattooed persons are not low educated criminals with any drug or alcohol abuse or with risky life style. Nowadays being tattooed encompasses a kind of body art and displays a certain kind of lifestyle habit.

Naeini, F., et al. (2017). Looking beyond the cosmetic tattoo lesion near the eyebrow: Screening the lungs. J Postgrad Med. 63(2). 132-134.
– We report a 45 year-old patient with history of dyspnea and mild cough since two years who had subsequently developed reddish, scaly lesions in her 15-year old tattoo done near her right eyebrow. Skin biopsy of the tattoo lesion revealed cutaneous sarcoidosis which led to further investigations and a diagnosis of pulmonary sarcoidosis. The present case highlights the fact that cutaneous sarcoidosis can develop in a long-standing tattoo. Also such a patient should be screened for systemic sarcoidosis disease.

Naga, L. & Alster, T. (2017). Laser Tattoo Removal: An Update. Am J Clin Dermatol. 18(1). 59-65.
– Tattoo art has been around for thousands of years in every culture and is currently flourishing in all age groups, social classes, and occupations. Despite the rising popularity of tattoos, demand for their removal has also increased. While various treatments, including surgical excision, dermabrasion, and chemical destruction have historically been applied, over the past 2 decades, lasers have revolutionized the way tattoos are treated and have become the gold standard of treatment. To achieve optimal cosmetic outcome of treatment, lasers emitting high energies and short pulses are required to adequately destroy tattoo ink. We review the history of laser tattoo removal, outlining the challenges inherent in developing lasers that can most effectively remove tattoo particles while safely protecting skin from unwanted injury.
Napolitano, M., et al. (2017, May 16). Skin diseases and tattoos: a five-year experience. G Ital Dermatol Venereol.
– A retrospective study analyzing records data of patients attending the Department of Dermatology, University of Naples « Federico II » during 2011-2015 was performed. All cases of tattoo related or closely located dermatitis were selected.
– We observed 19 patients (mean age: 26.4 year-old) showing cutaneous conditions related to the practice of tattooing. Allergic contact dermatitis was reported as the most common cutaneous disease linked to tattooing (31.6%), followed by granulomatous reactions (26.3%). These data are consistent with those already reported in literature.
– Our results highlight the need to develop detailed regulations regarding tattoos practice, used materials, as well as execution procedures in order to limit the outbreak of tattooing related skin diseases.
O’Beirne, S., et al. (2017). The lady with the dragon tattoo. Ir J Med Sci. 186(1). 157-160.
– A 35-year-old Caucasian female with multiple tattoos presented with a 5-week history of tenderness of the black dye in a tattoo depicting a dragon.
– Sarcoidal tattoo reactions in those without systemic sarcoidosis are a rare occurrence, and their presence should prompt a search for systemic involvement. The accurate identification of skin involvement in sarcoidosis is important, as it tends to occur early in the course of disease, and the skin is a readily accessible site for biopsy, allowing for prompt diagnosis.
Ogawa, R. (2017). Keloid and Hypertrophic Scars Are the Result of Chronic Inflammation in the Reticular Dermis. Int J Mol Sci. 18(3).
– Keloids and hypertrophic scars are caused by cutaneous injury and irritation, including trauma, insect bite, burn, surgery, vaccination, skin piercing, acne, folliculitis, chicken pox, and herpes zoster infection. Notably, superficial injuries that do not reach the reticular dermis never cause keloidal and hypertrophic scarring. This suggests that these pathological scars are due to injury to this skin layer and the subsequent aberrant wound healing therein.

Ormerod, E., et al. (2017). Allergic contact dermatitis caused by resorcinol following a temporary black henna tattoo. Contact Dermatitis. 77(3). 187-188.
Ortiz, J., et al. (2017). Para-phenylenediamine allergic contact dermatitis due to henna tattoos in a child and adolescent population. An Pediatr (Barc). 86(3). 122-126.
– Almost half (49.7%; (361 cases) of the children had one or more positive patch test findings, with 4.7% (34) being allergic to PPDA. Mean age of patients allergic to PPDA was 12.4 years, and 44.2% were male. There were 2 cases (5.9%) of atopic dermatitis. Of the positive reactions, 73.5% were considered to be current clinically relevant. The sensitisation origin was a Henna tattoo in 50% of cases.
– PPDA sensitisation is relatively common in the child and adolescent population. The most frequent origin is the performing of Henna tattoos adulterated with PPDA. Adolescents are at the higher risk of developing ACD due to Henna tattoos. Henna tattooing should be strongly discouraged in children.

Pandya, V., et al. (2017). Tattoo-associated uveitis with choroidal granuloma: A rare presentation of systemic sarcoidosis. Retin Cases Brief Rep. (11(3). 272-276.
– A 30-year-old man presented with headaches, ocular pain, photophobia, and blurred vision. He was found to have significant skin inflammation, predominantly involving areas of tattoos…. He was diagnosed with systemic sarcoidosis.
– The authors report another rare case of tattoo-associated uveitis, in which inflammation is limited to tattooed skin and the uvea. This uncommon presentation may prove informative in elucidating the pathogenesis of systemic sarcoidosis.

Painsi, C. & Lange-Asschenfeldt, B. (2017), Image Gallery: Pink papules within a tattoo linked to Mycobacterium chelonae infection. Br J Dermatol. 177(1).

Panfili, E., et al. (2017). Temporary Black Henna Tattoos and Sensitization to para-Phenylenediamine (PPD): Two Paediatric Case Reports and a Review of the Literature. Int J Environ Res Public Health. 14(4).
– Because of its molecular characteristics, PPD can induce skin sensitization that may cause various clinical manifestations with successive exposures, among which the most common is allergic contact dermatitis (ACD). This report describes two paediatric cases of PPD sensitization and ACD after the exposure to TBHT and summarizes the literature on this emerging clinical problem.

Perez-Lopez, I., et al. (2017). Tattoo in 3 dimensions, foreign body granuloma. Med Clin (Barc). 148(6). e35.

Pinto, F., et al. (2017). Neodymium-doped yttrium aluminium garnet (Nd:YAG) 1064-nm picosecond laser vs. Nd:YAG 1064-nm nanosecond laser in tattoo removal: a randomized controlled single-blind clinical trial. Br J Dermatol. 176(2). 457-464.
– For decades, nanosecond lasers (NSLs) have been used to remove tattoos. Since 2012, pulses of picosecond lasers (PSLs) have been available for tattoo removal. Based on a few observational studies, the claim has been made that PSLs are considerably more effective while showing fewer side-effects in comparison with NSLs.
– Twenty-one patients with 30 black tattoos were treated with PSL and NSL in a split-study design in two sessions at intervals of 6 weeks.
– The average clearance overall as evaluated showed no statistical difference between NSL and PSL (P = 1·00). Using a visual analogue scale (0 = no pain, 10 = maximum pain), a value of 3·8 ± 1·0 was reported for the PSL, which was statistically different from NSL (7·9 ± 1·1, P < 0·001). Transient side-effects were observed, as well as hypo- and hyperpigmentation, but there was no statistically significant difference between PSL and NSL.
– After two treatments of black tattoos with a neodymium-doped yttrium aluminium garnet laser (1064 nm), the use of picosecond pulses does not provide better clearance than nanosecond pulses. However, pain is less severe when using a PSL.

Reinhard, R., et al. (2017, February 21). Recurrent tattoo reactions in a patient treated with BRAF and MEK inhibitors. J Eur Acad Dermatol Venereol.

Reiter, O., et al. (2017). Erratum to: Picosecond lasers for tattoo removal: a systematic review. Lasers Med Sci. 32(2). 483.

Ross, E. (2017). The picosecond revolution and laser tattoo treatments: are shorter pulses really better? Br J Dermatol. 176(2). 299-300.

Ross, N., et al. (2017). Eruptive Milia Within a Tattoo: A Case Report and Review of the Literature. J Drugs Dermatol. 16(6). 621-624.
– Of the many tattoo reactions the most common are allergic, granulomatous, lichenoid, photosensitive, pseudolymphomatous, and infectious. Eruptive milia are a rare complication with only three prior reports in the English literature. A 19-year-old African American female presented with tiny, white papules confined within the margins of a tattoo. She denied trauma or associated symptoms at the site. Biopsy demonstrated deposits of black granular material within the dermis and a small infundibular cyst; a diagnosis of eruptive milia within tattoo was made.
– Given its rarity, it is important to recognize the presentation of this disorder as other tattoo reactions require more aggressive management.

Santosh, A. & Reddy, B. (2017). Oral Mucosal Infections: Insights into Specimen Collection and Medication Management. Dent Clin North Am. 61(2). 283-304.
– Oral mucosal infections appear as localized or generalized lesions. Symptoms range from almost unnoticeable lesions to severe pain. Systemic disease, age, immunocompromised condition, and medication use are common causes. Local causes include dentures, poor oral hygiene, traumatized epithelium, ulcerations, dentures, implants, oral piercing, and reduced salivary secretion…

Sasaki, K., et al. (2017). Type 2 Minocycline-induced hyperpigmentation successfully treated with the novel 755 nm picosecond alexandrite laser – a case report. Laser Ther. 26(2). 137-144.
– Minocycline therapy for acne vulgaris is associated with the occasional induction of various types of unsightly and often persistent hyperpigmentation, which is frequently resistant to hydroquinone treatment. Pigment-specific lasers have achieved some success with multiple treatment sessions. Recently, the picosecond domain 755 nm alexandrite laser (ps-Alex) has attracted attention in tattoo removal. The present study reports on the successful treatment, in a single ps-Alex session, of minocycline-associated pigmentation.
– Our results in this single case strongly suggest that the novel 755-nm ps-Alex laser is both safe and very effective for the treatment of type 2 minocycline-induced hyperpigmentation even in PIH-prone type IV Asian skin.

Schmitz, I, et al. (2017). Squamous cell carcinoma in association with red tattoo. J Dtsch Dermatol Ges. 15(1). 98-100.
– Although tattoos have become exceedingly popular in recent years, only few cases of severe reactions leading to malignant transformation have been reported in the literature. This stands in contrast to the virtually innumerable number of tattoos worldwide. The composition of tattoo dyes is highly variable, and even the same colors may contain different compounds. The objective of our study was to investigate in what way tattoo dyes may potentially trigger skin cancer.
– We report the rare case of a 24-year-old woman who – seven months after getting a tattoo on the back of her foot – developed a squamous cell carcinoma in close proximity to the red dye used.
– While the tattoo dye primarily consisted of barium sulfate, traces of Al, S, Ti, P, Mg, and Cl were also detected. The analysis showed pigment granules of varying sizes. In rare cases, tattoo inks may have carcinogenic effects, which appear to be multifactorial.

Sepehri, M., et al. (2017). Search for Internal Cancers in Mice Tattooed with Inks of High Contents of Potential Carcinogens: A One-Year Autopsy Study of Red and Black Tattoo Inks Banned in the Market. Dermatology. 233(1). 94-99.
– Tattoo ink stock products often contain potential carcinogens, which on large-scale population exposure may be clinically relevant. The aim of this autopsy study in mice was to screen major organs for clinical and subclinical cancers.
– The black and red inks were both stock products banned on the Danish market due to the measured contents of potential carcinogens; benzo(a)pyrene and 2-anisidine, respectively.
– Despite extensive tattoos with 2 banned inks, the long-term observation in mice showed no internal cancers nor was the combination of carcinogen and UVR associated with cancer. Lack of observed malignancy might be explained by the fact that tattooing is only a single dose exposure. Registered data on carcinogens relies on repeated or chronic exposures. The study does not support the hypothesis that tattooing causes cancer.

Sepehri, M., et al. (2017). Tattoo Pigments Are Observed in the Kupffer Cells of the Liver Indicating Blood-Borne Distribution of Tattoo Ink. Dermatology. 233(1). 86-93.
– Tattoo pigments are deposited in the skin and known to distribute to regional lymph nodes. Tattoo pigments are small particles and may be hypothesized to reach the blood stream and become distributed to peripheral organs. This has not been studied in the past. The aim of the study was to trace tattoo pigments in internal organs in mice extensively tattooed with 2 different tattoo ink products.
– The study demonstrated black and red tattoo pigment deposits in the liver; thus, tattoo pigment distributed from the tattooed skin via the blood stream to this important organ of detoxification. The finding adds a new dimension to tattoo pigment distribution in the body, i.e., as observed via the blood in addition to the lymphatic pathway.

Sepehri, M. & Jorgensen, B. (2017). Surgical Treatment of Tattoo Complications. Curr Probl Dermatol. 52. 82-93.
– With a continuing increase in the number of tattoos performed worldwide, the need to treat tattoo complications is growing. Earlier treatments of chronic inflammatory tattoo reactions were dominated by a medical approach, or with no active intervention. In this chapter, we will address modern surgical approaches applied to situations when medical treatment is inefficient and lasers are not applicable. Dermatome shaving is positioned as first-line treatment of allergic tattoo reactions and also indicated in a number of other tattoo reactions, supplemented with excision in selected cases. The methods allow fundamental treatment with removal of the culprit pigment from the dermis. The different instruments, surgical methods, and treatment schedules are reviewed, and a guide to surgeons is presented. Postoperative treatments and the long-term outcomes are described in detail. An algorithm on specialist treatment and follow-up of tattoo reactions, which can be practiced in other countries, is presented.

Sepehri, M., et al. (2017). Papulo-Nodular Reactions in Black Tattoos as Markers of Sarcoidosis: Study of 92 Tattoo Reactions from a Hospital Material. Dermatology. 232(6). 679-686.
– This is a consecutive study of patients with tattoo complications, diagnosed in the « Tattoo Clinic » at Bispebjerg University Hospital in Copenhagen, Denmark, from 2008 to 2015, based on clinical assessment and histology. From the overall group of 494 tattoo complications in 406 patients, 92 reactions in 72 patients showed a papulo-nodular pattern studied for local and systemic sarcoidosis, since sarcoidosis is expected to be nodular.
– Black tattoos with papulo-nodular reactions should be seen as markers of sarcoidosis. Papulo-nodular reactions may, as triggers, induce widespread reactions in other black tattoos – a « rush phenomenon » – depending on individual predisposition. Sarcoidosis is estimated to be 500-fold increased in papulo-nodular reactions compared to the prevalence in the general population, and the association with black tattoos is strong.

Serup, J. (2017). Diagnostic Tools for Doctors’ Evaluation of Tattoo Complications. Curr Probl Dermatol. 52. 42-57.
– Diagnosis of tattoo complications is a multi-facetted field since many clinical entities and disease mechanisms are represented. Infections, allergies, and pigment foreign body reactions with granuloma are the major groups. The clinician needs a structured approach to diagnosis and an armamentarium of standard tests. Diagnosis primarily builds on patient history, objective clinical examination, and punch biopsy, supplemented with microbiology testing, ultrasound scanning, and clinical photography.

Serup, J. (2017). Medical Treatment of Tattoo Complications. Curr Probl Dermatol. 52. 74-81.
– Tattooing is a skin trauma and involves a special vulnus punctatum (with inserted tattoo ink, a vulnus venenatum), which should heal with no infection and no local complication. Local treatment in the healing phase ideally builds on the ‘moist wound’ principle using plastic film, hydrocolloids, silver dressing, and compression.
– A warning against the use of lactic acid and other caustic chemicals for tattoo removal is given, since such chemicals and commercial products cannot be dosed properly and very often result in disfiguring scarring.

Serup, J. (2017). How to Diagnose and Classify Tattoo Complications in the Clinic: A System of Distinctive Patterns. Curr Probl Dermatol. 52. 58-73.
– Tattoo complications represent a broad spectrum of clinical entities and disease mechanisms. Infections are known, but chronic inflammatory reactions have hitherto been inconsistently reported and given many interpretations and terms. A clinical classification system of distinct patterns with emphasis on inflammatory tattoo reactions is introduced. Allergic reactions prevalent in red tattoos and often associated with azo pigments are manifested as the ‘plaque elevation’, ‘excessive hyperkeratosis’, and ‘ulceronecrotic’ patterns. The allergen is a hapten. Nonallergic reactions prevalent in black tattoos and associated with carbon black are manifested as the ‘papulonodular’ pattern. Carbon black nanoparticles agglomerate in the dermis over time forming foreign bodies that elicit reactions. Many black tattoos even develop sarcoid granuloma, and the ‘papulonodular’ pattern is strongly associated with sarcoidosis affecting other organs. Tattoo complications include a large group of less frequent but nevertheless specific entities, i.e. irritant and toxic local events, photosensitivity, urticaria, eczematous rash due to soluble allergen, neurosensitivity and pain syndrome, lymphopathies, pigment diffusion or fan, scars, and other sequels of tattooing or tattoo removal. Keratoacanthoma occurs in tattoos. Carcinoma and melanoma are rare and occur by coincidence only. Different tattoo complications require different therapeutic approaches, and precise diagnosis is thus important as a key to therapy. The proposed new classification with characteristic patterns relies on simple tools, namely patient history, objective findings, and supplementary punch biopsy. By virtue of simplicity and broad access, these methods make the proposed classification widely applicable in clinics and hospitals. The system is reported to the 11th revision of the WHO diagnosis classification used as international standard.

Serup, J. (2017). From Technique of Tattooing to Biokinetics and Toxicology of Injected Tattoo Ink Particles and Chemicals. Curr Probl Dermatol. 52. 1-17.
– Tattoo colourants are colourful nano- and microparticles, which are practically insoluble and thus permanent once installed in the dermis by the tattooist. Tattoo ink also has soluble ingredients and contaminants. Pigments can distribute via the lymph and possibly also directly to the blood, and a minute fraction may over time undergo metabolic breakdown and as hapten(s) induce allergic reactions of red tattoos. Carbon black of black tattoos has a tendency to agglomerate and form larger bodies that can elicit foreign body reactions in black tattoos and even granuloma formation with overlap to sarcoidosis in the clinic. Very little is known about the biokinetics and safety profile of the many tattoo pigments in use, and no specific pigment-related chemical of tattoo ink causing identified adverse reactions in humans has been depicted. Inks have many ingredients and contaminants.
– Controlling the safety of tattoo inks by banning potentially critical chemicals hitherto has been unsuccessful due to lacking documentation of clinical and epidemiological relevance and because the tattoo industry is already internationally established, free, and in the ownership of the people. Doctors treating patients with tattoo complications consequently have a key role in identifying risk situations and local outbreaks, which needs clarification, therapy, and the intervention of authorities. In the treatment of complications, as seen in general practice and in other specialties, basic insight into the fate of tattoo pigments in the body is necessary. Tattoo complications are complicated and facetted with many entities and disease mechanisms; they are a new subspecialty in medicine and dermatology.

Serup, J. (2017). Tattoo Infections, Personal Resistance, and Contagious Exposure through Tattooing. Curr Probl Dermatol. 52. 30-41.
– Bacterial infection of tattoos remains a common complication. Pyogenic bacteria can cause infections shortly after the tattoo is made. Severity of infection varies from minor to major, ultimately with life-threatening septicemia.
– Doctors have a role not only in treating tattoo infections but also in reporting cases to the competent authority in their country to support the monitoring of tattoo infections at any time, as an instrument for the authority to detect local outbreaks of tattoo infections early and prevent that new tattoo customers become infected. It is a potential risk of the future that new and very aggressive bacteria not seen in the past may unexpectedly show up in the tattoo scene.

Serup, J. (2017). Atlas of Illustrative Cases of Tattoo Complications. Curr Probl Dermatol. 52. 139-229.
– Tattoos, and tattoo complications as well, are colorful and visually flashy. A clinical outlook provides important clues to diagnosis by pattern recognition. This atlas,which is a report of 79 case illustrations, is made as a practical tool and vade mecum for the clinician.
– This atlas is a tutorial in modern medical and surgical treatments of tattoo complications.

Serup, J. (2017). Individual Risk and Prevention of Complications: Doctors’ Advice to Persons Wishing a New Tattoo. Curr Probl Dermatol. 52. 18-29.
– Doctors who are consulted about health and tattoo risks have an important role in the prevention of an individual’s tattoo complications. Tattooing is a tremendous exposure of the human body to needle operation, particles, and chemicals. The risk is related to a person’s health condition, level of insight, decision-making, and to the operation of tattooing, tattoo inks and utensils, tattoo parlour, and the aftercare.
– A campaign called ‘Tattoo – know your risk’ is presented with detailed fact sheets about tattoos, tattoo problems, how to reduce risk, and a checklist for the tattoo customer before decision-making. The sheets with keynote information are useful aids for doctors giving advice to persons curious about acquiring a tattoo.

Serup, J. & Baumler, W. (2017). Guide to Treatment of Tattoo Complications and Tattoo Removal. 52. 132-138.
– Clinicians in the fields of general medicine, dermatology, and plastic surgery are in their work now and then confronted with tattoo complications. Recognizing the rather few important diagnostic groups and urgencies, the medical ‘decision tree’ of treatment becomes quite simple. Acute conditions are dominated by bacterial infections needing antibiotic treatment. Systemic infection is a matter of urgency and requires intravenous treatment in a hospital without delay to prevent septic shock. Inflammatory reactions are a real challenge.
– Tattoo complications also include many rare but specific entities, which require individual treatment depending on the case and the disease mechanism. Removal of tattoos in individuals regretting their tattoo is performed using Q-switched nanosecond lasers and the recently introduced picosecond lasers. In view of the various tattoo pigments with different absorption spectra and the limited number of laser wavelengths, it is difficult to predict treatment outcome, and it is recommended to pretreat small test spots. Black and red colors are removed best, while other colors are difficult. Removal of large tattoos, especially when multicolored, is hardly achievable and not recommended. Clients often have unrealistic expectations, and informed consent and dialogue between the client and the laser surgeon before and during a treatment course is important since the client shall know the risk that removal can be unsuccessful, with complications and even disfiguring leading to regret at the end.

Shashikumar, B., et al. (2017). Hypersensitive Reaction to Tattoos: A Growing Menace in Rural India. Indian J Dermatol. 62(3). 291-296.
– Fifty cutaneous allergic reactions were diagnosed among 39 patients. Mean age of subjects was 22 years and mean duration before the appearance of lesion was 7 months. Common colors associated with reactions were red (53.9%), black (33.3%), green (5.1%), and multicolor (7.7%). Itching was the predominant symptom. Skin lesions mainly consisted of lichenoid papules and plaques, eczematous lesions, and verrucous lesions. Lichenoid histopathology reaction was the most common tissue allergic reaction.
– Increasing popularity of tattooing among young people has predisposed to parallel increase in adverse reactions. Red pigment is most common cause of allergic reaction in the present study, and lichenoid reaction is the most common reaction.

Silk, H. & Kwok, A. (2017). Addressing Adolescent Oral Health: A Review. Pediatr Rev. 38(2). 61-68.
– Oral health is one of the most unmet health care needs of adolescents. Oral disease can have a profound effect on overall health, including pain, missed school, heart disease, and even death. Adolescents have specific needs pertaining to oral health in addition to the usual lifelong issues of caries management, sports injury prevention, and dental referrals. Teen years are a higher risk time for oral piercings, increased sugar intake, nicotine initiation, and orthodontic considerations. Adolescents need a unique approach to motivate them about their oral health issues. This is particularly important because lifelong health habits are created during these formative years, and prevention opportunities for sealants and varnish are only available at this age.

Soran, A., et al. (2017, July 6). The importance of tattoo pigment in sentinel lymph nodes. Breast Dis.
– The presence of pigment in axillary lymph nodes (LN) secondary to migration of tattoo ink can imitate the appearance of a blue sentinel lymph node (SLN) on visual inspection, causing the operator to either miss the true SLN or excise more than is needed.
– Patients were retrospectively reviewed from medical records and clinicopathologic data was collected. A total of 52 LNs were retrieved from 15 patients for sentinel mapping and 29 of them had tattoo pigmentation on pathologic evaluation.
– Of those 29 SLNs, 2 of them (6.9%) were pigmented, but did not contain either blue dye or Tc-99m (pseudopigmented SLN). Two (3.8%) SLNs were positive for metastasis; both of these had either blue dye or Tc99m uptake, and 1 demonstrated tattoo pigment in the node.
– In this cohort of patients with ipsilateral tattoos, removed more LNs lead to unnecessary excision which may important for increasing the risk of arm morbidity from SLN biopsy. However, the presence of tattoo pigment did not interfere with understaging for axillary mapping and it did not effect of pathological identification of SLNs positivity.

Stirn, A. & Zannoni, R. (2017, July 25). Body modifications and sexual health : Impact of tattoos, body piercing and esthetic genital plastic surgery on the sexual health of women and men Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz.
– The present paper addresses the psychological impact of body modifications (e.g. tattoos, body piercing and esthetic genital plastic surgery) on the sexual health of individuals and refers to past and present research insights. Body modifications are understood as invasive interventions on the human body, especially interventions on the human skin which result in (semi-)permanent changes. Tattoos and body piercing (in particular genital piercing) positively affect the sexual satisfaction and the sexual appeal of men and women but there is a controversial association with high risk sexual behavior. Moreover, this article focuses on esthetic genital plastic surgery based on the increasing interest and insights of the impact on female genital self-perception and sexual behavior.
Sun, J., et al. (2017, August 7). Evaluation of metabolism of azo dyes and their effects on Staphylococcus aureus metabolome. J Ind Microbiol Biotechnol.
– Dyes containing one or more azo linkages are widely applied in cosmetics, tattooing, food and drinks, pharmaceuticals, printing inks, plastics, leather, as well as paper industries. Previously we reported that bacteria living on human skin have the ability to reduce some azo dyes to aromatic amines, which raises potential safety concerns regarding human dermal exposure to azo dyes such as those in tattoo ink and cosmetic colorant formulations.
– In summary, this study provided novel information regarding azo dye metabolism by the skin bacterium, the effects of azo dyes on the bacterial cells and the important role on the toxicity and/or inactivation of these compounds due to microbial metabolism.

Tammaro, A., et al. (2017). Aminoazobenzene in tattoo: another case of allergic contact dermatitis. Int J Dermatol. 56(4). e79-e81.

Tanner, S. & Menzies, S. (2017, January 5). Cutaneous sarcoid granulomas within a cosmetic tattoo. 356.

Tomazevic, T., et al. (2017). Occurrence of Dental Injuries and Periodontal Complications in Tongue-piercing Jewellery Users. Oral Health Prev Dent. 15(3). 293-297.
– Tongue piercing (TP) has been gaining in popularity, mainly among adolescents and young adults, and there has been a corresponding increase in reports of dental injury and adverse effects on periodontal tissue due to TP jewellery. The purpose of this study was to assess the type and prevalence of dental injury and periodontal complications in a group of Slovenian adolescents and young adults with TP in comparison with a control group.
– This case-control study included 17 subjects with TP (study group) and 28 subjects without TP (control group). Subjects were clinically examined for dental injuries, as classified according to Andreasen. Periodontal complications were evaluated using an estimation of clinical attachment loss (CAL) and gingival recession (GR).
– Subjects with TP had 12.2 higher odds of dental injury compared with subjects without TP. Enamel fractures were more prevalent in the study group. Frequencies of other dental injuries in the two groups were similar. GR was significantly associated with TP while differences in CAL between the groups were not statistically significant.

Trinh, S., & Angarone, M. (2017). Purpureocillium lilacinum tattoo-related skin infection in a kidney transplant recipient. Transpl Infect Dis. 19(3).
– Purpureocillium lilacinum is an emerging pathogenic mold among immunocompromised hosts that causes cutaneous infections related to skin breakdown. We present the first reported case of P. lilacinum tattoo-related skin infection, to our knowledge. A kidney transplant recipient recently treated for acute cellular rejection presented with skin papules overlying a tattoo.

Vanarase, M., et al. (2017, April 10). Comparison of Q-switched Nd:YAG laser alone versus its combination with ultrapulse CO2 laser for the treatment of black tattoo. 1-7.
– Sixty patients with black tattoo were randomized into two groups viz., group A and group B. Group A was treated with QS Nd:YAG laser (1064 nm) alone, and group B received combination of ablative ultrapulse CO2 followed by fixed-dose QS Nd:YAG laser (1064 nm), at 6-week interval for a maximum of 6 sittings. After each sitting, 3 independent physicians noted percentage of improvement that was evaluated using visual analogue scale (VAS) and grading system for tattoo ink lightening (TIL).
– Combination laser (group B) showed statistically significant improvement in mean VAS score in the last 2 noted visits as compared to 1st session (p < 0.007, p < 0.001) and TIL mean score in last three noted visits as compared to 1st session (p < 0.008, p < 0.020, and p < 0.004). There was no statistically significant difference in the side effect profile of both the groups.
– For refractory professional tattoos, combination of ultrapulse CO2 laser and QS Nd:YAG laser is superior to QS Nd:YAG laser alone.

Van Hoover, C., et al. (2017, August 14). Body piercing: Motivations and implications for health. J Midwifery Women’s Health.
– Body piercing has evolved from a behavior once considered extreme to an accepted choice among the general population. Earlobe piercing is so common that it is now considered a normative behavior. The motivations for choosing body piercing have changed and are associated with piercing site and number of piercings chosen by the individual. Meanings ascribed to body piercing were traditionally related to enhanced sexual desirability and experience, but now range from the innocuous, such as a fashion statement, to the risk laden, such as non-suicidal self-injury. Professional piercers are the primary providers of piercing services, and people will first turn to their professional piercer for advice when complications of the site arise, thus delaying entry into needed health care. Health care providers are often perceived as uninformed, dismissive, and biased against individuals, who are pierced particularly those with multiple piercings and piercings in intimate areas of the body. Common complications of piercing include infection, bleeding, and problems relating to tissue trauma and scarring, and are reported by nearly 50% of individuals who are pierced. Metal allergies can develop as a result of piercing, making the type of jewelry used for body adornment an important consideration. Additionally, management of the piercing site becomes critical under certain conditions, such as during pregnancy and birth, lactation, or surgery. This article provides information supporting midwives and other health care providers to offer anticipatory guidance and health care services in a nonjudgmental and supportive manner to individuals choosing body piercing.
Waton, J., et al. (2017). A putative case of allergic contact dermatitis caused by a jagua tattoo. Contact Dermatitis. 76(5). 296-297.
Wegner, T., et al. (2017). Ulcerative plaque within a tattoo in a 49-year-old man. J Dtsch Dermatol Ges. 15(6). 678-681.
Weiss, R., et al. (2017). Safety and efficacy of a novel diffractive lens array using a picosecond 755 nm alexandrite laser for treatment of wrinkles. Lasers Surg Med. 49(1). 40-44.
– Forty female subjects presenting with wrinkles from photo-damage were enrolled in an IRB approved study. Subjects received four picosecond diffractive lens array treatments to the full face at 1 month intervals. Six subjects were biopsied (two subjects at 1 month, two subjects at 3 months, and two subjects at 6 months). Digital photographic images were taken at 1, 3, and 6 months post-final treatment visits. Images were graded by blinded physicians for fine lines/wrinkles, erythema, dyschromia, and global improvement. Data on discomfort level, satisfaction, and side effects were recorded.
– Overall blinded physician rated global improvement ranged from improved to much improved at 1-, 3-, and 6-month time points. At baseline the average Fitzpatrick wrinkle score was 5.48. At the 6-month follow-up the average score was 3.47. The overall average change in score from pre-treatment to post-treatment was 1.97. Subject self-assessment at 6 months indicated that 90% of subjects were extremely or satisfied with their results. Unanticipated adverse events were absent with anticipated post-treatment erythema lasting for just several hours.
– A novel diffractive lens array used with a picosecond 755 nm alexandrite laser for treatment of wrinkles is highly effective and safe for wrinkles and other signs of photoaging.
Willardson, H., et al. (2017). Diffuse Urticarial Reaction Associated with Titanium Dioxide Following Laser Tattoo Removal Treatments. Photomed Laser Surg. 35(3). 176-180.
– Local and generalized allergic reactions following laser tattoo removal have been documented, but are rare. To our knowledge, this is the fourth documented case of widespread urticarial eruptions following laser tattoo removal treatment. Unlike previously documented cases, this patient’s reaction was found to be associated with titanium dioxide within the tattoo and her symptoms were recalcitrant to medical therapy.
– Ours is the first documented case of a diffuse urticarial reaction following laser tattoo removal treatments that shows a strong association to titanium dioxide within the tattoo pigment. Herein, we describe a novel surgical approach to treat recalcitrant generalized allergic reaction to tattoo pigment.
Winn, A., et al. (2017, March 23). Dermal Piercing Removal: Searching for an Optimal Technique. Dermatol Surg.
– Short article summary of dermal piercings and two different removal techniques in the outpatient setting (punch removal & rock back & forth with hemostats/remove)

Zajdel, N., et al. (2017). Chemical Tattoo Treatment Leading to Systemic Cobalt Hypersensitivity. Skinmed. 15(3). 221-222.
– An otherwise healthy 36-year-old Caucasian woman, without prior history of atopic dermatitis or eczema, presented to an outside dermatologist with a generalized, severely pruritic eruption involving the entire body except the face. One month previously, she had used a 50% trichloroacetic acid tattoo removal solution on a blue-colored tattoo on the medial aspect of the left ankle. The patient’s eruption persisted for 7 months, and after several attempts to slowly taper her prednisone dose, she presented to our institution.
– Biopsy of a truncal lesion revealed spongiotic pustules with a mixed dermal infiltrate and scattered eosinophils, consistent with subacute spongiotic dermatitis.

Zestcott, C., et al. (2017, February 26). What do you think about ink? An examination of implicit and explicit attitudes toward tattooed individuals. J Soc Psychol. 1-16.
– Tattoos are increasing in popularity, yet minimal research has examined implicit attitudes or the relationship between implicit and explicit attitudes toward tattooed individuals. Seventy-seven online participants (Mage = 36.09, 52% women, 78% white, 26% tattooed) completed measures assessing implicit and explicit attitudes toward tattooed individuals. Results revealed evidence of negative implicit attitudes, which were associated with less perceived warmth, competence, and negative explicit evaluations. However, implicit attitudes were not correlated with measures of disgust or social distance. In addition, age predicted implicit prejudice, but other individual difference measures-such as personal tattoo possession, political identity, and internal/external motivations to respond without prejudice-did not. These findings are discussed in terms of how attitudes toward tattooed individuals may be multifaceted, and research may benefit from measuring implicit and explicit attitudes.

A propos de quelques phénomènes éponymes en dermatologie

IMG_6504.JPG

Pour ce petit blog, quelques « phénomènes » éponymes en dermatologie pour vous permettre de les distinguer (car certains se ressemblent de loin) mais aussi de briller pendant la visite du patron.

 

Le phénomène de Sutton

On commence facile avec un des phénomènes éponymes classiques de la dermatologie, aussi appelé le halo-naevus de Sutton. Il s’agit d’une situation fréquente avec l’apparition d’un halo de dépigmentation autour d’un ou de plusieurs naevi mélanocytaires. C’est un phénomène fréquent qui touche 1% de la population, quelque soit le sexe ou l’origine ethnique avec une prédilection pour le sujet jeune.

Le nombre de naevus concerné varie de 1 à plusieurs. L’évolution est variable. La situation peut rester stable (naevus + halo), le naevus peut regresser alors que le halo perdure, le naevus peut regresser totalement et le halo persiste; ce dernier peut se repigmenter partiellemement et enfin le processus se résoudre totalement (disparition du naevus, et repigmentation complète du halo). Notons que le processus dure plus de plusieurs mois.

Ce phénomène n’est pas propre aux naevi acquis, il a été observé aussi sur naevi congénitaux, des tumeurs non mélanocytaires, des carcinomes et aussi des mélanomes (halo-mélanome).

L’excision chirurgicale n’est préconisée que si atypie clinique faisant suspecter un mélanome. Dans la grande majorité des cas, il faut être rassurant et proposé un suivi plus qu’une exérèse de principe qui aboutirait à une cicatrice disgracieuse (la plupart des halo-naevus siège sur le tronc, et le haut du dos surtout).  L’association avec un vitiligo n’a pas été clairement démontré.

Un exemple entre autre

Aouthmany M, et al. J Am Acad Dermatol 2011

 

Le phénomène de Meyerson

On peut voir le Meyerson comme le petit cousin du Sutton. On peut l’appeler halo-eczema ou halo-dermatitis aussi.

Il s’agit cette fois-ci d’un halo érythémateux, et même eczématiforme, autour d’un naevus mélanocytaire ou d’autres lésions (naevus atypique, kératose séborrhéique, molluscum contagiosum, dermatofibrome etc.).

Il touche également plutôt les sujets jeunes. Il peut être asymptomatique ou démanger et toucher un ou plusieurs naevus. Le processus peut disparaitre spontanément ou sous corticoïdes locaux. Il n’a pas de valeur péjorative ou de signification particulière. Il n’est pas associé à une transformation tumorale.

Meyerson L, Arch Dermatol 1971

 

Le signe de Léser-Trélat

Le signe de Léser-Trélat (le terme consacré en anglais est Leser-Trélat sign), qui semble avoir été attribué à tort à messieurs Leser (un allemand) et Trélat (un bordelais), ést défini par l’efflorescence brutale ou l’augmentation en nombre et en taille rapide de kératoses séborrhéiques. Parfois ces dernières peuvent aussi être inflammatoires.

Le signe de Léser-Trélat est à connaitre car il est considéré comme un syndrome paranéoplasique, mais un syndrome paranéoplasique discuté car ce phénomène touche souvent des sujets âgés et la définition du Léser-Trélat n’est pas claire en terme du nombre ou de la rapidité d’augmentation des lésions, surtout que le nombre de KS augmente naturellement avec l’âge !

On considère que la recherche de cancers chez un patient présentant un syndrome de Leser-Trélat doit être fonction de l’examen clinique et des antécédents carcinologiques du patient. Un screening systématique complet est à proscrire.

Schwartz RA. J Am Acad Dermatol 1996

 

Le phénomène de Köbner

Celui est également bien connu, décrit en 1872 par Köbner (ou Koebner), le phénomène de Koebner se définit par la survenue d’une dermatose sur un site de traumatisme/cicatrice.

On parle également de réaction isomorphique de Köbner (iso-morphique = la même dermatose).

Pour certains puristes, le terme de phénomène de Köbner devrait être restreint à 3 maladies: le psoriasis, le vitiligo et le lichen plan. En effet, pour ces 3 dermatoses chroniques, le phénomène fait partie intégrante la physiopathogénie de la maladie. De plus, les causes infectieuses devraient être exclues (comme les verrues par exemple). Bien sur les infections d’inoculation ne répondent pas à la définition du phénomène de Koebner. On peut considérer que virtuellement n’importe quelle dermatose chronique peut un jour finir sur une cicatrice. La liste des dermatoses et des traumatismes responsables qui a été publié est longue.  Pour les autres, il s’agit alors d’association occasionnelle ou discutable.

En pratique, dans la littérature et au lit du malade, on parle facilement de phénomène de Köbner  ou même de Köbnerisation dès que l’on voit une lésion dermatologique sur une cicatrice ou un traumatisme.

 

Le phénomène de Wolf

Le phénomène de Wolf est d’individualisation plus récente, puisqu’il date de 1995 (même si un autre auteur l’avait déjà observé dans les années 50). La définition initiale était très précise: il s’agit du développement d’une nouvelle dermatose (que le patiente ne présente donc pas avant) uniquement sur le site d’une autre dermatose, non apparentée, cicatrisée et guérie. On parle ici de réaction isotopique (iso-topique = au même site). La définition princeps précisait qu’il fallait que la peau soit normale ou le siège de modifications minimes et les auteurs avaient exclus les traumatismes chirurgicaux, la vaccination et la radiothérapie. A l’époque et en pratique il s’agit dans la très grande majorité des cas de cancers ou de granulomes cutanés se développant sur une cicatrice de zona.

L’intérêt ici était la définition très précise du phénomène. Cependant, Mr Wolf (qui est toujours en vie) s’amuse à modifier au cours du temps la définition du phénomène qui porte son nom. La dernière modification en date (pour faire simple): une nouvelle dermatose qui apparait tout d’abord au site d’une autre dermatose guérie, quelle qu’elle soit et qu’elle que soit l’aspect de la peau sous-jacente.

Cette nouvelle définition pose un problème car elle commence à se rapprocher de la définition du phénomène de Koebner, au prix d’une certaine confusion pour le néophyte.

 

Le phénomène de Renbök

Le terme de phénomène de Renbök (oui, c’est bien Köbner en verlan) ou bien de phénomène de Köbner inverse a été proposé en 1991 pour décrire initialement un phénomène rare mais tout à fait particulier à savoir la repousse de cheveux peladiques sur une plaque de psoriasis.

Je m’explique:  la pelade est une maladie autoimmune responsable de chutes de cheveux sous la forme de plaques d’alopécie sans peau inflammée. Or, dans des cas exceptionnels, des patients avec des plaques de psoriasis du cuir chevelu ont vu les zones atteintes par le psoriasis épargnées par la chute de cheveux ! Par ailleurs, on a aussi observé l’inverse avec des plaques de pelade épargnés par le psoriasis. L’hypothèse est qu’il existe une exclusion des deux maladies en raison d’un profil cytokinique et lymphocytaire différent.

Ce phénomène est principalement décrit pour l’association pelade-psoriasis, mais il a été rapporté avec la pelade dans quelques cas de lésions cutanées congénitales (naevus).

Le hic, est que par abus de language, certains auteurs utilisent le terme de « phénomène de Renbök » pour parler de l’exclusion mutuelle de 2 dermatoses sur un même site. Il convient de garder (à mon avis) le terme de Renbök à l’observation princeps.

Un article en accès libre avec des photographies

 

Les phénomènes « réverse » de Köbner et de Wolf

Il s’agit de phénomènes opposés. Ainsi en cas de disparition d’une plaque de psoriasis après un traumatisme, on parle de phénomène de Köbner réverse et en cas d’absence de dermatose au site d’une autre dermatose guérie, on parle de phénomène de Wolf réverse.

 

Le phénomène de Bork-Bakal

Celui-là, c’est cadeau. tout chaud publié l’année dernière. Si vous le placez en visite de dermatologie ou de pédiatrie, vous sécurisez votre clinicat.

Il s’agit d’une curiosité observationnelle qui concerne essentiellement les patients avec de très larges naevus congénitaux du tronc qui doivent toucher le sein et le mamelon. Pour des raisons inconnus ou embryologique, on note que la pigmentation du naevus congénital épargne bien souvent l’aréole et le téton.

Ci-dessous une photo scanné du traité de dermatologie de Robert Degos où l’on peut noter que le téton est épargné par le large naevus congénital.

step0001.jpg

Happle R. J Eur Acad Dermatol 2017 (sous presse)

 

Les syndromes rouges en dermatologie

60519077.jpg

Une petite mise au point sur ces syndromes dermatologiques, qui ont tous pour point commun de donner une couleur rouge à une partie du corps. Hormis le syndrome de l’homme rouge, tous ces syndromes sont chroniques, permanent ou paroxystique. Certains sont des curiosités qu’il convient de connaître pour éviter les explorations inutiles (les paumes rouges de Lane par exemple), d’autres sont à connaître comme le syndrome des oreilles rouges, qui oui existe, et est douloureux et invalidant.

 

Les paumes rouges de Lane (ou erythema palmare hereditarium)

Les paumes rouge de Lane (ou maladie de Lane OMIM 133000) est un érythème palmo- plantaire congénital bénin, asymptomatique et stable dans le temps. Il est bilatéral, fixe, atteint les éminences thénar et hypothénar et la face palmaire des doigts, respectant plus ou moins le centre de la paume. Il atteint plus rarement les plantes. Il n’y a pas d’autres signes fonctionnels ou physiques particuliers. Il s’agit d’une curiosité bénigne probablement sous-estimée de transmission dominante. L’aspect est due a une disposition particulières des capillaires sanguins qui sont dilatés en boucles géantes, plus nombreux et disposés de facon parallèle à la peau. Les diagnostics différentiels des formes acquises comprennent principalement l’insuffisance hépatique, les collagénoses, et les médicaments vasodilatateurs. Aucun traitement n’est proposé.

 Lane JE. Erythema palmare hereditarium. Arch Derm Syphilol 1929;20:445—8.

step0001.jpg

Paume rouge de Lane chez une patiente âgée. L’interrogatoire retrouve cet aspect connu depuis l’adolescence sans modification depuis. Notez l’aspect central de la paume épargnée et l’atteinte des éminences thénar et hypothénar. 

Le syndrome des doigts rouges («red fingers syndrome»)

Il s’agit d’un syndrome rapporté initialement chez les patients VIH (Pechere, 1996). Il a été rapporté dans le co-infection VIH – Hépatite C et puis plus rarement lors de l’hépatite C isolée.  Il se présente sous la forme d’un érythème bien délimité de la face dorse des doigts et des orteils. C’est totalement asymptomatique. On suppose que l’explication reside dans des alterations de la circulation cutanée des extrémités en raison de l’hépatopathie, des infections par le VIH et/ou le VHC, les injections de drogues IV et la presence d’une cryoglobulinémie circulante.

Pechère M, Krischer J, Rosay A, Hirschel B, Saurat JH. Red fingers syndrome in patients with HIV and hepatitis C infection. Lancet. 1996 Jul 20;348(9021):196-7.

 

Pour les maniaques, les causes d’érythèmes acraux sont résumés ici

  • Red fingers syndrome
  • Erythème acral nécrolytique
  • Lupus
  • Dermatomyosite
  • Engelure
  • Erythème acral médicamenteux
  • Syndrome en gants et chaussettes (Parvovirus B19 etc.)

 

Le syndrome du scalp rouge («red scalp syndrome»)

Alors ce syndrome, j’avoue qu’il me laisse un peu perplexe. Il est principalement mentionné par quelques auteurs allemands et danois à ma connaissance. Il s’agit de patients avec un scalp érythémateux résistant d’un côté à la corticotérapie locale et de l’autre aux traitements classiques de la dermatite séborrhéique.

Le scalp est prurigineux, picote ou brûle. On retouve également des papules, des pustules et des télangiectasies. Une alopécie androgénétique est possible. Ce syndrome toucherait les hommes et les femmes adultes.  La biopsie montre une inflammation périfolliculaire et une augmentation de l’expression du neuropeptide P. Pour certains, il s’agirait d’une forme extra-faciale de rosacée à traiter de la même facon (cyclines par voie orale, doses filées d’isotrétinoine et photoprotection indispensable).

Il faut cependant rappeler que la liste de dermatoses inflammatoires et infectieuses du cuir chevelu à éliminer avant de poser le diagnostic de scalp rouge est longue sans oublier les kératoses actiniques étendues et le fameux champ de cancérisation.

Oberholzer PA, Nobbe S, Kolm I, Kerl K, Kamarachev J, Trüeb RM. Red scalpdisease–a rosacea-like dermatosis of the scalp? Successful therapy with oral tetracycline. Dermatology. 2009;219(2):179-81.

 

Le syndrome de oreilles rouges

Le syndrome des oreilles rouges (« red ear syndrome ») est une affection neuro-cutanée méconnue car d’indivualisation assez récente (Lance, 1995). Elle se définit comme la survenue par des poussées paroxystiques de douleurs et de sensation de brûlures uni ou bilatérale de l’oreille externe. La durée des poussées ainsi que la fréquence et les facteurs déclenchants sont variables selon les patients. On distingue des formes idiopathiques de formes secondaires associées à diverses pathologies cervico-neurologiques pouvant affecter les branches C2 et C3 impliquées dans l’innervation de l’oreille  (arachnoidite, arthrose, syndrome thalamique, compression des racines cervicales etc.). D’autres auteurs considèrent ce syndromes comme apparentés au céphalées dites trigémino-autonomiques (algies vasculaires de la face, Short-lasting Unilateral Neuralgiform headache with Conjunctival injection and Tearing SUNCT). Le traitement est difficile et décevant. Il inclue les traitements antimigraineux, les infiltrations locales ou des gestes de dénervation. Les bêta-bloquants, les anti-dépresseurs tricycliques ou les inhibiteurs calciques.

Lance JW. The mystery of one red ear. Clin Exp Neurol. 1994;31:13-8.

Lance JW. The red ear syndrome. Neurology. 1996 Sep;47(3):617-20.

 

Le syndrome babouin (SDRIFE)

Le syndrome Babouin a été décrit en 1984 comme une éruption cutanée qui par son aspect clinique rappelait la région fessière, rouge, du babouin. Il a été rebaptisé il y a 10 ans de cela Symmetrical Drug-Related Intertriginous and Flexural Exanthema (SDRIFE). Il s’agit d’une forme rare et bénigne de toxidermie responsable d’un tableau d’eczéma à limites nettes atteignant les fesses et les plis le plus souvent associé à la prise d’un allergène par voie systémique.

Le délai d’apparition après la prise médicamenteuse est habituellement rapide, variant en général de quelques heures à deux jours, le plus souvent après une prise de bêta-lactame.

Andersen KE, Hjorth N, Menne T. The baboon syndrome:  systemically-induced allergic contact dermatitis. Contact Dermatitis 1984;10:97—100.


 

Le syndrome du scrotum rouge («red scrotum syndrome»)

Se reporter à mon billet sur Les hommes aux scrotums rouges

Le syndrome de l’homme rouge («red man syndrome»)

Le syndrome de l’homme rouge traduit une réaction d’hypersensibilité à la vancomycine. Elle survient dans les 10 premières minutes suivant la perfusion de vancomycine ou à la fin de cette dernière. Elle arrive le plus souvent lors de la 1ère perfusion si cette dernière est trop rapide (< 1h) . Cependant elle peut aussi bien survenir aprÈs plusieurs perfusions ou en cas de perfusion lente. Il se présente sous la forme d’un exanthème prurigineux de la face et du tronc parfois associé avec hypotension et angiooedeme. D’autres symptômes sont possibles comme une agitation, un inconfort, des céphalées, des frissons, des paresthésies péribuccale voire des douleurs thoraciques et une dyspnée. Dans la majeure partie des cas, la présentation est minime sous la forme d’un prurit évanescent.

La vancomycine n’est pas la seule responsable de cette réaction (ciprofloxacine, rifampicine, teicoplanine ou amphoptéricine B).

Le mécanisme est probablement une histamino-libération. Le traitement comprend les anti-histaminiques et l’arrêt temporaire de la vancomycine. Une reprise est possible en fractionnant les doses.

 

About the use of patient’s report and pictures in public journals…

While performing my daily routine of checking articles related to tattoo complications on Pubmed, i read with interest on the 30th of May the recent case report by Hendren et al about an exceptional case of lethal infection by Vibrio vulnificus after tattooing in a 31 yo male

Hendren N, Sukumar S, Glazer CS. Vibrio vulnificus septic shock due to a
contaminated tattoo. BMJ Case Rep. 2017 May 27;2017. pii: bcr-2017-220199.

To summarize this case report, it is the exceptional and unfortunate conjonctions of several factors: i) an immunocompromised patient with liver cirrhosis 2) who took a bath in the Gulf of Mexico, 3) several days after getting a tattoo on the leg. The tattoo wound acted as a door for the aquatic bacteria to lead to sepsis shock, intensive care unit and death of the patient 2 months after admission.

The article includes several pictures of the patient, including the « culprit » tattoo. As it is customary in a rising number of medical journal, a consent was obtain from the patient  for the use of the clinical information and picture for possible medical publication. The mention « patient consent: obtain » is stated at the end of the article.

 

 

In the field of medical publishing, it is well known that tattoos, as well as bracelets, rings, even manucure nails may allow patient ‘s recognition. It is customary to obtain the permissions to use the pictures of a patient for medical publications. More and more journals are now demanding a signed consent of the patients in case of recognizable picture during the submission process.

Robinson JK, Bhatia AC, Callen JP. Protection of patients’ right to privacy in clinical photographs, video, and detailed case descriptions. JAMA Dermatol. 2014
Jan;150(1):14-6.

 

However, we are talking here about publishing in medical/scientific articles, for which the access is usually limited to health care professional with institutional access (or private subscription. Lay people may read it as well in exchange of an access fee.  The clinical data and pictures remain restricted to a medical setting and not a mass media coverage.

I was rather surprised this morning to discover by a link sent by a friend of an article on cnn.com about that very case.

The case report has gone viral (as it is usually the case) over the internet

All the pictures of the BMJ Case report article are here reproduced. The journalist wrote « In a typical case study, patients are referred to by their initials. In this case, what happened was so rare, the authors declined to provide even that, to prevent anyone from figuring out his identity ». However, the (commemorative) tattoo displays some specificities such as a date and a text, so anonymity is not guaranteed

Of course, the BMJ case report website has a very comprehensive and detailed patient consent and confidentiality policy with a form to be signed (and smartly available in different language)

When a patient signs the BMJ consent, he agrees to 7 different points including the following;

2)  » The Information will be published without my name attached and BMJ Group will make every attempt to ensure my anonymity. I understand, however, that complete anonymity cannot be guaranteed. It is possible that somebody somewhere – perhaps, for example, somebody who looked after me if I was in hospital or a relative – may identify me »

However, in the BMJ consent, the point 5) draws some attentions 

5) « The Information may also be used in full or in part in other publications and products published by the BMJ Group or by other publishers to whom the BMJ Group licenses its content. This includes publication in English and in translation, in print, in electronic formats, and in any other formats that may be used by the BMJ Group or its licensees now and in the future. In particular the Information may appear in local editions of the journal or other journals and publications published overseas ».

To me, either from the point of view of a physician who writes medical articles or from those of a patient, the consent is not sufficiently clear. I would not think that by « other journals and publication published overseas », the BMJ actually mean the potential viral diffusion by internet through high-impact high-audience journal such as cnn.com, http://www.independent.co.uk etc…

As a reminder, last year, during summer 2016, Thorax, an other BMJ journal published an exceptional case report of lung inflammation in a bagpipe player, with media coverage that lead a few days later the patient’s family to learn the diagnosis, once the case was published.

 

In 2013, Hacard et al reported that 78% of the patients considered that the consent form should list all the possible uses of the images. Only 44,3% were favorable for the use in health magazines and 32% in websites.

Hacard F, Maruani A, Delaplace M, Caille A, Machet L, Lorette G, Samimi M.
Patients’ acceptance of medical photography in a French adult and paediatric
dermatology department: a questionnaire survey. Br J Dermatol. 2013
Aug;169(2):298-305.

The possible use of patients’ picture for large audience journals should clearly be distinguished from other academic uses/publishing and explained to the patients.

 

 

Le détatouage par destruction chimique: Le retour d’une méthode du XIXème siècle…

 

Dans un billet précédent, nous avions abordé le problème des crèmes de détouage, disponibles sur internet et qui sont au mieux toxiques pour le porte-monnaie, au pire responsable d’allergies de contact et parfois de brûlures chimiques.

Dans ce billet, nous allons aborder le problème de certaines techniques de détatouage du XIXème siècle qui connaissent un véritable revival depuis le début des années 2000. La destruction chimique ainsi que la mobilisation dans le derme des «particules colorées» sont en vogue à la fin du XIXème siècle. Un grand nombre de procédés a été publié, tous entrainant la « nécrose des tissus colorés » avec un modus operandi commun puisqu’il s’agit d’introduire avec des aiguilles à travers l’épiderme (donc de tatouer !) différents produits caustiques comme le « bioxalate de potasse » dans la méthode du Dr Jullien, « une solution de chlorure de zinc à 30 pour 40 d’eau » dans la méthode du Dr Brault (1901) ou 20% de sel ordinaire dissous dans de l’acide oxalique chez le Dr Martin (1900)… Le Dr Brunet, a développé lui une méthode qui « fait tomber l’épiderme par un vésicatoire à l’ammoniaque puis passe à plusieurs reprises le nitrate d’argent sur les lignes du tatouage ».

Les conséquences de ces méthodes sont imaginables : une « inflammation », une « escarrification des parties tatouées » ou une « nécrose » tissulaire suivi d’un processus cicatriciel de plus ou moins bonne qualité.

Bruno C. Tatoués, qui êtes-vous…? Editions de Feynerolles, Bruxelles, 1974

Kluger N. Le détatouage à l’aube du XXè siècle. Ann Dermatol Venereol 2010 Aug-Sep;137(8-9):582-4. 

 

La méthode du Dr Variot (1888)

La méthode de destruction chimique la plus connue reste probablement celle du Dr Variot. Gaston Variot est un pédiatre plus connu pour ses travaux dans le domaine de la puériculture, mais il a également travaillé sur les tatouages à l’époque où il exerçait à l’infirmerie centrale des prisons de Paris. Il publie en 1888 un procédé « assez simple et assez précis », bien toléré et sans complication. Il s’agit d’appliquer sur la peau tatouée une solution concentrée de tannin ; puis à l’aide d’un jeu d’aiguilles de faire des piqûres serrées sur toute la surface de peau à décolorer, introduisant ainsi le tannin dans le derme (où se trouve le tatouage). Dans un seconde temps, il passe fortement un crayon de nitrate d’argent. Très rapidement, le tatouage devient noir avec formation chimique de tannate d’argent. D’après Variot, le procédé est peu douloureux, suivie d’une réaction inflammatoire modérée et transitoire puis du développement « d’eschare mince, très adhérente » qui « se détache spontanément » au bout de deux semaines environ. Le résultat esthétique est bon selon Variot. Ce dernier a testé sur des prisonniers de la Santé. Cependant, Variot décrit n’être « arrivé à appliquer ce procédé si commode qu’après bien des tâtonnements » et il n’est pas possible de savoir combien d’échecs et de complications sont survenues avant que Variot ne trouve la bonne méthode. On apprend cependant que les tatouages à « l’acide acétique » et à « l’oxalate acide de potasse, avec une solution concentrée de nitrate d’argent au dixième ou vingtième » sont mal tolérés, douloureux et responsables d’ « eschares trop superficiels ».

Variot G. Nouveau procédé de destruction des tatouages. Bulletins de la Société d’anthropologie de Paris 1888; 11: 480-483.

nar_geoffroy_003f.jpg

Gaston Variot, fondateur de la puériculture, et aussi inventeur de la méthode éponyme de détatouage

L’e-raze®, skinial®, magicpen® etc… ou comment faire du neuf avec du vieux…

Depuis une dizaine d’années, des compagnies, surfant sur le boom du marché du détatouage, ont « redécouvert » ces méthodes et se sont mis à développer des procédés de destruction/extraction chimique à l’image de celle du Dr Variot, à savoir l’injection de divers produits dans le derme pour stimuler une réaction et l’explusion des encres. A ma connaissance, la première a été l’e-raze® (dévoloppée par Rejuvi Laboratory en Calfornie) qui a même fait l’objet d’une publication par son auteur en 2001.

http:/www.e-raze.com

Cheng W. A non-laser method to reverse permanent makeup and tattoos. Cosmet Dermatol 2001;14:47–50.

Depuis d’autres produits , avec par exemple l’injection d’acide lactique dans la peau, ont été développé, comme par exemple skinial, qui semble-t-il est disponible en France.

http://fr.skinial.com ; http://fr.skinial.com/resultats-avant-et-apres/

Alors pour les résultats avant – après, comme vous le voyez il y a bien une réaction escharotique nécrotique après injection du produit. On retrouve les classiques photos de qualité médiocre, surexposées et non reproductibles.

Mention spéciale pour ces deux produits/ le magic pen et le tatt2away… car ces deux procédés concurrents ont pour origine le même produit !

https://medicaldevices-bg.com/therapy-devices/magic-pen/

http://tatt2away.com

Et comme toujours, pour toutes ces techniques, il n’existe aucune publication scientifique sur l ‘efficacité ou l’innocuité de ces produits dans le détatouage, que ce soit seuls ou dans des études les comparant à un traitement standard par laser de détatouage.

 

Est-ce que ça marche au final ou pas ?

Il ne fait pas de doute que cette technique marche. Il s’agit d’une technique d’escarrification de l’épiderme et du derme tatoué qui aboutit à l’expulsion des pigments. Les vraies questions sont: quelle est leur efficacité réelle et quels sont les risques pour le client ?

Il ne faut pas oublier que quand Variot et d’autres développent ces techniques, ils n’ont rien d’autres à disposition. De plus, nous n’avons pas vraiment d’images des résultats finaux et de l’acceptabilité esthétique des résultats. On imagine bien qu’à l’époque les patients détatoués acceptaient plus facilement une cicatrice en l’absence d’alternative. Enfin n’oublions pas que les tatouages que traite Variot n’ont rien à voir avec les tatouages professionnels actuels ! Il s’agit de tatouages de prisonniers, de tatouages amateurs faits sans dermographe … et qui, d’ailleurs, partent habituellement facilement et posent peu de problèmes par laser. De plus, comme le mentionnent aussi bien Variot au XIXème siècle que l’inventeur de l’e-raze, le traitement a des bons résultats avec des « mains expérimentées » ! Bref on peut imaginer que cette technique peut peut être avoir une place dans de petits tatouages amateurs (genre mort aux vaches !) mais pour un tatouage professionnel étendu, je doute…

De plus, plusieurs cas de complications cicatricielles ont été décrites dans le littérature suite à l’usage de l’e-raze.

Veysey E, Downs AMR. Adverse side-effects following attempted removal of tattoos using a non-laser method. Br J Dermatol 2004; 150: 770–771.

Snelling A, Ball E, Adams T. Full thickness skin loss following chemical tattoo removal. Burns. 2006;32:387-388.  

Un cas de complication cicatricielle après usage d’un produit à base d’acide lactique pour détatouage a déjà été rapporté en 2015

Wollina U. Depigmentation and hypertrophic scars after application of a fluid lactic acid tattoo eraser. Wien Med Wochenschr. 2015 May;165(9-10):195-8.

 

Quel est la qualification officielle de ces produits ?

Il s’agit la du vrai problème. Honnêtement, je n’en sais rien. Ces procédés ne sont pas des médicaments, mais ils sont utilisés pour corriger les tatouages. S’agit-il de dispositifs médicaux et, dans ce cas, il y a un cahier des charges à respecter. Qui donnent les autorisations d’utilisation de ces produits et dans quelle indication ? Qui doit pratiquer ?est-ce au tatoueur (après lui sait tatouer, mais n’est pas médecin) ? à l’esthéticienne ? au médecin seul de disposer de ces produits (après tout ces techniques sont d’authentiques traitements développés par des médecins) ?

http://ansm.sante.fr/Produits-de-sante/Dispositifs-medicaux

De la même façon qu’une législation est cours pour les tatouages, il est temps pour le législateur de s’interesser à ce problème et de réguler ces produits, qui au final doivent respecter le même cahier des charges que les encres de tatouage, puisqu’il s’agit d’un tatouage de produits chimiques dans le derme.

Comme St Thomas d’Aquin, je ne crois que ce que je vois. Je ne saurais que conseiller d’en rester aux méthodes « traditionnelles » de détatouage, dans l’attente de preuves d’efficacité de ces produits et au risque de garder des cicatrices post-traitement.

 

Conflits d’interêt: pour être clair, je ne pratique aucun acte de détatouage à ce jour qu’il soit chirurgical ou par laser

Non, il n’y a (toujours) pas de crème (miracle) de détatouage à ce jour…

La nécessité de développer des procédés efficaces de détatouage s’est naturellement très rapidement imposée dès l’Antiquité. Les premiers témoignages de détatouage remontent vers le VIème siècle après JC, via un médecin grec, Aetius, qui décrit un procédé de salabrasion.

Dans un tatouage, les pigments et autres colorants qui donnent leur permanence aux tatouages sont localisés dans le derme, sous la couche de l’épiderme. Il apparait vite évident qu’un détatouage ne peut se faire sans des conséquences esthétiques et sans altérer la peau. Les difficultés techniques et les conséquences esthétiques étaient déjà connues au XIXème siècle. Ainsi, Variot et Morau écrivent en 1887 : « Le siège intradermique de la matière colorante rend parfaitement compte des tentatives infructueuses qui sont faites à l’aide de différents agents pour faire disparaître les tatouages. Un tatouage ne pourra donc être détruit qu’à la condition que toute la proportion dans laquelle il est situé soit détruite également ».

Variot G, Morau H. Etude microscopique et expérimentale sur les tatouages européens. Bulletins de la Société d’anthropologie de Paris, 1887; 10: 730-736.

Ainsi, seules 3 possibilités s’offrent aux médecins: 1) l’exérèse complète du tatouage (et de la peau tatouée) par chirurgie traditionnelle, 2) la destruction de l’épiderme afin de mettre le derme à nu (et donc le tatouage et les pigments): ce sont les techniques de destruction thermique par la chaleur, dermabrasion à la meule, de la salabrasion, mais aussi les techniques d’extraction chimique par injection de produits caustiques dans la peau tatouée et 3) la stimulation de l’élimination de pigments dans le derme par l’organisme lui-même.

De nos jours, seules deux techniques de détatouage sont principalement utilisées

1) l’exérèse chirurgicale de la peau tatouée

Il s’agit d’une technique radicale, efficace à 100%, mais au prix d’une cicatrice. Elle n’est adaptée que sur des petits tatouages sur des zones de peau suffisamment taxes. Parfois, certains patients motivés acceptent des chirurgies en plusieurs temps.

Certains proposent également un shaving au dermatome. Le chirurgien pèle la peau à la manière de fines tranches de jambons (sous anesthésie évidemment), jusqu’à atteindre le tatouage et favoriser l’expulsion des pigments via la plaie ouverte.

2) le détatouage laser (type Q-switched nanosecondes et les nouveaux lasers picosecondes, plus rarement les lasers CO2).  Le détatouage laser est efficace, mais dont l’efficacité à 100% n’est pas garantie; traitement long, avec des séances qui peuvent être douloureuses et avec un certain coût.

Les techniques de salabrasion et de dermabrasion ont été abandonnées en raison des cicatrices. Quant aux techniques d’application ou d’injection de produits caustiques dans la peau, elles étaient en vogue au XIXème siècle et ont perduré jusque dans les années 90. Le laser de détatouage s’est placé comme la première méthode de détatouage. Pour ces dernières techniques, nous y reviendrons dans un prochain billet.

Il n’existe donc pas à ce jour de méthodes de détatouage qui soit à la fois rapide, efficace, peu cher et sans effets indésirables.

 

La crème miracle n’existe (toujours) pas !

Malheureusement Internet a vu se développer un marché parallèle de crèmes de détatouage exploitant la naïveté (et le porte-monnaie) de certains…

Reprenons: pour qu’une hypothétique crème de détatouage puisse marcher, il faudrait que le produit actif contenu dans la crème (ou la pommade) appliquée sur la peau soit : 1) absorbée par l’épiderme, 2) traverse la membrane basale (ou jonction derme-épidermique), 3) arrive intacte et toujours dans le derme, 4) ait une action sur les pigments du tatouage qui sont soit contenu dans les cellules macrophagiques, soit dans des cellules dites fibroblastes et mais aussi parfois libres entre les espaces de collagène. Cette crème devrait stimuler l’immunité à « manger » du pigment ou à favoriser sa destruction in situ et tout celà SANS EFFET SECONDAIRE s’il vous plait.

Alors évidemment, il ne suffit pas d’appliquer la crème.  On vous explique qu’il faut réaliser une exfoliation avec une éponge ou un dispositif électrique (bref décaper l’épiderme pour faire pénétrer la crème… on en revient donc à la nécessité de faire sauter l’épiderme). Pour mémoire, Alexandre Lasagne médecin Lyonnais du XIXème avait rapporté d’excellents résultats en frottant le peau tatouée avec une toile émeri

On retrouve sur les sites des photos de qualité médiocre, peu reproductibles, floues, et retouchées pour certaines. Dans mon expérience, pire, certains n’hésitent même pas à fournir des faux-documents de pseudo-études pour vanter leur crème (véridique, j’ai les documents).

La composition de ces encres révèle souvent la présence d’agents éclaircissants (comme l’acide kojique…) ou d’acide salicylique (que l’on utilise pour décaper les verrues en dermatologie)… Ainsi, l’effet « éclaircissant » que l’on peut apercevoir sur les photos « après » sur les sites commerciaux n’est pas un effet direct sur le tatouage, mais un éclaircissement de surface de la peau. Comme toute crème appliquée sur la peau, un risque d’allergie de contact à un des ingrédients est possible… Nous avons rapporté il y a quelques années le cas de deux patients qui s’étaient brûlés la peau en voulant se détatouer en usant des crèmes verrucides à base d’acide salicylique. Un autre patient de la littérature s’est lui brûlé en utilisant de l’acide trichloro-acétique disponible en ventre libre à but de détatouage (l’acide trichloro-acétique a été effectivement proposé comme traitement à la fin de années 80).

Kluger N, Koljonen V. Chemical burn and hypertrophic scar due to misuse of a
wart ointment for tattoo removal. Int J Dermatol. 2014 Jan;53(1):e9-11.

Une crème prévue pour dans 10 ans… ?

Et oui, il faut prouver scientifiquement l’efficacité de ces produits. A ma connaissance, aucune des soi-disant crèmes disponibles sur Internet n’a fait l’objet d’aucune étude clinique publiée dans un journal scientifique, ni démontrée une efficacité dans le détatouage.

Mais, rappelez-vous en 2015,… gros buzz d’Alec Falkenham, un PhD canadien, qui affirmait avoir développé une crème de détatouage miraculeuse,… Communiqué de presse sans aucune photo, aucun produit, aucune molécule… on apprenait juste que la crème avait été testée sur des oreilles de porcs (!). Gros emballement sur Internet comme d’habitude, la crème « va sortir » (SIC!).

Alec Falkenham est un vrai chercheur (ci joint sa liste de publication dans pubmed) et il travaille sur les macrophages (ces cellules qui arrivent dans la peau pour tenter de manger les pigments). Son buzz avait donc probablement pour but de lever des fonds ou de trouver une compagnie intéréssée.

Et bien depuis 2015, quoi de neuf? Sans surprise une compagnie pharmaceutique ( nommée Cipher prescription drugs) a acheté les droits sur le produit de Falkenham, dénommé Bisphosphonate Lipsomal Tattoo Removing (BLTR) pour le développer. Il faudra cependant attendre presque 10 ans de tests, d’études et d’autorisations avant de voir cette crème de détatouage sur le marché SI elle confirme son efficacité et son innocuité…

La crème de détatouage, ce n’est pas pour demain, et le laser et la chirurgie ont encore de beaux jours devant eux….

donc rappelez-vous….

Think

 

Pour en savoir plus

Kluger N. The risks of do-it-yourself and over-the-counter devices for tattoo
removal. Int J Dermatol. 2015;54(1):13-8. 

Ouverture d’une consultation médicale spécialisée « tatouage » sur Paris

IMG_0520.jpg

D’après le sondage tout récent publié par l’IFOP en partenariat avec le syndicat national des artistes tatoueurs (SNAT), 14% des français arboreraient au moins un tatouage. Ce chiffre est en (légère) augmentation par rapport au sondage IFOP-Ouest France publié en 2010 qui retrouvait un chiffre de 10%. Le succès du tatouage en France est grandissant, à l’image du mondial du tatouage qui attire plus de monde chaque année (30 000 visiteurs en 2017). Ajoutons à cela la couverture médiatique dans les journaux papiers et télévisés, le tatouage restant quand même un marronnier depuis quelques années…

IMG_5211.jpg

Alors je dis augmentation « légère » car aux Etats-Unis le dernier chiffre, publié début 2016, monte à presque 30% des américains (!) selon le Harris Poll. Ceci dit 14% des français sont tatoués, je vous laisse faire le calcul en valeur absolue du nombre de français tatoués par extrapolation avec les chiffres de l’INSEE.

Tattoo+infographic.jpg

 

Aux alentours de 2006 – après m’être occupé de mon patient « zéro » (comprendre par: mon « premier » patient tatoué venu en consultation pour un problème dermatologique sur ses tatouages) – j’ai commencé à m’intéresser aux différents problèmes de santé associés aux modifications corporelles, tatouages en tête. Les questions étant qu’avec la popularité grandissante du tatouage depuis le début des années 2000 des tatouages: y aurait-il une augmentation des complications et y aurait-il des nouveaux problèmes en vue ?

Kluger N, Bessis D, Raison-Peyron N, Guillot B. Tatouages permanents: de nouvelles complications au XXIè siècle. Presse Med. 2006 Nov;35(11 Pt 1):1598-600.

Avec l’augmentation du nombre de tatoués, mathématiquement le nombre de clients tatoués avec des problèmes sur un de leurs tatouages a augmenté depuis 2006, sans que l’on puisse donner des chiffres précis. Avec le temps, je me suis mis à recevoir de plus en plus de mails de médecins ou de tatoueurs. S’ajoute une augmentation du nombre de publications dans la littérature médicale. Il est apparu que d’un côté la demande augmentait du côté des personnes tatouées avec des problèmes sur leurs tatouages. Oui, certains clients tatoués en bonne santé sont devenus des patients qui nécessitent comme tout autre patient une consultation médicale. Cependant, les médecins, dermatologues ou non, sont parfois en difficulté pour donner des réponses adéquates aux questions des patients, aussi bien en terme d’explications physiopathologiques, d’attitude diagnostique ou de proposition thérapeutique. De plus, nous, médecins, essayons aussi de comprendre pourquoi certains clients font des réactions allergiques sur tatouage (entre autres). La recherche avance mais lentement. En 2013, une société de recherche a été créé: La European Society on Tattoo and Pigment research (ESTP). Elle a pour but de promouvoir la recherche clinique et fondamentale en association médecins, chercheurs, fabricants d’encres, tatoueurs (si, si) et législateurs ensemble.  J’en suis le vice-président depuis 2013.

En attendant, sur le terrain, les médecins généralistes, les dermatologues, mais aussi des tatoueurs, des patients et d’associations de malades nécessitent une aide spécialisé. Face à cette demande qui semble croissante, il n’existe que peu de consultations spécialisés. A notre connais, il en existe une au Danemark ou une toute récemment ouverte à Amsterdam, aux Pays-bas. Il en existe probablement d’autres en Europe, notamment en Italie. Pour la France, à ma connaissance, il n’existait pas jusqu’à ce jour de consultation spécialisé. Au début des années 2000, les infectiologues de l’hôpital Rothschild à Paris avaient collaboré avec les perceurs surtout.

Nous avons donc décidé cette année d’ouvrir une consultation spécialisée dédiée aux complications sur tatouages permanents à la consultation de dermatologie du service du Pr Descamps de l’hôpital Bichat – Claude Bernard à Paris (46 Rue Henri Huchard, 75018 Paris, ).

IMG_5331.jpg

Elle prendra la forme d’une vacation mensuelle, 1 vendredi par mois, durant laquelle les médecins (et possiblement les tatoueurs eux-mêmes) pourront adresser leurs patients avec des complications associées aux tatouages. Le but de cette consultation est bien sur de diagnostiquer et traiter les patients mais également de centraliser les cas et d’essayer de mieux comprendre les raisons pour lesquelles  un individu développe une réaction et pas un autre. En revanche, il ne s’agit en aucun cas d’une consultation pour détatouage (la liste des dermatologues ayant un laser est disponible sur le site du syndicat des dermatologues), ni d’une consultation « conseil » tout venant à n’importe quelle personne en bonne santé qui souhaite se faire tatouer (ou se faire décourager).

Cette consultation sera probablement et certainement amenée à évoluer en fonction de son succès ou non. Nous espérons qu’elle permettra d’aider évidemment les patients mais également de faire avancer notre compréhension des complications sur tatouage pour les prévenir et rendre le tatouage plus sur.

Lien vers le service http://hupnvs.aphp.fr/liste-des-specialites/dermatologie-bichat/

 

Du mythe de l’«allergie» à l’iode

Pas plus tard qu’avant-hier, ce mardi 7 Mars 2017, durant un topo dans le service sur les plaies et cicatrisations,  ne voilà-t-il pas que j’entends (et je lis) sur une slide écrit en rouge, s’il vous plaît, la nécessité de ne pas appliquer le iodosorb chez un patient avec une allergie à l’iode. Le iodosorb est un pansement des laboratoires Smith et Nephew qui comme son nom l’indique, contient de 0,9% d’iode. Ce produit n’est pas à ma connaissance disponible en France. Mais, ce n’est au final pas vraiment le problème. Le problème, c’est la référence explicite à l’« allergie à l’iode ».   Pis durant la réunion, où étaient présents de nombreux dermatologues, internes et infirmières, personne n’a bronché.

IMG_5148

« Le iodosorb peut-il être utilisé chez des patients sensibilisés à l’iode ? Réponse: Non, celà n’est pas recommande »

 

Que des compagnies pharmaceutiques sortent le parachute, bon… mais il est quelque peu dommageable qu’en 2017 le concept d’allergie à l’iode soit encore colporté dans le milieu universitaire…

La croyance en l’allergie à l’iode est responsable de craintes et d’attitudes d’éviction médicamenteuse ou alimentaire inutiles et délétères.

En effet, l’évolution des connaissances a amené à ne plus considérer comme liées à une « allergie à l’iode » les réactions survenant après injections de produits de contraste autant qu’après la prise d’autres médicaments ou la consommation de crustacés.

Une très jolie revue a été publiée en 2015 dans la Presse Médicale [1].

 

Les aliments naturellement riches en iode sont les mollusques, les poissons de mer, les poissons d’eau douce, les algues, suivies… du lait et des produits laitiers et fromagers. Quant à notre sel de table, il est enrichi en iode depuis les années 50 dans le cadre de la politique de santé publique de lutte contre la carence en iode…

Les allergies alimentaires aux poissons, mollusques, ou algues ne sont pas liées à l’iode et les allergènes en causes ont été bien identifiées.

Concernant les réactions médicamenteuses avec des médicaments contenant de l’iode, en aucun cas l’iode n’a été imputée dans aucune réaction aiguë médiée par les IgE ou retardée. Le schéma suivant est insipiré de l’article  de la Presse médicale [1]. Les allergènes précis impliqués dans les réactions aux PCI ne sont pas identifiés , mais les tests allergologiques confirment que l’iode n’est pas responsable.

Allergie a l'iode

Allergie a l’iode

 

 

Messages – clés [1]

  • L’iode n’est pas impliquée dans les réactions aiguës ou retardées pour les médicaments contenant l’iode
  • Une allergie à un produit de contraste iodé n’est pas une contre-indication À l’application de povidone iodée (et réciproquement)
  • Une allergie à un fruit de la mer ou un poisson n’est pas une contre-indication à la prise d’une médicament iodé

 

Référence

Dewachter P, Mouton-Faivre C. Allergie aux médicaments et aliments iodés : la séquence allergénique n’est pas l’iode. PresseMed 2015;44:1136—45.

 

Autres lectures 

Dewachter P, Tréchot P, Mouton-Faivre C. « Allergie à l’iode » : le point sur la question. Revue Francaise d’allergologie et d’immunologie clinique 2005;45:476-488

Amsler E, Autegarden JE, Senet P, Frances C, Soria A. Récidives de toxidermies après nouvelleinjection de produit de contraste iodé chezdes patients allergiques connus. Ann Dermatol Venereol 2016;143:804-807.