J. Serup

Patients with tattoo reactions have reduced quality of life and suffer from itch: Dermatology Life Quality Index and Itch Severity Score measurements.

Tattoos are a trend with increasing side‐effects. The burden of local reaction with swelling, itching and discomfort may impel sufferers to consult medical assistance.

Papulo-Nodular Reactions in Black Tattoos as Markers of Sarcoidosis: Study of 92 Tattoo Reactions from a Hospital Material

Background/Aims: Sarcoidosis is, from historical data, suggested to be more prevalent among patients with tattoo reactions. We aimed to evaluate this association in a systematic study. Methods: 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. Results: Of the 92 reactions with a papulo-nodular pattern, 27 (29%) reactions in 19 patients were diagnosed as cutaneous or systemic sarcoidosis, supported by histology; 65 (71%) were diagnosed as non-sarcoidosis due to histology and no clinical sarcoid manifestations. “Rush phenomenon” with concomitant reaction in many other black tattoos, triggered by a recent tattoo with a papulo-nodular reaction, was observed in 70% in the sarcoidosis group and 28% in the non-sarcoidosis group, indicating a predisposing factor which may be autoimmune and linked with sarcoidosis. Agglomerates of black pigment forming foreign bodies may in the predisposed individual trigger widespread reaction in the skin and internal organs. Conclusion: 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.

High-frequency ultrasound imaging of tattoo reactions with histopathology as a comparative method. Introduction of preoperative ultrasound diagnostics as a guide to therapeutic intervention.

Tattoo adverse reactions requiring diagnostic evaluation and treatment are becoming more common. The aim of this study was to assess tattoo reactions by 20‐MHz ultrasonography referenced to histopathology as a comparative method.

Allergic reactions in red tattoos: Raman spectroscopy for 'fingerprint' detection of chemical risk spectra in tattooed skin and culprit tattoo inks.

The aim of this study was to assess the feasibility of Raman spectroscopy as a screening technique for chemical characterisation of tattoo pigments in pathologic reacting tattoos and tattoo ink stock products to depict unsafe pigments and metabolites of pigments.

Laser Surgeon, Client Education, and Satisfaction with Tattoo Removal

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 satisfaction is influenced by numerous factors: pretreatment expectations, objective observations, pretreatment information, laser treatment procedures, and outcome, including subjective experiences such as pain. 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.

Psoriasis and Adherence to Therapy: Individual, Treatment-Related and General Factors

In the field of dermatology, psoriasis patients are more prone to therapy non-adherence. Patients’ perception of psoriasis, choice of medication and personal factors are some of the causes for therapy non-adherence. A positive physician-patient relationship is of paramount importance to achieve improved therapy adherence results and both have a responsibility. Doctors must be aware of pros and cons concerning medicine and patients economy. Early follow-up consultations are important to encourage patients’ treatment behaviour and to substitute medicine if necessary. Emails, daily text messages and app downloads are tools which can help the patients to remember their medicine (e.g. dosage, time intervals) and doctors consultations.

Tattooing may cause life-threatening latex allergy.

et al. found increased levels of phytoporphyrin ranging from 0.4 to 2.9 lm/mL (normally <0.1 lm/mL in healthy animals) in the sera of ruminant livestock with photosensitive eczema. The marginally elevated red blood cell porphyrin levels in cases 1 and 3 may reflect the elevated phytoporphyrins in these patients, as Campbell’s study of chlorophyll-fed, photosensitive ruminant livestock found elevated levels of serum phytoporphyrins. The direct immunofluorescence showing ++ immunoglobulins near vessels and at the dermo-epidermal junction (DEJ) in case 1 may reflect the damage caused by visible light penetrating to the depth of the DEJ and superficial dermis as per chlorophyll’s absorption maxima. After case 1’s chlorophyll was ceased, he still had + IgG in the intercellular spaces of the keratinocytes and near vessels, as with case 3, who still had ++ IgG near vessels and the DEJ. These findings cannot be explained so far, but parallels the ongoing photosensitivity experienced by these 2 patients. Chlorophyll cessation did not lead to complete symptom resolution in 3 of 4 patients, who experienced ongoing photosensitivity and skin fragility up to 8 months. The mechanism of this is uncertain. We suspect a prolonged half-life or persistent binding of chlorophyll metabolites in genetically or metabolically susceptible patients. Binding sites may include the skin, blood plasma or liver; the latter was suggested by Tapper et al. study in which pheophorbide-a was extracted from the blood and liver of pheophorbide-a-fed rats. Liver dysfunction may impair hepatic clearance of chlorophyll, which may have contributed to case 1’s symptoms, given his excess alcohol consumption and elevated gamma-glutamyltranspeptidase. Initial treatment for chlorophyll-induced pseudoporphyria includes sun-protection and cessation of chlorophyll intake. Patients with ongoing symptoms require further research and trials. Carotenoid was suggested, having been established to protect green plants and photosynthetic bacteria against their own photosensitization. It is also worthy of note that although chlorophyll’s photosensitive properties can be harmful, it may be utilized to enhance photodynamic therapy (PDT) for acne, as shown by a randomized controlled trial of 24 acne patients treated with chlorophylla PDT. To conclude, we emphasize chlorophyll supplementation as a cause of pseudoporphyria, with potential persistent symptoms after cessation. As the worldwide trend to “natural superfoods” gathers momentum, dermatologists must be aware of this, and specifically interrogate patients who present with a new blistering disorder about chlorophyll.

Sequels to tattoo removal by caustic products

Caustic products are used as affordable alternatives to laser removal of tattoos.

Tattoo removal by Q-switched yttrium aluminium garnet laser: client satisfaction

Tattoo removal by Q‐switched yttrium aluminium garnet (YAG) lasers is golden standard; however, clients’ satisfaction with treatment is little known.

Non-attendance, Predictors and Interventions

Non-attendance is the act of patients failing to attend their planned consultations and in advance failing to inform the hospital/clinic involved. This practise is an economic and practical burden in health care and an abuse of resources.