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How to Diagnose and Classify Tattoo Complications in the Clinic: A System of Distinctive Patterns

Research output: Chapter in Book/Report/Conference proceedingBook chapterCommunication


  1. Identification of pigments related to allergic tattoo reactions in 104 human skin biopsies

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  3. Tattoos and skin barrier function: Measurements of TEWL, stratum corneum conductance and capacitance, pH, and filaggrin

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Tattoo complications represent a broad spectrum of clinical entities and disease mechanisms. Infections are known, but chronic inflammatory reactions have hitherto been inconsistently reported and given many interpretations and terms. A clinical classification system of distinct patterns with emphasis on inflammatory tattoo reactions is introduced. Allergic reactions prevalent in red tattoos and often associated with azo pigments are manifested as the 'plaque elevation', 'excessive hyperkeratosis', and 'ulceronecrotic' patterns. The allergen is a hapten. Nonallergic reactions prevalent in black tattoos and associated with carbon black are manifested as the 'papulonodular' pattern. Carbon black nanoparticles agglomerate in the dermis over time forming foreign bodies that elicit reactions. Many black tattoos even develop sarcoid granuloma, and the 'papulonodular' pattern is strongly associated with sarcoidosis affecting other organs. Tattoo complications include a large group of less frequent but nevertheless specific entities, i.e. irritant and toxic local events, photosensitivity, urticaria, eczematous rash due to soluble allergen, neurosensitivity and pain syndrome, lymphopathies, pigment diffusion or fan, scars, and other sequels of tattooing or tattoo removal. Keratoacanthoma occurs in tattoos. Carcinoma and melanoma are rare and occur by coincidence only. Different tattoo complications require different therapeutic approaches, and precise diagnosis is thus important as a key to therapy. The proposed new classification with characteristic patterns relies on simple tools, namely patient history, objective findings, and supplementary punch biopsy. By virtue of simplicity and broad access, these methods make the proposed classification widely applicable in clinics and hospitals. The system is reported to the 11th revision of the WHO diagnosis classification used as international standard.

Original languageEnglish
Title of host publicationDiagnosis and Therapy of Tattoo Complications : With Atlas of Illustrative Cases
EditorsJ Serup, W Bäumler
Number of pages16
PublisherS. Karger AG
Publication date2017
Publication statusPublished - 2017
SeriesCurrent Problems in Dermatology

    Research areas

  • Biopsy, Needle, Denmark, Dermatitis, Allergic Contact, Foreign-Body Reaction, Humans, Ink, Needles, Skin, Skin Diseases, Skin Diseases, Bacterial, Skin Neoplasms, Tattooing, Urticaria, Journal Article

ID: 52642901