D Christa De Cuyper e C Maria-Luisa Pérez-Cotapos u y p Editors e r · Dermatologic P é r e z - C Complications with o t a p o s Body Art E d s . 1 D e r m a t o l o g Tattoos, Piercings and i c C Permanent Make-Up o m p l i c a t i o n s w i t h B o d y A 1 23 r t Dermatologic Complications with Body Art Christa De Cuyper, Maria Luisa Pérez-Cotapos S Editors Dermatologic Complications with Body Art Tattoos, Piercings and Permanent Make-Up Dr. Christa De Cuyper Dr. Maria Luisa Pérez-Cotapos S Department of Dermatology Pontifi cia Universidad Católica de Chile, AZ Sint-Jan Department of Dermatology, Ruddershove 10 Clinica Las Condes, 8000 Brugge Lo Fontecilla 441, Belgium Santiago, Chile [email protected] [email protected] ISBN: 978-3-642-03291-2 e-ISBN: 978-3-642-03292-9 DOI: 10.1007/978-3-642-03292-9 Springer Heidelberg Dordrecht London New York Library of Congress Control Number: 2009933268 © Springer-Verlag Berlin Heidelberg 2010 This work is subject to copyright. 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In every individual case the user must check such information by consulting the relevant literature. Cover design: Frido Steinen-Broo, eStudio Calamar, Figueres/Berlin Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Contents 1 History and Epidemiology of Tattoos and Piercings. Legislation in the United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Anne E. Laumann 2 Materials Used in Body Art . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Christa De Cuyper and Davy D’hollander 3 Tattooing and Scarring: Technique and Complications. . . . . . . . . . . . 29 Maria Luisa Pérez-Cotapos S, Christa De Cuyper, and Laura Cossio 4 Piercings: Techniques and Complications. . . . . . . . . . . . . . . . . . . . . . . 43 Christa De Cuyper, Maria Luisa Pérez-Cotapos S and Laura Cossio 5 Cosmetic and Medical Applications of Tattooing. . . . . . . . . . . . . . . . . 53 Christa De Cuyper 6 Allergic Reaction to Pigments and Metals. . . . . . . . . . . . . . . . . . . . . . . 61 Werner Aberer, Johan E. Snauwaert, and Ulf-Maria Render 7 Techniques and Devices Used for Tattoo Removal . . . . . . . . . . . . . . . . 91 Evelien Verhaeghe Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 v Introduction Body art in its different forms dates back to ancient times. Body modifi cation is a common human characteristic that has been practised on all continents and in all races. Specifi c types of body art have been associated with specifi c social, ethnic and religious societies. Temporary decorations include the traditional customs, costumes, the use of jewellery and body painting. Permanent modifi cations such as piercing and tattooing are old forms of body adornment that have gained popularity as a fashion statement in the last decades and that have been accepted in all social classes nowa- days. Cosmetic tattoos or permanent make up have been introduced as an excellent alternative for conventional make up. The technique of micropigmentation consists of implantation of pigment into the skin or the mucosa using a small tattoo pen. The same procedure with a modifi ed instrument, known as dermatography, has found its place in the medical world to camoufl age pathological skin conditions such as vitiligo and alopecia or to mask scars and birth marks and it can offer the fi nishing touch in reconstructive surgery. It can also be used for implantation of pharmacological sub- stances for therapeutic indications. Tattoos are also used as a permanent mark for medical procedures. The imagination in body adornment and body transforming techniques is amazing and endless. More invasive body modifying techniques such as implanting, scarifi ca- tion, branding, scalping and even amputation recently seem to attract the young pop- ulation and unfortunately often result in impressive, irreversible body mutilation. All body-modifying methods can lead to complications, which depend on the hygienic conditions in which the procedures are performed, on the training and the skills of the practitioner and on the materials used. Allergic reactions can be attributed to the sub- stances used. Poor hygienic standards and careless procedures can result in localised infections but can also lead to severe life-threatening conditions or even result in irreversible damage. Blood-borne diseases can be transmitted (hepatitis B, C, HIV), granuloma and keloid formation can occur. Health care professionals should be aware of the complications that can arise from these procedures. The body art industry is one of the fastest growing industries in the last years unaf- fected by the economic crisis. Considering the high number of people who have cho- sen for a tattoo, a piercing or any other form of body modifi cation, one can estimate that millions of people on the globe live with a self-infl icted health risk that could have an important impact and consequences for the health care system in general. Many efforts have been done yet to identify risk factors and to develop preventive measures aimed at protecting public health. Regulation of the composition of the products, harmonisation of the methods for the analytical determination of possible harmful substances, guidelines and recommendations to ensure that procedures are vii viii Introduction carried out under appropriate hygienic conditions can offer a big step forward to pro- moting consumer health. However there is still a lack of uniform universal regulation and control. The purpose of this book is to illustrate the different aspects of body art starting from the history through epidemiology, to improve the knowledge about materials, with their toxic and allergenic potential, to discuss the procedures and the complica- tions that can arise. Therapeutic modalities will be addressed with a focus on laser techniques for tattoo removal. To realise this book we had the assistance and contributions of many people we would like to thank, in particular our colleagues, our secretaries and our families for their help and support. Brugge, Belgium Dr. Christa De Cuyper Santiago, Chile Dr. Maria Luisa Pérez-Cotapos S Contributors Werner Aberer Department of Dermatology and Environmental Dermatology, Medical University of Graz, Auenbruggerplatz 8, 8010 Graz, Austria Laura Cossio Department of Dermatology, Pontifi cia Universidad Católica de Chile, Santiago, Chile Christa De Cuyper Department of Dermatology, AZ Sint-Jan, Ruddershove 10, 8000 Brugge, Belgium Davy D’hollander Professor Claraplein 14/002, 2018 Antwerpen, Belgium Anne E. Laumann Feinberg School of Medicine, Northwestern University 676, North St. Clair #1600, Chicago, IL 60611, USA Maria Luisa Pérez-Cotapos S Pontifi cia Universidad Católica de Chile, Department of Dermatology, Clinica Las Condes, Lo Fontecilla 441, Santiago, Chile Ulf-Maria Render Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, 8010 Graz, Austria Johan E. Snauwaert Augustijnslei 36, 2930 Brasschaat, Belgium Evelien Verhaeghe Department of Dermatology, UZ Gent, De Pintelaan 185, 9000 Gent, Belgium 1 History and Epidemiology of Tattoos and Piercings. Legislation in the United States Anne E. Laumann history related to tattooing, but rather many concur- Core Messages rent happenings in different societies across the world. › Tattooing and body piercing date back to early Tattoos disappear when their canvas goes; in other words, civilizations. with the death of the individual, so our current informa- › In the past, they were used during initiation tion may be more discontinuous than the reality. rites or as an indication of social status. The famous 5,300-year-old preserved corpse, nick- › Tattooing has been used to identify criminals, named Otzi, found in the mountains of the South Tyrol prisoners, and slaves, and for punishment. in 1991 was covered in tattoos. These included linear › Body modifi cation has become more common marks over many of his joints and a cross on the inside and more sophisticated over the last 30 years. of the left knee. They may have been placed to help › Body art may be associated with risky behavior. with pain from his evident arthritis [2, 3] . › Body piercing may be associated with depres- Dark blackish-blue inscriptions have been found on sion. Egyptian mummies dating as far back as 2100 b .c . › Regulation in the United States of America is Interestingly, it appears that this practice of tattooing variable from state to state. was limited to women. It may have been only for deco- ration, but other hypotheses suggest a ritualistic signifi - cance or a relationship to fertility and sexuality. The tattoos were groups of dots and dashes in geometric patterns, often across the abdomen. The oldest of these mummies is that of Amunet, a priestess of Hathor, the 1.1 History Egyptian goddess of love. Later (circa 1532–1070 b .c .), female mummies from the New Kingdom of Nubia (South Egypt) were embellished with representational 1.1.1 Tattoos tattoos, for example, the image of the god Bes, on the thighs. Tattooing, defi ned as the practice of producing an indel- In the late eighth century b .c. , Isaiah prophesied “This ible mark or fi gure on the human body by inserting one will say, ‘I am the Lord’s,’ another will call himself pigment under the skin using needles or other sharp by the name of Jacob, and another will write on his hand, instruments, has probably been around since the begin- ‘ The Lord’s,’ and surname himself by the name of Israel” ning of humanity [1] . There is not so much a continuous [4] . Old testament sayings like this together with the injunction “You shall not make any cuttings in your fl esh for the dead nor print any marks upon you: I am the Lord” [5] in Leviticus, composed circa 550–400 b .c. , belie the presence of these marks on the bodies of A. E. Laumann Israelites at that time. This latter admonition may have Feinberg School of Medicine, Northwestern University , 676, been motivated by the use of tattoos among non-Jewish North St. Clair #1600 , Chicago , IL , 60611 , USA e-mail: [email protected] people, for example, those of the cult of Baal [6] . C. de Cuyper, M. L. Pérez-Cotapos S. (eds.), Dermatologic Complications with Body Art, 11 DOI: 10.1007/978-3-642-03292-9_1, © Springer-Verlag Berlin Heidelberg 2010 22 A. E. Laumann A bout the same period, the Pazyryk were a nomadic identify “untouchables”. Decorative tattooing, heavily tribe living in the Altai Mountains of Siberia. A num- infl uenced by the imagery of wood-block print artists, ber of their tombs have been opened and previously developed during the Edo period (1600–1800 a .d. ). undisturbed bodies found to be elaborately decorated The Yakuza, who initially were fl amboyant and crazy with real and mythical beasts. These pictures are samurai in the service of the emperor, degenerated into thought to refl ect the societal status of the bearer [6] . the criminal class, and it was this group who became Likewise, it is clear that tattooing occurred in China. known for elaborate full body tattoos. (Fig. 1.1 ) These Although, in some parts men tattooed their hands as a tattoos, even today, may be applied by hand and take sign of valor and women tattooed the nape of the neck many days to complete. Their painful acquisition is a as a sign of marital status, in general, tattooing hap- measure of courage and group solidarity. During the pened among “barbarian” peoples. Tattoos may have Meji era (1868 to present), tattooing has been forbid- been used as facial cosmetics, to ward off evils spirits, den, increasing the association with criminality, although, or as marks of slavery or punishment [7] . as in the rest of the developed world, tattooing is becom- I n Japan, there is evidence from clay fi gures from ing more mainstream [8] . the Jomon period (10,000–300 b .c. ) of facial tattoos, L ittle is known about tattooing during the latter part and later, during the Yahoi period (300 b .c .–300 a.d .) of the fi rst millennium and the early part of the second tattooing occurred on the face for decorative and reli- millennium a .d ., but the Inuit (Eskimos), who lived gious purposes and to ward off evil spirits. Later, tat- along the Arctic coasts of Siberia, Alaska, Greenland, tooing fell into disrepute, and during the Kofun period and Canada, continued to use facial tattoos over the (300–600 a .d .), it was used as a punishment and to centuries. They served to protect them from enemies, Fig. 1.1 Nakamura Fukusuke in the role of Koito with Ichimura Signed: Toyokuni ga in a Toshidama cartouche. Artist: Utagawa Ichizo in role of Sashichi. Color woodcut diptych with gauffrage Kunisada (1786–1865). Publisher: Otaya Takishi 1858, 7th month. From the play F uka unbaka ikiji shinwara .