Body modifications pose challenges for treating skin

New York - Dermatologists are best positioned to treat and educate patients whose tattoos, piercings and other body adornments are causing problems, an expert says.

“Most tattoos are there for exhibitionistic reasons - to send a message for the viewer. Often they tell you something about a person. As dermatologists, we can get clues about their health and psyche,” says Terrence A. Cronin Jr., M.D. He is a dermatologist in private practice in Melbourne, Fla., and assistant professor, department of dermatology and cutaneous surgery, University of Miami Miller School of Medicine.

The body of the 5,300-year-old “Iceman” found in the Italian Alps in 1991 bore several small tattoos over joints where he was found to have arthritis. “Archaeologists believe they were there for shamanistic or medicinal reasons.” Conversely, Dr. Cronin says, the Maori of New Zealand used facial tattoos to indicate their jobs within the community.

Tattoo’s beginnings

The word “tattoo” entered the English language in the mid-1700s, when Capt. James Cook used it to describe Tahitian natives’ practice of tapping ink into the skin with tiny bamboo needles. “Before that, ‘tattoo’ was always used to describe the beating of a drum,” Dr. Cronin says.

Today’s tattoo wearers probably don’t know that the concentric circle motif of so-called tribal tattoos was originally patterned after the whorled appearance of skin afflicted by tinea imbricata, Dr. Cronin adds. Other popular trends include the following:

• Tattoos with fluorescent inks that glow under special lighting;

• Overtattooing - placing a new tattoo over an old one that has faded or no longer holds meaning to the wearer;

• Innovative cosmetics designed to camouflage tattoos at work or in formal environments.

Nowadays, “Tattoos show everything, from the names of family members to gang affiliations.” Other tattoos may indicate solidarity with sociopolitical movements or causes, Dr. Cronin says. And when a dermatologist sees the image of a hypodermic needle tattooed on an IV drug abuser’s forearm, “That opens up a line of thought - has the person been exposed to hepatitis or HIV? As dermatologists, we like to be able to read the skin. Sometimes when you see a tattoo, it’s already spelled out for you.”

Increasingly, Dr. Cronin says, dermatologists must treat infections caused by tattoos and skin decorations. Additional side effects can include granulomas and allergic reactions to pigments and metals. In the former area, he says, the red pigment cinnabar frequently causes granulomas, although it’s mostly used in Asia.

Realistic expectations

In other cases, “Patients want tattoos removed and don’t understand the difficulties involved. They believe the tattoo will go away as if by magic” after one treatment, Dr. Cronin says. “Everyone who does tattoo removal would be wise to lower patients’ expectations - it may take multiple treatments. And those treatments are expensive,” he says.

Showing sequential before and after photos clarifies the challenges of tattoo removal, Dr. Cronin says.

“You can say, ‘Here’s the tattoo after one treatment, five treatments, and 10 treatments.’ When they hear 10 treatments, that’s scary to them because usually they’re paying out-of-pocket.” Regarding lasers, he says that alexandrite lasers are the best type to use for tattoo removal, although different colors respond to different wavelengths.

Also of concern is the practice of gauging, or stretching the earlobe or other appendage using progressively larger jewelry over time. Treating the aftereffects of this practice requires surgical repair, including tissue removal and multilayered closure, he says. Additionally, Dr. Cronin says, any skin piercing creates the possibility of traumatic removal, or having the jewelry accidentally ripped out the earlobe, nipple or other body location, a problem that also requires surgical repair.

“Tattoos and skin decorations teach us a lot about patients and society. And dermatologists are at the forefront of understanding the human condition,” he says. “Every day we see more tattoos. There’s a lot we can do to help tattooed patients with their skin - whether it’s removing the tattoos with lasers or treating the infections, keloids and hypertrophic scars they may cause.”

Disclosures: Dr. Cronin reports no relevant financial interests.