Abstract
Tattoo removal by laser therapy is a frequently performed procedure in dermatological practices. Quality-switched ruby, alexandrite, or Nd:YAG lasers are the most suitable treatment devices. Although these techniques are regarded as safe, both temporary and permanent side effects might occur. Little has been published on the frequency of complications associated with laser tattoo removal. We performed an Internet survey in German-speaking countries on characteristics of laser tattoo removal and associated side effects. A total number of 157 questionnaires entered the final analysis. Motivations for laser tattoo removal were mainly considering the tattoo as youthful folly (29 %), esthetic reasons (28 %), and 6 % indicated medical problems. One third of participants were unsatisfied with the result of laser tattoo removal, and a complete removal of the tattoo pigment was obtained in 38 % only. Local transient side effects occurred in nearly all participants, but an important rate of slightly visible scars (24 %) or even important scarring (8 %) was reported. Every fourth participant described mild or intense tan when the laser treatment was performed, and the same number of people indicated UV exposure following laser therapy, which should normally be avoided in these circumstances. As reported in the literature, nearly half of the participants experienced hypopigmentation in the treated area. Our results show that from the patients’ point of view there is an important rate of side effects occurring after laser tattoo removal. Appropriate pretreatment counseling with regard to realistic expectations, possible side effects, and the application of test spots is mandatory to ensure patient satisfaction. Laser treatment should be performed by appropriately trained personnel only.
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References
Long GE, Rickman LS (1994) Infectious complications of tattoos. Clin Infect Dis 18(4):610–619
Stirn A, Hinz A, Brahler E (2006) Prevalence of tattooing and body piercing in Germany and perception of health, mental disorders, and sensation seeking among tattooed and body-pierced individuals. J Psychosom Res 60(5):531–534
Laumann AE, Derick AJ (2006) Tattoos and body piercings in the United States: a national data set. J Am Acad Dermatol 55(3):413–421
Klugl I, Hiller KA, Landthaler M, Baumler W (2010) Incidence of health problems associated with tattooed skin: a nation-wide survey in German-speaking countries. Dermatology 221(1):43–50
Latreille J, Levy JL, Guinot C (2011) Decorative tattoos and reasons for their removal: a prospective study in 151 adults living in South of France. J Eur Acad Dermatol Venereol 25(2):181–187
Koljonen V, Kluger N (2012) Specifically requesting surgical tattoo removal: are deep personal motivations involved? J Eur Acad Dermatol Venereol 26(6):685–689
Bernstein EF (2006) Laser treatment of tattoos. Clin Dermatol 24(1):43–55
Kossida T, Rigopoulos D, Katsambas A, Anderson RR (2012) Optimal tattoo removal in a single laser session based on the method of repeated exposures. J Am Acad Dermatol 66(2):271–277
Izikson L, Farinelli W, Sakamoto F, Tannous Z, Anderson RR (2010) Safety and effectiveness of black tattoo clearance in a pig model after a single treatment with a novel 758 nm 500 picosecond laser: a pilot study. Lasers Surg Med 42(7):640–646
Brauer JA, Reddy KK, Anolik R, Weiss ET, Karen JK, Hale EK, Brightman LA, Bernstein L, Geronemus RG (2012) Successful and rapid treatment of blue and green tattoo pigment with a novel picosecond laser. Arch Dermatol 148(7):820–823
Baumler W, Eibler ET, Hohenleutner U, Sens B, Sauer J, Landthaler M (2000) Q-switch laser and tattoo pigments: first results of the chemical and photophysical analysis of 41 compounds. Lasers Surg Med 26(1):13–21
Ross V, Naseef G, Lin G, Kelly M, Michaud N, Flotte TJ, Raythen J, Anderson RR (1998) Comparison of responses of tattoos to picosecond and nanosecond Q-switched neodymium: YAG lasers. Arch Dermatol 134(2):167–171
Handley JM (2006) Adverse events associated with nonablative cutaneous visible and infrared laser treatment. J Am Acad Dermatol 55(3):482–489
Wenzel S, Landthaler M, Baumler W (2009) Recurring mistakes in tattoo removal. A case series. Dermatology 218(2):164–167
Fitzpatrick RE, Goldman MP (1994) Tattoo removal using the alexandrite laser. Arch Dermatol 130(12):1508–1514
Kluger N, Hakimi S, Del Giudice P (2009) Keloid occurring in a tattoo after laser hair removal. Acta dermato-venereologica 89(3):334–335
Alora MB, Arndt KA, Taylor CR (2000) Scarring following Q-switched laser treatment of "double tattoos". Arch Dermatol 136(2):269–270
Hammes S, Karsai S, Metelmann HR, Pohl L, Kaiser K, Park BH, Raulin C (2013) Treatment errors resulting from use of lasers and IPL by medical laypersons: results of a nationwide survey. J Dtsch Dermatol Ges 11(2):149–56
Armstrong ML, Roberts AE, Koch JR, Saunders JC, Owen DC, Anderson RR (2008) Motivation for contemporary tattoo removal: a shift in identity. Arch Dermatol 144(7):879–884
Lubeck G, Epstein E (1952) Complications of tattooing. Calif Med 76(2):83–85
Leuenberger ML, Mulas MW, Hata TR, Goldman MP, Fitzpatrick RE, Grevelink JM (1999) Comparison of the Q-switched alexandrite, Nd:YAG, and ruby lasers in treating blue-black tattoos. Dermatol Surg 25(1):10–14
Zelickson BD, Mehregan DA, Zarrin AA, Coles C, Hartwig P, Olson S, Leaf-Davis J (1994) Clinical, histologic, and ultrastructural evaluation of tattoos treated with three laser systems. Lasers Surg Med 15(4):364–372
Levine VJ, Geronemus RG (1995) Tattoo removal with the Q-switched ruby laser and the Q-switched Nd:YAGlaser: a comparative study. Cutis 55(5):291–296
Alster TS (1995) Q-switched alexandrite laser treatment (755 nm) of professional and amateur tattoos. J Am Acad Dermatol 33(1):69–73
Kilmer SL, Lee MS, Grevelink JM, Flotte TJ, Anderson RR (1993) The Q-switched Nd:YAG laser effectively treats tattoos. A controlled, dose–response study. Arch Dermatol 129(8):971–978
Vasold R, Naarmann N, Ulrich H, Fischer D, Konig B, Landthaler M, Baumler W (2004) Tattoo pigments are cleaved by laser light-the chemical analysis in vitro provide evidence for hazardous compounds. Photochem Photobiol 80(2):185–190
Gottschaller C, Hohenleutner U, Landthaler M (2006) Metastasis of a malignant melanoma 2 years after carbon dioxide laser treatment of a pigmented lesion: case report and review of the literature. Acta Derm Venereol 86(1):44–47
Boer A, Wolter M, Kaufmann R (2003) [Pseudomelanoma following laser treatment or laser-treated melanoma?]. J Dtsch Dermatol Ges 1(1):47–50
Muller-Lissner S, Tack J, Feng Y, Schenck F, Specht Gryp R (2013) Levels of satisfaction with current chronic constipation treatment options in Europe—an internet survey. Aliment Pharmacol Ther 37(1):137–145
Mayr A, Gefeller O, Prokosch HU, Pirkl A, Frohlich A, de Zwaan M (2012) Web-based data collection yielded an additional response bias–but had no direct effect on outcome scales. J Clin Epidemiol 65(9):970–977
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Klein, A., Rittmann, I., Hiller, KA. et al. An Internet-based survey on characteristics of laser tattoo removal and associated side effects. Lasers Med Sci 29, 729–738 (2014). https://doi.org/10.1007/s10103-013-1395-1
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DOI: https://doi.org/10.1007/s10103-013-1395-1