Tattoos – Dermal Inking

It is the penetration into the skin, specifically into the dermis, of permanent ink with the purpose of permanently changing its color.

The word tattoo comes from Polynesia (tatau), which means skillfully – correctly. Sailors, through their long voyages, introduced the word to Europe in the 18^th century. Officially, the word tattoo was recorded by explorer James Cook when returning from Haiti and New Zealand in 1769.

What happens – what is the process followed when a tattoo is done… First of all, the process begins with the injection of permanent pigment (ink) under the epidermis and specifically into the dermis (the layer beneath our skin). Immediately, the body recognizes a foreign substance, i.e., an intruder, and activates our immune system. Thus begins a local war, where the immune system’s soldiers, the phagocytes, attempt to trap the pigment particles. This is followed by local irritation, which results in the pigment being trapped within fibroblasts and concentrated in a layer at the boundary between the epidermis and dermis. Over the years, however, in some cases, the pigment moves deeper into the dermis, which can cause old tattoos to fade.

According to the American Academy of Dermatology, tattoos are classified into:

1.TRAUMATIC: the penetration of substances due to injury, e.g., in a car accident, where scraping of the skin allows cement to penetrate. Also, injuries caused by pencils or pens. Orwell famously described such damage in coal miners, where tattoos were caused by coal dust entering wounds in the workers’ skin.

2.PROFESSIONAL – AMATEUR: in various tribes and cultures, tattoos indicate a person’s position or hierarchy, or may have symbolic meaning (courage, sexuality, etc.). In modern societies, tattoos are mostly done for artistic – aesthetic – emotional or even religious reasons.

3.AESTHETIC, e.g., for enhancing eyebrows (alopecia), outlining lips or eyes. Women often use tattoos to cover scars, especially after breast reconstruction.

4.FUNCTIONAL and MEDICAL, e.g., for patients with Alzheimer’s, where name and identification details are tattooed. Skin-colored tattoos can be used to cover vitiligo.

RISKS

At least one in five people who get a tattoo regret it for some reason and wish to remove it. Tattoo removal, however, is a costly procedure, neither very easy nor simple, even with the most advanced Laser methods. Proper skin restoration is difficult because the tattoo is meant to remain permanently. In the last two decades, the number of people getting tattoos has increased significantly, and recently, there is a trend toward larger tattoos. Preferences and life circumstances constantly change. What we like at 15 or 25 may not appeal at 55.

People often come to our clinic for help in removing their tattoos. Common explanations include: “I was too young when I got it,” “We broke up, and I want to erase their name,” “I just don’t like it anymore,” or “I aged, my skin sagged, and it looks awful.”

HEALTH IMPACTS: Piercing the skin carries a risk of INFECTIONS. Therefore, tattoo studios must be legal and use sterilized equipment. If basic rules are not followed (non-sterile tools or contaminated inks), superficial infections, fungal infections, staphylococcal contamination, tetanus, HIV, or tuberculosis may occur. Due to this risk, blood banks in the USA prohibit people who had tattoos in the last 12 months from donating blood unless they provide certification that the procedure was done in a licensed studio. ALLERGIC REACTIONS: Pigments (nickel, metals) and especially certain colors like red, purple, pink, orange, may cause problems. Reactions start with itching, followed by swelling, clear fluid discharge, and bumps. A European committee researching tattoo inks found about 40% of pigments were unapproved, and 20% contained a carcinogenic aromatic amine. For all these reasons, some doctors recommend strict regulations on tattoo inks.

COMPLICATIONS IN MRI SCANS: Large tattoos containing black ink (which contains iron oxide) can heat up in the magnetic field, potentially causing burns.

Additionally, GRANULOMAS can form, i.e., hard, raised tissue nodules due to the skin’s reaction to the tattooing process.

Social interest: Tattoos are used in marketing and advertising. This practice, called “SKINVERTISING”, involves companies paying people to tattoo their logo on their bodies. Previously, Western society associated tattoos with marginal groups. Today, society recognizes them, especially in artistic and athletic contexts, as a form of art — essentially, a fashion trend.

TREATMENT

If someone decides to remove their tattoo, a careful evaluation is recommended, consulting their dermatologist for available options. The doctor, depending on the size of the tattoo, the colors, and its location, will recommend the most suitable removal method.

Laser is the treatment of choice for tattoo removal. Usually, pulsed lasers break down the pigments, which are then eliminated by the immune system.

Colored tattoos are more difficult to treat and require specialized lasers depending on the colors present. The likelihood of discoloration or other complications is reduced with modern lasers, but guarantees for aesthetic results cannot be given. Many factors affect the outcome, including depth, age, amount, and colors of the ink.

The number of sessions required depends on the type of tattoo. Amateur tattoos may need 5–10 or more sessions, while professional tattoos may require up to 25 sessions.

Surgical removal can be used for small tattoos. It involves a scalpel and suturing of the skin edges, usually leaving a small scar. People prone to hypertrophic or keloid scars should avoid this method.

Dermabrasion, a less frequently used and somewhat painful method, can remove small tattoos. It involves a device with multiple tiny blades that remove layers of tattooed skin.

In conclusion, everyone is free to choose, but for permanent decisions, it is important to think carefully multiple times and understand potential negative consequences, so that the final decision is informed and confident.

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