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Current Problems in Dermatology Editors: P. Itin, G.B.E. Jemec Vol. 48 Tattooed Skin and Health Editors J. Serup N. Kluger W. Bäumler Tattooed Skin and Health Current Problems in Dermatology Vol. 48 Series Editors Peter Itin Basel Gregor B.E. Jemec Roskilde Tattooed Skin and Health Volume Editors Jørgen Serup Copenhagen Nicolas Kluger Helsinki Wolfgang Bäumler Regensburg 110 figures, 85 in color, and 25 tables, 2015 Basel · Freiburg · Paris · London · New York · Chennai · New Delhi · Bangkok · Beijing · Shanghai · Tokyo · Kuala Lumpur · Singapore · Sydney Current Problems in Dermatology Prof. Jørgen Serup Dr. Nicolas Kluger Bispebjerg University Hospital Department of Skin and Allergic Diseases Department of Dermatology D Helsinki University Central Hospital Copenhagen (Denmark) Helsinki (Finland) Prof. Wolfgang Bäumler Department of Dermatology University of Regensburg Regensburg (Germany) Library of Congress Cataloging-in-Publication Data Tattooed skin and health / volume editors, Jørgen Serup, Nicolas Kluger, Wolfgang Bäumler. p. ; cm. -- (Current problems in dermatology, ISSN 1421-5721 ; vol. 48) Includes bibliographical references and indexes. ISBN 978-3-318-02776-1 (hard cover : alk. paper) -- ISBN 978-3-318-02777-8 (electronic version) I. Serup, Jørgen, editor. II. Kluger, Nicolas, editor. III. Bäumler, Wolfgang, 1959- , editor. IV. Series: Current problems in dermatology ; v. 48. 1421-5721 [DNLM: 1. Tattooing--adverse effects. 2. Coloring Agents. 3. Epidermis--pathology. 4. Tattooing--legislation & jurisprudence. 5. Tattooing--methods. W1 CU804L v.48 2015 / WR 140] GT2345 391.6’5--dc23 2015000919 Bibliographic Indices. This publication is listed in bibliographic services, including MEDLINE/Pubmed. Disclaimer. The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publisher and the editor(s). The appearance of advertisements in the book is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements. Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. © Copyright 2015 by S. Karger AG, P.O. Box, CH-4009 Basel (Switzerland) and DOT/UETA (chapter by Schmidt) www.karger.com Printed in Germany on acid-free and non-aging paper (ISO 9706) by Kraft Druck, Ettlingen ISSN 1421–5721 e-ISSN 1662–2944 ISBN 978–3–318–02776–1 e-ISBN 978–3–318–02777–8 Contents IX Preface Serup, J. (Copenhagen); Kluger, N. (Helsinki); Bäumler, W. (Regensburg) The Tattooed and the Social Environment 1 The Cultural Heritage of Tattooing: A Brief History Krutak, L. (Washington, D.C.) 6 Epidemiology of Tattoos in Industrialized Countries Kluger, N. (Helsinki) The Practise of Tattooing 21 Tattoo Machines, Needles and Utilities Rosenkilde, F. (Copenhagen) 31 The Technique and Craftsmanship of Tattooing in the Professional Tattoo Parlour Kristensen, L. (Sorø) 37 Tattoo as Art, the Drivers Behind the Fascination and the Decision to Become Tattooed Kierstein, L. (Copenhagen); Kjelskau, K.C. (Oslo) 41 Personal Records from My Tattoo Parlour: Deep Emotions Drawn as Life-Long Pictures on the Skin’s Canvas Kierstein, L. (Copenhagen) 45 Tattooist-Customer Relationships in a Diversified Environment of Professional Tattooists and ‘Scratchers’ Wedel Kristensen, M. (Copenhagen) Tattoos and Adverse Events 48 Tattoo Complaints and Complications: Diagnosis and Clinical Spectrum Serup, J.; Hutton Carlsen, K.; Sepehri, M. (Copenhagen) 61 Complications of Cosmetic Tattoos De Cuyper, C. (Brugge) 71 Chronic Tattoo Reactions Cause Reduced Quality of Life Equaling Cumbersome Skin Diseases Hutton Carlsen, K.; Serup, J. (Copenhagen) V 76 Contraindications for Tattooing Kluger, N. (Helsinki) 88 Laser Tattoo Removal, Precautions, and Unwanted Effects Eklund, Y.; Troilius Rubin, A. (Malmö) 97 Nano-Scale Observations of Tattoo Pigments in Skin by Atomic Force Microscopy Grant, C.A.; Twigg, P.C.; Tobin, D.J. (Bradford) Manufacturing, Materials and Properties of Marketed Tattoo Ink Stock Products 103 Manufacturing of Tattoo Ink Products Today and in Future: Europe Michel, R. (Neuburg am Rhein) 112 The Realistic Variables Underlying True Safety in Tattoo Pigment Manufacturing Barth, M. (Hackensack, N.J.) 118 Making Innovative Tattoo Ink Products with Improved Safety: Possible and Impossible Ingredients in Practical Usage Dirks, M. (Esslingen) 128 Tailored Surface Engineering of Pigments by Layer-by-Layer Coating Dähne, L.; Schneider, J.; Lewe, D.; Petersen, H. (Berlin) Ingredients, Chemical Analysis and Safety of Marketed Tattoo Ink Stock Products 136 Chemical Purity and Toxicology of Pigments Used in Tattoo Inks Petersen, H.; Lewe, D. (Berlin) 142 Survey on European Studies of the Chemical Characterisation of Tattoo Ink Products and the Measurement of Potentially Harmful Ingredients Agnello, M.; Fontana, M. (Grugliasco) 152 Tattoo Inks: Legislation, Pigments, Metals and Chemical Analysis Prior, G. (Bielefeld) 158 The Challenges and Limitations of Chemical Analysis of Particulate Pigments of Very Low Solubility Olsen, O. (Vedbaek) 164 Photostability and Breakdown Products of Pigments Currently Used in Tattoo Inks Hauri, U.; Hohl, C. (Basel) 170 Carbon Black Nanoparticles and Other Problematic Constituents of Black Ink and Their Potential to Harm Tattooed Humans Jacobsen, N.R.; Clausen, P.A. (Copenhagen) 176 Absorption, Distribution, Metabolism and Excretion of Tattoo Colorants and Ingredients in Mouse and Man: The Known and the Unknown Bäumler, W. (Regensburg) 185 Towards the Limiting of Health Risks Associated with Tattooing: Whitelists for Tattoo Pigments and Preservatives Blume, A.; Platzek, T.; Vieth, B.; Hutzler, C.; Luch, A. (Berlin) 190 Survey of Studies on Microbial Contamination of Marketed Tattoo Inks Bonadonna, L. (Rome) VI Contents Regulation of and Intervention in the Tattoo Business 196 The European Landscape of National Regulations of Tattoo Inks and Businesses Laux, P.; Luch, A. (Berlin) 201 Implementation of European Council Resolution ResAP(2008)1 in Italy. National and Regional Regulation of Tattoo Practices: Diversity and Challenges Renzoni, A.; Pirrera, A.; Novello, F.; Diamante, M.S.; Guarino, C. (Rome) 206 EU Actions to Ensure the Safety of Tattoos and the Protection of Consumers Blass Rico, A.M. (Brussels) 210 Surveillance of Tattoo-Related Adverse Events by the EU RAPEX System and by National Monitoring Verdier, C. (Marines) 218 The Amsterdam Model for Control of Tattoo Parlours and Businesses Veenstra, T. (Amsterdam) 223 Hygiene Standards for Tattooists Schmidt, A. (Willich-Neersen) 228 Hygiene Standards in the Tattoo Parlour and Practices for Prevention of Infection Bergström, J. (Åkersberga); Bodlund, M. (Helsingborg) 236 Seamless Prevention of Adverse Events from Tattooing: Integrated Strategy Emphasising the Customer-Tattooist Interaction Serup, J. (Copenhagen) 248 Regulation of Tattoo Ink Production and the Tattoo Business in the US Haugh, I.M.; Laumann, S.L.; Laumann, A.E. (Chicago, Ill.) 253 Author Index 254 Subject Index Contents VII Preface With some 100 million Europeans being tattooed, one highly pure drug chemical, which passes as- i.e. 10–20% of the adult population, it is timely to tronomical regulatory requirements before being highlight tattooed skin and health. launched, the lack of regulation of tattooing is not Tattoos have been part of human history for logical. thousands of years and have flourished due to The adverse events that we see in the clinic and people’s emotions, aspirations and wishes to per- know about have cast a shadow on tattooing and manently express themselves as individuals. To- include allergic reactions from red tattoos, papu- day, as in the past, people hold the ownership of lo-nodular reactions from black tattoos, scars and tattoos. Tattoos have a sunny side and a rebellious technical complications, psycho-social complica- drive as well as a shadow. In modern society, tat- tions, and bacterial and viral infections, particu- toos are mainly decorative, used by both genders larly those that may be life-threatening, such as and span a broad range of social segments, age acute blood infection and death, followed by groups and ethnicities. The tattoo culture is glob- slow-progressing viral infections and possible or- al and serviced by a huge industry that operates gan failure with a fatal outcome. The growing across national borders and continents. concern about multi-resistant bacteria, especially Unlike in the
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