TATTOO AND ITS PRACTICE

NIGERIAN ASSOCIATION OF DERMATOLOGISTS' (NAD) HEALTH EDUCATION PUBLICATION


TATTOO AND ITS PRACTICE BY DR SEBASTINE OIWOH

Tattoo, derived from the Tahitian word tatau, are temporary or permanent markings on the skin for the purpose of beautification, socio-cultural, religious, record keeping, for delineation and identification of a particular set of people. Tattoo has over time transcended the socioeconomic, age, gender as well as ethnic divides. It is a practice that has held sway for awhile, as tattoos have been found in Egyptian mummies as far as the eighteenth century.  In recent times in Nigeria studies have shown tattoo as gradually gaining ground with some component parts having been shown to contain allergeneic metals such as nickel, chromium and cobalt at concentration above suggested limit of 1microgram per gram for greater skin protection. Sites for tattoo includes arm, face, back, chest, abdomen, shoulders, sclera amongst others. 
 

The reasons for tattoo vary in different parts of the world’s population. It is used to accentuate beauty being a temporary (black henna) or permanent adornment; to make a statement. It has also been used to accentuate aggression or ugliness in order to make the wearer more intimidating. Tattoos have also been used for record keeping (time of birth, family name etc). Culturally it has been used as rites of passage, fertility and marriage rites. It is nowadays seen by many as an acceptable fashion accessory. Tattoos may also be a manifestation of deliberate self-harm. Tattoos can result from abrasion injuries, from close exposure to black gunpowder, as used in replica firearms. Tattooing can occur from contact with jewellery (e.g. earrings)

The professional and licensed tattooist uses an electric needle to introduce particles of pigment into the dermis through a group of oscillating needles injecting ink into the skin 80 to 150 times a second. It can also be by pricking particles of soot, Indian ink and ash into skin with any pointed object or through a cut on skin. The pigments commonly employed include blue-black (carbon), red (cinnabar and vegetable dyes), light blue (cobaltous aluminate), green (chromic oxide or chromium sesquioxide), yellow (cadmium sulphide), brown (ochre, iron oxides. Ideally a properly equipped tattoo studio will have a sharps container for used needles, biohazard containers and an autoclave for sterilizing equipment but this is hardly available in other settings. 

The potential infection risk has led to the prohibition of blood donation for 12 months after receiving a tattoo in the US (unless the procedure was done in a state-regulated and licensed studio) and for 6 months in the UK. Temporary black henna ‘tattoos’ can contain a high concentration of the well-known contact sensitizer paraphenylenediamine.

Complications of tattoos vary from immediately after the procedure to long term complications. Immediately after tattooing there is a local traumatic response with pain, some swellings with possible formation of a scab (dried blood on the skin). Infections could be found after the procedure like pyogenic infection skin infection, Hepatitis, HIV, molluscum contagiosum, syphilis and viral warts among others. 

Non-infectious skin diseases like lichen planus, psoriasis, Darier’s disease and discoid lupus erythematosus, sarcoidosis have also been noted. The skin can also react to the component of ink especially red pigment cinnabar (mercuric sulphide), cobalt, chrome, manganese and aluminium (purple).  

Temporary tattoos with henna have also been shown to cause reactions to paraphenylenediamine which is found in some cases.
Malignancies has been recorded following tattoo ie B-cell lymphoma evolving from a tattoo-induced pseudolymphoma and also malignant melanoma. Photoreaction to pigment containing cadmium yellow is also possible. 

Treatment varies from dermabrasion, skin grafting, intraleisional steroid, salabrasion, chemosurgery, keratotome amongst others after a review by a dermatologist with necessary modalties employed depending on the extent of the review.

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