Tattooing deposits millions of coloured ink particles into the dermis. Your body may not react well to the presence of this foreign material, resulting in allergic reactions to the ink. I've seen quite a few cases of tattoo allergies in the course of performing laser tattoo removal in Singapore.
Allergic reactions can arise soon after the tattoo has been placed but they can also be delayed and appear months or years later. Sometimes the tattoo could have been absolutely fine for a long time. Then out of nowhere, an allergic reaction can be triggered by sunlight, laser tattoo removal or even surgery elsewhere in the body. This is especially as we get high levels of UV radiation in Singapore.
This may cause a red, itchy, bumpy rash that may eventually lead to scarring if not managed properly.
Why does tattoo allergy develop?
After implantation, tattoo pigments form an insoluble reservoir in the skin. These organic or inorganic pigments undergo slow degradation (enzymatic, chemical and physical) releasing toxic or allergenic decomposition products. Some degradation products can induce sensitization. Due to delayed ink decomposition, most allergic reactions in tattoos occur after months to years.
Physical factors can induce changes in the ink composition and release allergenic components. Sunlight and UV can enhance the decomposition of tattoo pigments, triggering allergic reactions. Laser irradiation is another source of degradation. Laser removal produces heat-induced decomposition of tattoo pigments that might release sensitizing compounds.
Treat the allergic reaction
Before attempting any sort of tattoo removal, it is essential to treat the allergic reaction. For minor reactions that are limited in surface area, I usually use topical corticosteroids with or without occlusion to calm the area down.
For worse reactions, particularly if the area is indurated or looks like it may be trending toward a hypertrophic/keloid reaction, I usually treat aggressively to try and suppress the allergic reaction as severe inflammation may lead to scarring. I find that vascular lasers or intralesional injections such as corticosteroids/neurotoxin useful. In severe or widespread reactions, oral medications may be needed to suppress the allergic reaction.
Remove the tattoo that is triggering the allergy
Removal of the problematic tattoo aims to eliminate the allergen from the skin, preventing further triggering of an allergic reaction by the tattoo.
Different techniques can be employed to remove an allergic tattoo. Careful assessment of each case is critical to deciding on what method to use. The aesthetic result such as the risk of residual scars, as well as the risk of triggering further allergic reactions, has to be taken into account.
Surgical treatment of patients with chronic tattoo reactions has been proposed. Surgical excision is practically limited to small tattoos in favourable anatomic locations and will definitely result in a linear scar at least. Dermatome shaving with or without skin grafting has the advantage of rapid removal of tattoo pigment thus reducing the chance of further allergy but it bears a high risk of scarring and pigmentary changes.
Q-switched nanosecond or picosecond laser to break up tattoo pigments can be tried but very cautiously with test patches and close monitoring as the tattoo pigments are broken up but still within the skin, which may react to these breakdown products. Furthermore, the swelling and induration due to the allergic reaction may potentially limit the penetration of laser energy, reducing effectiveness.
Ablative lasers such as CO2 and Erbium-YAG can also be used. They remove pigment directly and thus pose less risk of triggering an allergic reaction compared to q-switched lasers. Ablative lasers can be used in a fractional or full-field approach. Full-field laser ablation is similar to mechanical dermatome shaving. However, bleeding is controlled resulting in better visibility. The depth of removal can be more nuanced resulting in less risk of scarring. However, full-field ablative laser can be very time consuming and still bear significant risks of scarring and pigment changes.
Fractional ablation vaporizes a fraction of the skin at a time by emitting microbeams that create microthermal ablation and coagulation zones leaving unaffected tissue around these zones. Thus it is less invasive with faster healing, lowered scarring and pigmentation risk in comparison to full surface ablation. However, more treatment sessions are required and it may be less effective at completely removing the tattoo.
Allergic reactions to tattoos can be very nasty and difficult to treat. Tattoo removal is essential to achieving a permanent remission of allergic symptoms to the tattoo. Many options exist however the best option depends on the individual case. Tattoo removal with q-switched lasers can trigger allergic reactions and it is important for your doctor to know how to deal with this and switch the approach if necessary.
As you've probably noticed, I have put a lot of thought into how best to remove tattoos with lasers. If you have any further questions, feel free to drop me a message or contact me through my office. I’ll try my best to help!
- De Cuyper C. Tattoo allergy. Can we identify the allergen? Presse Med. 2020 Dec;49(4):104047. doi: 10.1016/j.lpm.2020.104047. Epub 2020 Aug 5. PMID: 32768611.
- Ashinoff R, Levine VJ, Soter NA. Allergic reactions to tattoo pigment after laser treatment. Dermatol Surg. 1995 Apr;21(4):291-4. doi: 10.1111/j.1524-4725.1995.tb00175.x. PMID: 7728477.]
- Sepehri M, Jørgensen B. Surgical Treatment of Tattoo Complications. Curr Probl Dermatol. 2017;52:82-93. doi: 10.1159/000450808. Epub 2017 Mar 13. PMID: 28288468.
- van der Bent SAS, Huisman S, Rustemeyer T, Wolkerstorfer A. Ablative laser surgery for allergic tattoo reactions: a retrospective study. Lasers Med Sci. 2020 Oct 26. doi: 10.1007/s10103-020-03164-2. Epub ahead of print. PMID: 33104896.
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