Anderson 1993  Title: Cosmetic tattoo ink darkening. A complication
of Q-switched and pulsed-laser treatment.
Author: Anderson RR, Geronemus R, Kilmer SL,
Farinelli W, Fitzpatrick RE
Journal: Arch Dermatol 1993 Aug;129(8):1010-4
PMID: 8352605, UI: 93356555
Affiliated institution: Department of Dermatology, Wellman Laboratories of Photomedicine, Massachusetts
General Hospital, Boston.
Cited in:
BACKGROUND: High-energy, short-pulse lasers, eg, Q-switched lasers,
emitting visible and near-infrared light have recently been developed
for removing tattoos, with little risk of scarring. The mechanisms
of action, and possible adverse effects other than scarring and
hypopigmentation, are not fully understood.
OBSERVATIONS: We describe five cases of pulsed-laser-induced,
immediate, irreversible darkening of cosmetic, white, flesh (skin-color),
and pink-red colored tattoos. Irreversible ink darkening can be
an insidious complication, because immediate whitening of the
skin temporarily obscures the subsequently impressive color change.
Among these cases, irreversible ink darkening occurred with Q-switched
ruby (694 nm), Q-switched neodymium (Nd):YAG (1064 nm/532 nm),
and pulsed green dye (510 nm) lasers. Attempts to remove the darkened
ink with further laser treatment failed in two cases, and surgical
excision was necessary. In the other three cases, subsequent laser
treatments successfully removed the darkened ink. The red cosmetic
tattoo ink used in one of the cases was placed in agar in vitro
and was converted to a black compound immediately on Q-switched
ruby laser exposure. Ferric oxide, a brown-red ingredient commonly
used in cosmetic tattoos, was similarly tested and blackened in
vitro by Q-switched ruby laser exposures.
CONCLUSIONS: Although most tattoos are not darkened by laser
treatment, short-pulsed lasers over a wide spectrum can cause
immediate darkening of some tattoo inks. Patients should be warned
of the potential for irreversible cosmetic tattoo darkening, and
test-site exposures should be performed prior to treatment. In
some cases, subsequent laser treatments may remove the blackened
ink. The mechanism probably involves, at least for some tattoos,
reduction of ferric oxide (Fe2O3, "rust") to ferrous
oxide (FeO, jet black), but the chemical reaction that is involved
remains unknown.
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