Christa De Cuyper - Dermatologic Complications with Body Art: Tattoos, Piercings and Permanent Make-Up

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Body modification is a common human characteristic that has been practiced on all continents and in all races since ancient times. Specific types of body art have been associated with specific social, ethnic and religious societies. Permanent modifications such as piercing and tattooing are common forms of body adornment. In the last decades they have been promoted as a fashion statement by celebrities and nowadays they are accepted in all social classes. Cosmetic tattoos or permanent Make-Up (PMU) have been introduced as an alternative for conventional Make-Up. Tattoos are also used in medical procedures, e.g. for field demarcation in radiation oncology and endoscopic surgery. Tattooing, also known as dermatography, has found its place to camouflage pathological skin conditions such as vitiligo and alopecia or to mask scars and birth marks and it can offer the finishing touch in reconstructive surgery. Its use can also be extended to therapeutic indications and for the implantation of pharmacological substances. Tattooing is only one aspect of body art. The imagination in body adornment and body transforming techniques is amazing and endless. Piercing is often combined with stretching, tunnelling and embedding of jewels. Invasive body-modifying techniques such as implanting, scarification, branding, scalping and even amputation seem to attract the young population; unfortunately these procedures often result in impressive, irreversible body mutilation. All body-modifying methods can lead to complications, which depend on the hygienic conditions in which the procedures are performed, on the training and the skills of the practitioner and on the materials. Allergic reactions can be attributed to the substances used. Poor hygienic standards and careless procedures can result in localised infections but can also lead to severe life-threatening conditions or even result in irreversible damage. Blood-borne diseases can be transmitted (hepatitis B, C, HIV); granuloma and keloid formation can occur. Health care professionals should be aware of the complications that can arise from these procedures.

The body art industry is one of the fastest growing industries in the last years unaffected by the economic crisis. Considering the high number of people that have chosen for a tattoo, a piercing or any other form of body modification, one can estimate that millions of people on the globe live with a self-inflicted health risk with consequences for the health care system in general. Many efforts have been made yet to identify risk factors and to develop preventive measures aimed at protecting public health. Regulation of the composition of the products, harmonisation of the methods for the analytical determination of possible harmful substances, guidelines and recommendations to ensure that procedures are carried out under appropriate hygienic conditions can offer a big step forward to promoting consumers health. However there is still a lack of uniform universal regulations and control. Recently, new initiatives have been taken by the Council of Europe and by the European Commission to improve the safety of the procedures and the materials, more in particular to limit the risk of side effects caused by poor hygiene and unsafe substances.

The purpose of this book is to illustrate the different aspects of body art starting from the history through epidemiology, to improve the knowledge about materials, with their toxic and allergenic potential, to describe the procedures and the complications that can arise. Cosmetic and medical indications and therapeutic modalities of tattooing will be addressed. A separate chapter is dedicated to tattoo removal with a focus on laser techniques.

To realise this book we had the assistance and contributions of many people whom we would like to thank, in particular the members of the European Society on Tattoo and Pigment Research (ESTP) for their advice, our colleagues, our secretaries and our families for their help and support.

Yves Bogaerts

Videos and figures

Blankenberge, Belgium

Sandy Verfaille

Inksane, Roeselare, Belgium

Kim Maertens

Inksane, Roeselare, Belgium

Elayne Angel

The Piercing Bible, Merida, Mexico

Darline Vierstraete

The Color Studio, Waregem, Belgium

Jolle Senden

Aalst, Belgium

Bieke Heykants M.D.

Da Vinci Clinic, Beerse, Belgium

Els Wittouck M.D.

Dermatology AZ Sint-Jan Brugge-Oostende AV Belgium

Jens Bergstrm

Tattoo and Piercing Education Scandinavia, Akersberga, Sweden

Liz Kierstein

Tattoo Liz, Copenhagen, Denmark

Urs Hauri

Association of the Cantonal Chemists of Switzerland, Basel, Switzerland