TATTOOS-TREAT OR TRAUMA

Tattoo-backAmericans spend a countless amount of money ridding their skins of zits, brown spots, wrinkles, scars or other unwanted marks and yet, according to the Pew Research Center, more than a third of Americans ages 18 to 25 and about 40 percent of Americans ages 26 to 40 have tattoos for which they pay out-of-pocket 6 billion dollars each year.
Why?
I asked a 30-something professional woman the reason she had a visible tattoo on her ankle and she said “Because I want to show I own my body.”
Pew researchers found 29 percent of people with tattoos say the reason they had the tattoo because it makes them feel rebellious; another 31 percent says a tattoo makes them feel sexier and 5 percent say it makes them feel more intelligent.
I was surprised that according to PEW researchers only 17 percent regret having a tattoo and 11 percent opt to have it removed.
Tattoo art can be beautiful but before you ask for one that says “Mom” or expresses “Love” for a lover who may one day be replaced by another, here are some safety hints gathered from members of The American Academy of Dermatology and government agencies.

Tattoos, just like most cosmetics, are not regulated. The ink and tools and the tattoo artist may cause problems. The way these inks interact with the skin and within the body may be responsible for an increasing number of complications, according to experts at the American Academy of Dermatology.

Michi Shinohara, MD, FAAD, clinical assistant professor of dermatology at the University of Washington in Seattle points out one of the most common problems associated with tattooing is allergic reactions to the tattoo pigments. “Itching, bumps, or rashes can occur days, months or even years after the initial tattoo. The affected person might not suspect that the tattoo is the culprit. In people with psoriasis and eczema, tattoos may cause the chronic skin conditions to flare.”

The composition of tattoo ink has changed. In the past, metal salts, lead, cobalt, and carbon were used in inks. Today, many modern tattoo inks –especially intense reds and yellows– contain organic azo dyes, a large group described in my A Consumer’s Dictionary of Cosmetic Ingredients.

Skin problems dermatologists have associated with tattoos

Sarcoidosis: An autoimmune disorder characterized by swelling and itching that can occur in a tattoo decades after the procedure and can involve other organs, such as the lungs or eyes. This type of reaction is not directly caused by the original tattoo, but can show up within the tattoo. Treatments include topical creams and, in severe cases, immunosuppressant medications.

Skin cancer: A lesion which may occur within a tattoo, and for that reason Dr. Shinohara explained that tattoo artists need to be careful not to place a tattoo over an existing mole. However, one reaction that can result is a bump that mimics skin cancer, which can ruin the tattoo. Because the bump is so hard to distinguish from this skin cancer, it requires a biopsy and, in some cases, may need to be treated as a skin cancer, with additional surgery. Dr. Shinohara noted that this unusual reaction is thought to stem from tattoo ink and can result in potentially unnecessary and expensive skin cancer treatment.

Infections: The Food and Drug Administration (FDA) is particularly concerned about infections with a family of bacteria called Non-tuberculous Mycobacteria (NTM) that has been found in recent outbreaks of illnesses linked to contaminated tattoo inks. M. chelonae, one of several disease-causing NTM species, can cause infections of skin, joints, lungs, and other organs, as well as eye problems. These infections can be difficult to diagnose and can require treatment lasting six months or more.
“Contaminated inks have caused serious infections in at least four states in late 2011 and early 2012,” says Pamela LeBlanc, M.P.H., of FDA’s Coordinated Outbreak Response and Evaluation (CORE) Network says the FDA is reaching out to tattoo artists, ink and pigment manufacturers, public health officials, health care professionals and consumers to warn them of the potential for infection. FDA warns that tattoo inks can become contaminated by NTM and several other types of bacteria, mold and fungi.

Linda Katz, M.D., M.P.H., director of FDA’s Office of Cosmetics and Colors says “Getting the word out to tattoo artists is particularly critical. Even when they diligently follow hygienic practices, they may not know that an ink itself may be contaminated. Contamination is not always visible in the inks. “In addition, she says, there have been reports of syphilis and hepatitis B and C being transmitted due to non-sterile tattooing practices.”

If You Are Determined to Get a Tattoo

Dr. Michi Shinohara offered the following tips:
• Be sure to go to a professional tattoo parlor and to a tattoo artist who is licensed based on a state’s requirements.
• Insist on seeing equipment in sterile packaging.
• Let the tattoo artist know if you have a reaction. If a problem lasts more than one to two weeks, see a dermatologist.
• Those with a chronic skin condition such as psoriasis, eczema, or a tendency toward keloid scarring should check with a dermatologist before getting a tattoo.
• Avoid tattooing over a mole because it will make it more difficult to diagnose a problem if the mole changes in the future.

Bruce E. Katz, MD, FAAD, a dermatology private practioner in New York City, says in order to protect your investment, it’s important to keep tattooed skin healthy and vibrant. He recommends the following tips:

• If your tattooed skin feels dry, apply a water-based lotion or cream to the tattoo. Petroleum-based products, such as petroleum jelly, can cause the ink to fade.

• Protect your tattoo from the sun: Exposure to ultraviolet (UV) light can fade some tattoo inks and increase your risk for getting skin cancer. When you’re in the sun, protect your tattooed skin by applying a broad-spectrum, water-resistant sunscreen with a Sun Protection Factor (SPF) of 30 or more. Apply the sunscreen 15 minutes before you go outside and reapply at least every two hours.

• Stay out of tanning beds and away from sunlamps. These devices may also fade the ink in tattoos and increase your risk of skin cancer. In some people, the UV light may also react with the tattoo ink, causing a painful skin reaction

• See a dermatologist if you have a skin reaction or if your tattooed skin is changing in any way. Your skin may have a bad reaction to the ink in a tattoo. This can happen immediately after getting a tattoo or years later. A change could also be a sign of skin disease. A dermatologist can diagnose what’s happening and treat it.

If you want to have a tattoo removed
It is an expensive proposition, Dr. Katz says. “Although many tattoo removal kits are available online, these products are not regulated by the FDA and have led to permanent skin injuries.

An effective and safe way to remove tattoos is through laser surgery, performed by a dermatologist who specializes in tattoo removal, says FDA’s Mehmet Kosoglu, Ph.D., who reviews applications for marketing clearances of laser-devices. However, it can be a painstaking process.

“Complete removal, with no scarring, is sometimes not possible,” Kosoglu notes.
With laser removal, pulses of high-intensity laser energy pass through the skin and are selectively absorbed by the tattoo pigment. The laser breaks the pigment into smaller particles, which may be metabolized or excreted by the body, or transported to and stored in lymph nodes or other tissues, Kosoglu explains. The type of laser used to remove a tattoo depends on the tattoo’s pigment colors, he adds. Because every color of ink absorbs different wavelengths of light, multi-colored tattoos may require the use of multiple lasers. Lighter colors such as green, red, and yellow are the hardest colors to remove, while blue and black are the easiest.
Does it hurt?
“That depends on a person’s pain threshold,” Kosoglu says. Some people compare the sensation of laser removal to being spattered with drops of hot bacon grease or snapping a thin rubber band against the skin. A trained dermatologist will be able to adjust the treatment to the patient’s comfort level.
Generally speaking, just one laser treatment won’t do the trick. According to the American Academy of Dermatology, the procedure requires multiple treatments (typically six to 10) depending on a tattoo’s size and colors, and requires a few weeks of healing time between procedures. Some side effects may include pinpoint bleeding, redness, or soreness, none of which should last for long.

For more information:
American Academy of Dermatology: http://www.aad.org or Academy at 1-888-462-DERM (3376) or follow the Academy on Facebook (American Academy of Dermatology); Twitter (@AADskin); or YouTube (AcademyofDermatology).The “Tattoos: How to Care” video is posted to the Academy website and the Academy’s YouTube channel.
FDA Tattoos Pose Health Risks: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm316357.htm

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