Cosmetic, Psychological Impact of Punch Biopsy in Patients With Tattooed Skin is Minimal

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Biopsies should not be avoided in areas of tattooed skin, as the cosmetic and psychological impact of punch biopsies in patients with tattooed skin are minimal, according to authors of a study recently published in the Journal of the European Academy of Dermatology and Venereology.¹ Furthermore, recovery of patients who underwent punch biopsies in tattooed regions was relatively quick with minimal symptoms.

In industrialized regions of the world, including the United States and Europe, approximately 10% to 20% of the population has at least 1 tattoo.² Because an ideal punch biopsy should contain the epidermis, dermis and subcutaneous tissue, physicians may be wary of performing skin biopsies in patients with tattoos due to anticipated cosmetic outcomes, given the often cosmetic reason behind receiving a tattoo, according to study authors Poelhekken et al.

At the time of the study's publication, its authors noted that no known studies have been published to date exploring the expected outcomes versus consequences of punch biopsies in tattooed skin. Researchers aimed to assess the appearance, symptoms, and psychosocial burden of punch biopsies in tattooed skin, as well as the potential complications and patient-reported cosmetic outcomes and satisfaction of the procedure.

Researchers conducted the cross-sectional, retrospective, survey-based study with individuals above the age of 18 who had underwent a punch biopsy at the Tattoo Clinic of The Netherlands between 2021 and 2023. All patients had underwent a 3mm punch biopsy with an absence of sutures.

The study gathered baseline characteristics such as age, tattoo details, and biopsy-related data from patient charts. Tattoo complications were assessed using a defined classification system. Patients completed the SCAR-Q questionnaire, measuring scar appearance, symptoms, and psychosocial impact. Additional questions assessed recovery, complications, and overall satisfaction.

The study included 50 patients with a response rate of 75%. Most participants were female (70%) with an average age of 40 years. The majority of individuals had black tattoos (74%) on areas such as the trunk, upper, and lower extremities. The median age of tattoos was 37 months, and the median time between biopsy and survey completion was 14 months.

On the SCAR-Q questionnaire, median scores for appearance, symptoms, and psychosocial impact were high. Appearance scores were significantly higher when scars were no longer visible and with longer time since biopsy, especially after 8 months.

Additionally, most patients reported no post-biopsy complaints, with some experiencing symptoms such as itch, pain, redness, swelling, or bleeding, which typically resolved within 10 days.

The final cosmetic result of the biopsy scar was achieved within 30 days for 88% of patients. Patients above 40 years of age and those with biopsies on lower extremities or trunk more commonly reported still having visible biopsy scars. Overall, 60% of patients reported feeling very satisfied with the biopsy experience.

The most common diagnosis post-biopsy was chronic inflammatory black tattoo reaction (44%), followed by allergic tattoo reaction (26%). Fewer diagnoses included hypertrophic scarring (8%) and psoriasis (4%).

All patients received a specific diagnosis after biopsy, with 8% experiencing a flare-up of the diagnosed skin condition afterward. One patient opted for a cover-up tattoo over the biopsy scar.

"Physicians and patients must be aware of potential complications following a punch biopsy in tattooed skin, including cosmetic consequences and factors that may affect skin recovery," wrote Poelhekken et al. "This study demonstrates that the cosmetic and psychological impact of punch biopsies in tattooed skin is minimal, with fast recovery and minimal symptoms. Almost half of the patients recovered without a visible postbiopsy scar, with outcomes less favourable for patients over 40 years old or when the biopsy was conducted on the lower extremity or trunk. In conclusion, biopsies of tattooed skin should not be avoided in the diagnostic process."

References

1. Poelhekken M, Schornagel IJ, van der Bent SAS. Punch biopsies in tattooed skin: Complications and patient-reported outcomes. J Eur Acad Dermatol Venereol. April 23, 2024. Accessed April 26, 2024. https://doi.org/10.1002/jvc2.431
2. Kluger N. Epidemiology of tattoos in industrialized countries. Curr Probl Dermatol. 2015; 48: 6–20. Accessed April 26, 2024.