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Vitiligo and tattooing

Documented archaeological recordings from mummified preserved skin, indicate that humanity has practiced the art of tattooing since the Neolithic era. Despite their historical background, the popularity of tattoos grew rapidly from the 'Renaissance of the Tattoo' in the 1950s. Nowadays, tattoos are considered an artistic expression and decoration of the human body. Despite their aesthetic applications, tattoos are also used for medical purposes and are often referred to as micro-pigmentation or medical tattooing. Tattoos are considered an alternative treatment method for treating dermatological conditions associated with deforming skin conditions.

Vitiligo patients often use skin covering means to cover up the depigmented areas of the body. The deforming signs of vitiligo tend to affect the patients’ psychological state and degrade their quality of life. This is due to the fact that many patients do not only consider vitiligo as an aesthetic condition, but also as a major social dysfunction limiting their social, professional and interpersonal relationships. The decline in quality of life combined with relatively poor treatment results, compels vitiligo patients to choose tattoos as an alternative form of treatment. Nevertheless, this raises the debate about whether vitiligo patients should tattoo.

There are two interdependent parameters that affect one's view about the above-mentioned discussion and these are (a) the dermatological treatment of vitiligo and (b) the improvement of the patients’ quality of life. Despite the fact that a group of acclaimed researchers has reached the conclusion that cosmetic tattoos may improve vitiligo patients’ quality of life, there is no literature of studies on the evaluation of the effectiveness of micro-pigmentation and cosmetic tattoos. As a result, this debate has no winner. Nonetheless, using logic and scientific evidence, we would like to present our arguments for the use of tattoos as coverups for the lesions of vitiligo. Then, we would like to mention some of the main complications that can be caused by tattoos in the case of vitiligo.

Firstly, one of the main difficulties associated with tattooing and vitiligo, is the difficulty of matching the ink colour to the skin pigment. This happens due to various factors that affect and change the colour of the skin (eg.: sun exposure, age, etc.). Moreover, due to the Tyndall phenomenon, (photos 1-2), the selected tattoo hue will look quite different when it is inserted to the epidermis. Nevertheless, the particular designed pigments used in cosmetic tattoos contain iron oxides and can offer satisfactory results in colour matching and duration. However, the aforementioned tattoos can cause oxidation and darken over time.

The damages caused may range in size from millimetres to centimetres, they centrifugally and have an unpredictable spread rate. As a result, the size of a tattoo may ultimately smaller than the size of the discoloured blot that it was intended to cover. (Photos 3-4).

In this case, we must bear in mind the type of vitiligo, especially if it is active, because the Koebner effect may facilitate the progression of the vitiligo. Of course, piercing the skin with the tattoo needle can worsen any type of vitiligo or create a new outbreak, in the specific area of the tattoo.

While tattooing the skin, there may be reactions due to various factors, such as the type of ink, the handling techniques of the tattoo artist and the disinfecting conditions during the procedure. Complications due to the above mentioned reasons may result in:

  • Superficial or deep infection due to atypical mycobacteria (photos 5, 6 & 7)
  • Allergic reactions and allergic contact dermatitis (photos 8-9). Recurrence of pre-existing infections, such as simple herpes, and their expansion to new body areas
  • Granulomatous reactions and chronic granulomatous reaction due to tattoo pigments
  • Photo dermatitis
  • Lichinogenic reactions
  • Appearance of keloids (Photo 10)
  • Lesion expansion in patients with co-existing psoriasis
  • HIV and hepatitis infection

In addition to the above, there are some rare cases of patients who developed pseudo-lymphoma, which in its turn may - very rarely - cause cutaneous lymphatic hyperplasia (photo 11) and lupus erythematosus, after having a tattoo.

There are also patients who have the tattoo made close to the vitiligo lesion, so as to draw attention away from it, using an impresive design. This way they improve their psychological status and increase their self-esteem (Photo 12).

Having a tattoo requires maturity, as it is a permanent mark that you will have on you for the rest of your life. Often, a lot of people have a tattoo that they later regret. From a psychological point of view, this happens because of the illusion that people have - especially when it comes to a teenager or young adult - that what they really like now, they will also like later on. Nowadays, technology has evolved and a tattoo may be removed if it is no longer desirable.

Nevertheless, vitiligo patients should think twice when they are considering a tattoo because of the possible complications of a tattoo removal procedure. Q-switched lasers used to remove tattoos, develop high temperatures in order to facilitate depigmentation of the tattooed skin. The latter may lead to the formation of bubbles or inflammations that may cause the Koebner phenomenon, hence the spread of vitiligo.

In conclusion, we expressed our opinion suggesting that it is best for vitiligo patients to avoid tattooing. To support the above-mentioned view, we pointed out the negative effects of tattoos in case of vitiligo by documenting them with scientific evidence. Nevertheless, it is worth mentioning that from time to time in the literature, there have been reported cases of vitiligo patients that are satisfied after having a tattoo.

Finally, it is significant to take into account the negative psychological status of vitiligo patients, resulting from the deforming nature of the disease. Therefore, it is important to choose an effective treatment for vitiligo that achieves fast and consistent re-pigmentation, so as to improve the negative psychological status of the pati

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