Decorative tattoo L81.8

Introduction of coloured pigments into the skin with needle pricks. In professional tattoos, the dye is introduced into the upper to middle corium. In amateur tattoos, the pigment is irregularly distributed and reaches into the lower corium, possibly into the subcutaneous fatty tissue.z

A decorative tattoo of the lips and eyebrows is called permanent make-up (also permanent make-up).

Tattoo and allergy potential: Until a few years ago, metal salts were used as dyes. Today mostly organic pigments are used. There is no official approval regulation for tattooing substances in Germany. Pigments in cosmetics, textile dyes or food dyes have to be defined exactly according to the legal requirements, whereas pigments for tattoos are not subject to these regulations. This results in a high allergological potential (see contact allergies), as it is up to each tattoo salon to mix colour palettes and apply them to the consumer. It is not uncommon for exotic mixtures to be made due to competitive pressure, and in some cases basic colours are recruited from the automobile industry. The popular magenta red, for example, has now been taken off the market due to frequent skin reactions.

Tattoos with henna dyes are also becoming increasingly popular as temporary decorative tattoos. However, there are increasing reports of sensitization against p-phenylenediamine (PPD) as the henna dye Lawson is often mixed with highly concentrated p-phenylenediamine.

Tattooing and macrophages: By studying the origin and dynamics of the cutaneous cells (macrophages) that trap and "store" the particles of pigments contained in tattoos, it can be shown that these cells are subject to a continuous life cycle. That is, the cutaneous pigment particles undergo a continuous cycle of "capture, release and recapture". The longevity and localisation of the colouring particles are thus subject to a continuous temporal interplay, which is determined by the lifetime of the macrophages (Baranska et al. 2018). Nevertheless, the "tattoo" remains true to its original location. The consequences of e.g. extensive tattoos on the immune system of the body, which can be deduced from this knowledge, are completely unknown so far.

Note: Tattoo needles often contain nickel (6-8%) and/or chrome (15-20%). The allergens can get into the skin through abrasion during the tattooing process and thus contribute to type IV sensitization or cause an allergic reaction.

immediately after tattooing:

• Local: Consequences of needlestick injuries (crusts; swelling; pain, bleeding, blisters; wound infections) in 67.5% of cases
• Systemic: fatigue, headache, nausea, fever, occasional psychological complaints in 6.6% of cases

4 weeks after the tattoo:

• swelling, papules, itching in 6% of cases
• Persistent local reactions: Persistent itching, intermittent swelling, swelling after UV exposure.
• Complicative tumour development (cited from Wagner et al 2018): squamous cell carcinoma, keratoacanthoma; malignant melanoma; basal cell carcinoma; dermatofibroma; pilomatrixoma.

Also: lichenoid and pseudolymphomatous reactions. That of Kim and Mitarb. 2016 reported case of acute sarcoidosis (Löfgren's syndrome) under a combined anti-CTLA-4(ipilimumab)/anti-PD1(nivolumab) therapy of a metastatic bladder carcinoma, which primarily manifested itself in a tattoo, proves an increased susceptibility of the tattooed regions.

The most commonly used elements for coloured metal salts are mercury, titanium, copper and silicon. Coarsely oriented, the following can be given: cinnabar red = mercury, green = chromium oxide, blue = cobalt aluminate, yellow = cadmium salts.

Since 2009, the German Tattoo Agent Ordinance has been in force, banning numerous questionable dyes and introducing a labelling obligation.

1. Baranska A et al (2018) Unveiling skin macrophage dynamics explains both tattoo persistence and strenuous removal. J Exp Med 215:1115-1133.
2. Colsman et al (2007) Type IV allergy and foreign body reaction. The German Dermatologist 4: 266-268
3. Davies EE et al (2007) Para-phenylenediamine allergy from a henna tattoo. Arch Dis Child 92: 243
4. Jacob CI (2002) Tattoo-associated dermatoses: a case report and review of the literature. Dermatol Surge 28: 962-965
5. Kim C et al(2016) Systemic sarcoidosis first manifesting in a tattoo in the setting of immune checkpoint inhibition. BMJ Case Rep 26
6. Mafong EA et al (2003) Surgical pearl: Removal of cosmetic lip-liner tattoo with the pulsed carbon dioxide laser. J Am Acad Dermatol 48: 271-272
7. Shah G et al (2002) Treatment of an amalgam tattoo with a Q-switched alexandrite (755 nm) laser. Dermatol Surge 28: 1180-1181
8. Wagner G et al (2018) Pilomatrixoma in a tattoo. dermatologist 69: 242-244
9. Werner S et al (1999) Removal of tattoos with the Q-switched ruby laser and the Q-switched Nd:YAG laser. dermatologist 50: 174-180