Risks and Health Effects from Tattoos, Body Piercing and Related ...

Final draft –– 05.05.2003 - Review of risks and health effects from tattooing/piercing practices
F) A 42-year old white woman presented with oedematous, pruritic, crusted and tender
lips after receiving red cosmetic tattoos. 38 The subject had undergone two tattoo
procedures in the previous month; the second to define further the colour and borders
of the tattoo. The patient was treated with a topical corticosteroid ointment. The
reaction to the tattoo improved but did not completely clear. The ingredients of the
material in this patient included iron oxide, organic red (naphthanil red), alcohol and
glycerin.
G) A patient presented with skin ulceration 1 month after a new tattoo. On examination,
there was full-thickness skin loss in the areas of the red dye, but no damage in the
areas of black, green, yellow or blue dye. The patient had a tattoo 4 years earlier,
which was asymptomatic. However, this tattoo had shown an inflammatory response
following his new tattoo, with only the red pigment being affected 39 .
3.3.2 Granulomateous/lichenoid reactions
A granulomateous reaction is the growth of small rounded outgrowths, made up of small
blood vessels and connective tissue, on the healing surface of a wound or an ulcer. A
lichenoid reaction is any skin disease that resembles an extremely itchy skin. Shiny flattopped
may occur anywhere on the body.
In most cases the reactions are reported to be caused by different red pigments. While in
the past these reactions have been ascribed to mercury salts (cinnabar) and cadmium
sulphide, now synthetic inorganic azo dyes have also been found to be responsible for such
reactions.
A) A case on a potential etiologic role of nickel was published 40 .
B) On the effects of azo dyes a case report 41 describes allergic reactions in the red parts of
tattoos of a 42-year-old male. Histologically a chronic granulomatous, partly fibrous
inflammation with transfollicular elimination of pigment granules was found.
Spontaneous regression in a part of the inflammatory reaction was observed,
simultaneously with depigmentation and scarring of the overlying skin. The pigment
used for tattooing was found to be an aromatic azo derivative. In addition to a positive
cutaneous reaction to the dye, the patient also showed a positive patch test to Napthol
AS, used for the coupling of different dyes in the textile industry.
38
Duke, D; Urioste, SS; Dover, JS; Anderson, RR: A reaction to a red lip cosmetic tattoo, J. Am. Acad.
Dermatol. 1998 Sept; 39(3):488-490.
39
White, N; Rauf, G: Sensitization to red tattoo pigment. Br. J. Plast. Surg. 2002 Jun;55(4):365-366.
40
Corazza M; Zampino MR; Montanari A; Pagnoni A; Virgili A: Lichenoid reaction from a permanent red
tattoo: has nickel a possible aetiologic role?, Contact Dermatitis 2002 Feb;46(2):114-5
41
Waldmann I; Vakilzadeh F: [Delayed type allergic reaction to red azo dye in tattooing] [Allergische
Spattypreaktion auf roten Azofarbstoff in Tatowierungen.], Hautarzt 1997 Sep;48(9):666-70
18