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Studies find climate therapy (CT) at the Dead Sea of psoriasis efficient for induction therapy, but few studies address disease relapse, long‐term maintenance using CT, confounders, and the patient perspective. CT combines sunlight, balneotherapy, stress reduction, and education. This study aimed to examine Dead Sea CT and relapse of psoriasis over a 2 years period, patients' satisfaction, and treatment outcome and preference relative to other therapies. A structured questionnaire was offered to patients, who during the recent 2 years had undergone a 4 week course of CT at the Dead Sea. Patients included applied for a new CT session due to relapse of their psoriasis. Questionnaire items covered their recall of relapse, disease severity, potential triggers of relapse and patient's preference relative to other treatment options. The study enrolled 40 patients, with an average age of 55.5 years. CT was highly effective and resulted in marked reduction in the affected skin area, from 16% to less than 1% of the body surface. The median time from CT to first visible new lesion was 4.8 months, to first bothersome relapse 6.1 months and to full blown relapse 8.0 months. Patient satisfaction with conventional therapeutic modalities, especially oral methotrexate, was reserved, and CT was generally preferred. Relapse after CT was an inclusion criterion, and patients with long‐lasting healing were not assessed. CT for 4 week treatment course of moderate to severe psoriasis at the Dead Sea which was studied in patients with relapsing disease was highly efficient for induction for clearing of the skin, matching new biologicals. In the studied group, return to prestate level took median 8 months on average. Patients' satisfaction with CT scored high, and maintenance through repeated Dead Sea treatments often is best treatment of this segment having intolerance or poor effect of other treatments, or fear of medicines as a personal attitude. [ABSTRACT FROM AUTHOR]

Tattooing has been part of the human culture for thousands of years, yet only in the past decades has it entered the mainstream of the society. With the rise in popularity, tattoos also gained attention among researchers, with the aim to better understand the health risks posed by their application. 'A medical‐toxicological view of tattooing'—a work published in The Lancet almost a decade ago, resulted from the international collaboration of various experts in the field. Since then, much understanding has been achieved regarding adverse effects, treatment of complications, as well as their regulation for improving public health. Yet major knowledge gaps remain. This review article results from the Second International Conference on Tattoo Safety hosted by the German Federal Institute for Risk Assessment (BfR) and provides a glimpse from the medical‐toxicological perspective, regulatory strategies and advances in the analysis of tattoo inks. [ABSTRACT FROM AUTHOR]

Background: In Europe, Australia, and the USA, the estimated overall prevalence of tattooing is around 10–20%. Tattoo ink often comprises harmful chemicals and epidemiological studies on adverse effects of tattoos are lacking. Objectives: We aimed to estimate the prevalence of tattoo-associated skin reactions in the general Danish population and describe individuals with tattoo-associated skin reactions by socio-demographic factors and tattoo characteristics. Methods: The study was based on respondents aged 16 years or older from a population-based 2021 survey entitled "How are you?" conducted in the Central Denmark Region (n = 33,925). Logistic regression was used to characterise individuals with tattoo-associated skin reactions by socio-demographic factors (gender, age, educational level, and ethnic background). Also, the relationship between size, age and colour of the tattoo, and tattoo-associated skin reactions was studied. Model 1 was adjusted for all socio-demographic variables (gender, age, educational level, and ethnic background); model 2, for all socio-demographic variables and tattoo characteristics (size, age, and colour). Results: In total, 21.1% reported that they had at least one tattoo, 10.2% hereof reported that they had experienced tattoo-associated skin reactions (itching, pain, inflammation, and swelling) beyond the first 3 weeks after the tattoo was made. Lower age (16–44 years) (adjusted odds ratio (AOR) ≥1.75), larger tattoos (AOR ≥1.61) and having had tattoos for more than 10 years (AOR = 2.92, 95% confidence interval 1.45–5.88) increased the odds of tattoo-associated skin reactions. In general, tattooed individuals with colours other than black had higher odds of tattoo-associated skin reactions. Conclusion: Among participants with at least one tattoo, 10.2% had experienced tattoo-associated skin reactions beyond the first 3 weeks after their tattoo was made. This finding highlights the need for safer tattoo inks to prevent the adverse health problems experienced by many individuals with tattoos. [ABSTRACT FROM AUTHOR]

Background: Persons with cosmetic tattoos occasionally experience severe pain and burning sensation on magnetic resonance imaging (MRI). Objective: To explore the culprit magnetic substances in commonly used permanent makeup inks. Material and methods: 20 inks used for cosmetic tattooing of eyebrows, eyeliners, and lips were selected. Ink bottles were tested for magnetic behavior with a neodymium magnet. Eight iron oxide inks qualified for the final study. Metals were analyzed by Inductively Coupled Plasma Mass Spectrometry (ICP‐MS). The magnetic fraction of inks was isolated and analyzed by X‐ray fluorescence (XRF). Magnetic iron compounds were characterized by Mössbauer spectroscopy and powder X‐ray diffraction (XRD). Results: ICP‐MS showed iron in all magnetic samples, and some nickel and chromium. Mössbauer spectroscopy and XRD detected ferromagnetic minerals, particularly magnetite, followed by goethite and hematite. Conclusion: This original study of cosmetic ink stock products made with iron oxide pigments reports magnetic impurities in inks for cosmetic tattooing, e.g., magnetite, goethite, and hematite. These may be the main cause of MRI burn sensation in cosmetic tattoos. The mechanism behind sensations is hypothesized to be induction of electrical stimuli of axons from periaxonal pigment/impurity activated by magnetic force. Magnetite is considered the lead culprit. [ABSTRACT FROM AUTHOR]

I will see as many tattoo complications in my clinic as I used to see, infections, allergy in red, granuloma and sarcoidosis in black tattoos, etc. The EU should develop a positive list on acceptable ingredients and pigments in tattoo inks inspired by the positive list for cosmetic products. Keywords: REACH; ResAp(2008)1; Tattoo complication; Risk; Hazard; Carcinogenicity; Mutagenicity; Allergy; Granuloma; Sarcoidosis; Pigment; Pigment blue 15; Pigment green 7; Tattooist; Manufacturer; Supplier EN REACH ResAp(2008)1 Tattoo complication Risk Hazard Carcinogenicity Mutagenicity Allergy Granuloma Sarcoidosis Pigment Pigment blue 15 Pigment green 7 Tattooist Manufacturer Supplier 1 4 4 01/31/23 20230101 NES 230101 Facing high popularity of tattoos in modern time around the world, it is no longer acceptable that tattoo inks remain so little and so variably regulated. It was the political and bureaucratic levels of the EU that failed the good mission and made the regulation of inks in Europe go wrong. [Extracted from the article]

Background: Positive influence of the sun on psoriasis is a common assumption in dermatology. Other season‐related factors such as mental health may interfere. However, the role of seasonal effects on psoriasis needs to be clarified. This review aims to systematically analyze the literature on seasonal variation on psoriasis with emphasis on Northern and Central Europe representing temperate climate conditions. Materials and methods: Enrolled literature was identified through PubMed, EMBASE, and BIOSIS. An additional manual search of old reports before the introduction of efficient modern therapies, which can interfere with the spontaneous disease, was performed. Results: Thirteen studies were enrolled. About 50% of psoriasis patients were stable and showed no seasonal difference between seasons. Approximately 30% improved in summer, and 20% performed better in winter, some with marked summer worsening. European results matched international reports from different continents and hemispheres with climate extremes. The psychological effects could not be ruled out. Conclusion: About 50% of psoriasis patients experience a season‐independent disease, however, with a subset of patients who do better in summer. Others again do better in winter, with a few of these having marked worsening in warm periods. Individual season‐related activity records should be paid proper attention to when considering light therapy or climatotherapy as a treatment. [ABSTRACT FROM AUTHOR]

We describe a married couple who both presented with hypertension and hypokalaemia. Both patients were diagnosed with pseudohyperaldosteronism triggered by the widely used antifungal drug itraconazole. This effect appears to be dose-dependent, where a daily intake of 100 mg itraconazole is enough to induce pseudohyperaldosteronism. Clinicians should be aware of pseudohyperaldosteronism as a possible adverse effect of itraconazole, and we recommend monitoring potassium levels and blood pressure in all patients receiving this drug over a longer period of time. Voriconazole is probably an alternative antifungal treatment to itraconazole but also with this drug potassium levels should be monitored. [ABSTRACT FROM AUTHOR]

Therapies of common warts are cumbersome and not very effective. Recurrences are common. A new 20 MHz high-intensity focused ultrasound (HIFU) method is introduced as a new potential treatment modality. With HIFU, selected targets in the epidermis and dermis can be treated with full control of the depth and position of the ultrasound lesion and the energy applied to the target. The treatment can be monitored directly in real-time via an integrated dermoscope in the ultrasound probe. Two warts were treated with 8–10 shoulder-by-shoulder treatment doses, focal depth 1.3 mm, and 1.2 J/dose. Pretreatment ultrasound B-mode scanning had shown the thickness and depth of the warts. The treated areas developed a dry wound covered by a crust over the next 1–2 days. After 2 weeks the skin was healed, with no wart and no scar. Observation showed no reoccurrence. HIFU has future potential for treatment of common warts and flat warts, and a broad range of skin lesions being logic further candidates for targeted ablative treatment. One single treatment may suffice. It is, therefore, a new modality in dermatology with a large range of indications. [ABSTRACT FROM AUTHOR]

Background: Scleroderma en coup de sabre (ECDS) and Parry-Romberg idiopathic hemifacial atrophy (IHA) may affect the eyes, oral cavity, teeth and possibly the brain. Objective: Systematic follow-up study of ECDS/IHA-associated manifestations including ophthalmic and dental status. Methods: Medical records of ECDS and IHA patients diagnosed in a 40-year period (1975–2015) were reviewed, and patients were re-examined. Results: Thirty-five patients were included. Twenty-two patients (63%) had ECDS and 4 patients (11%) IHA. In 9 cases (26%), ECDS and IHA were found in the same patient. The ipsilateral eye was affected in 9 patients (26%). Ipsilateral abnormalities of the teeth and the tongue were found in 13 (46%) out of 28 examined. Eleven (31%) had extrafacial scleroderma on the trunk or the extremities. Neurological findings were not verified as ECDS/IHA related. Conclusion: ECDS and IHA are related and often overlap with concomitant affections of the connective tissues of the face on the ipsilateral side. Ocular and dental abnormalities are common and follow the distribution of the primary affection, for example, a paramedian line in the front and segmental affection of the maxilla and the mandible. The affections point to predisposing dysmorphogenetic events in embryonal life affecting the face, with abnormality of crest cells at the stage when they migrate from behind over the scalp or laterally to the face to mix up with mesenchymal tissues of the frontonasal, maxillary and mandibular processes. The study emphasizes that routine evaluation of ECDS and IHA should include ophthalmological and dental specialist examinations. [ABSTRACT FROM AUTHOR]

Tattooed patients undergoing magnetic resonance imaging (MRI) can develop cutaneous complications during the procedure. Our aim was to review all published case reports on MRI-induced tattoo complications to identify a possible pattern. So far, 17 cases have been reported. Five (29%) of the cases were in cosmetic tattoos. Symptoms are abrupt and painful with fast onset during MRI, sometimes requiring termination of the procedure. Clinical signs are absent or manifested as inflammation sensed as burning. No thermal skin burns have been recognized. Full recovery is fast, with no sequelae. MRI-induced tattoo complications are uncommon. Patients with cosmetic and traditional tattoos can undergo routine MRI. [ABSTRACT FROM AUTHOR]

Background: High‐intensity focused ultrasound (HIFU) operating at 20 MHz is new and potentially applicable to ablative tattoo removal. The method was documented safe and rational in preclinical testing. Materials and Methods: High‐intensity focused ultrasound was introduced to subjects when lasers and dermatome shaving had failed or caused side effects. Transducers with focal depths between 1.1 mm and 1.7 mm in the skin were used, and settings of 0.4‐1.2 J/shot at pulse durations of 150 ms were applied. Tattoos were covered with synergistic "shoulder‐by‐shoulder" focused ultrasound shots. Effectiveness and side effects were measured. Results: Twenty‐two subjects with 67 tattoos were treated. 62% benefitted (19% cleared, 43% partially cleared), and 28% had minor effect. VAS pain was 5‐6 versus 7‐9 with previous lasers removal. Wound healing was longer after HIFU ablation (1‐3 months). 57% of subjects had no scar or minor visible changes of skin surface markings only, while 19% had moderate or major skin thickening. Hypertrophic scar or keloid scars were not observed. Discussion/Conclusion: High‐intensity focused ultrasound was effective in removal of difficult tattoos of any color where Nd:YAG lasers had failed. The method only needs 1‐3 sessions. As an ablative method, the wound healing period is longer than with laser removal and needs attention. Focused ultrasound can be used as a first‐line treatment of smaller tattoos independent of color, and second line when Nd:YAG lasers have failed or caused problems. The operator shall be qualified, as with lasers. [ABSTRACT FROM AUTHOR]

Background: Twenty megahertz ultrasound is the preferred method for in vivo measurement of skin thickness. This study on methodology aimed to compare operator‐managed or "manual" measurement of skin thickness (MM) with measurement by automatic border detection (ABD). Methods: The skin thickness of the flexor mid‐forearm was measured in 48 subjects (subgroups 32 and 16) with the DermaScan C® (Cortex Technology). MM and ABD were performed on the same scans by two experienced operators. MM is measured on the peak of interface A‐mode echoes representing the epidermal surface and the dermis‐subcutis interface, while ABD measures on the slope of the echoes, for example, the acoustic contour. Result: Automatic border detection measured the skin about 20% thicker (mean: 0.94/0.89 mm, SD: 0.09/0.11) in comparison with MM (mean: 1.25/1.22 mm, SD: 0.09/0.12), P <.001. The two methods correlated, r =.9443 and.8663. Two individual researchers reached very close results using MM, that is, mean 0.91 and 0.93 mm, and the interobserver variation was nonsignificant. Conclusion: MM and ABD for ultrasound skin thickness measurement rely on different principles and consequently measure skin thickness differently, with ABD overestimating the thickness with about 20%. MM measures anatomically more correct and is preferred in research. MM has been validated against area‐based thickness measurement without contour artifact and produced identical results. ABD is less operator–dependent and applicable to field studies, and useful in the beauty industry to characterize aged skin. The two methods of recording each have a scene of use. [ABSTRACT FROM AUTHOR]

Background: Skin cancer is common, growing, challenging, and in need of progress in early‐stage treatment. 20 MHz high‐intensity focused ultrasound (HIFU) is new and applied to actinic keratosis (AK) and skin cancers for the first time. HIFU of lower frequency is already used in the treatment of internal cancers. Materials and Methods: Eight patients with 201 AK lesions, one patient with 7 basal cell carcinomas (reoccurrences after PDT), and one patient with 7 Kaposi sarcoma lesions (4 treated with radiotherapy in the past) were given 1‐3 HIFU treatments. Twenty megahertz HIFU was dosed as 150 ms at 0.6‐1.2 J/shot applied to target lesions. Probes with different target depths were available. The preferred shot energy and focal depth in AK were 0.9 J and 1.3 mm. A "Sandwich" strategy with HIFU applied in two depths were tried in cancers. The follow‐up period was 3‐6 months. Results: All AK cleared except 5, giving a cure rate of 97%. Post‐treatment lesion healed in 1‐2 weeks with no scar. VAS pain was from 1 to 8, and in any case less than experienced with previous PDT. In both basal cell carcinoma (BCC) and sarcoma, healing was confirmed by histological verification. Discussion/conclusion: 20 MHz HIFU was an effective and safe treatment of AK. This new treatment, applicable to any anatomical site, has promising advantages relative to PDT and has the potential to replace or supplement PDT in future. Case‐observations indicated that HIFU can be useful in skin cancers as well. [ABSTRACT FROM AUTHOR]

Background/aims: Fibre‐optic confocal imaging (FOCI) allows non‐invasive visualization of live skin in vivo. A contrast agent, a fluorophore, is injected into the dermis. FOCI images are horizontal optical sections with cellular resolution. The aim was to study in vivo epidermal changes and the cellular structure of keratinocytes in moderate to severe atopic eczema (AE). Methods: Eight patients with AE with active lesions on the forearms were studied and compared to a control group of six healthy individuals, and two cases of AE without activity. Fluorescein sodium was used as fluorophore. A hand‐held fibre‐optic laser scanner (Stratum®) was used. The study included morphometric analyses. Results: The confocal in vivo images identified characteristic features of epidermis and keratinocytes in active AE vs healthy skin controls. FOCI could non‐invasively image acanthosis, spongiosis, and parakeratosis in AE. Epidermal oedema and micro‐vesicles were visualized. Morphometry based on FOCI demonstrated 14% increased width of keratinocytes of atopic skin vs healthy controls. The epidermal structures and organization in distinctive cell layers were deviant as a result of the disease. Conclusions: Fibre‐optic confocal imaging can visualize essential epidermal structures of atopic eczema directly in vivo, in real‐time, and with cellular resolution thus without disturbing the natural state of the skin. FOCI is primarily a research tool, but with a potential to become used in the clinic for non‐invasive microscopic diagnosis of AE and monitoring of effect of therapies. [ABSTRACT FROM AUTHOR]

Background: Tattooist-related technical failures of tattooing were hitherto unstudied and related to clinical complications. Tattooing requires talent, training and experience. Amateurism is a challenge in popular tattoo industry with no formal education and certification of the tattooists.Objective: To study technical tattoo failures causing disease in a consecutive hospital material of tattoo complications.Material: 574 patients with 702 tattoo complications referred to the "Tattoo Clinic" (a subspecialised dermatological clinic) were enrolled. Patients were examined clinically and classified with respect to the cause of complication.Results: 147 (21%) tattooist and tattoo studio-related complications were recorded, i.e. excessive pigment installed in the dermis with "pigment overload" in 64 (9%), tattoo "needle trauma" with "overworked tattoos" in 43 (6%), contaminated ink causing infection in 20 (3%), and other sources of infections related to tattooing in 20 (3%). Pain and discomfort were particularly common as well as long-term complications including scarring induced by "needle trauma." "Pigment overload" with black pigment carried a special risk of granulomatous inflammation and sarcoid granuloma and was observed in 12/35 (34%) of punch biopsies taken from tattoos with "pigment overload." Keratoacanthoma associated with trauma was observed in 1 case. 82% of complications were related to professional tattooists working in a tattoo studio and 18% to amateurs.Conclusion: Technical failures of tattooing are associated with medical tattoo complications. "Needle trauma" with major skin damage, e.g. "overworked tattoo," and installation of excessive pigment, e.g. "pigment overload," and (re)use of contaminated tattoo ink bottles are identified failures calling for preventive intervention. [ABSTRACT FROM AUTHOR]

Background: The incidence of clinical complications such as granuloma formation and sarcoidosis is often seen in black tattoos and may be associated with agglomeration of black pigment. Aim: To measure count and dimensions of agglomerates in black tattoo inks vs red inks and to compare old inks and new inks of identical brands. Method: Examination was performed by light microscopy (Olympus BX51™) with magnification 40X, immersion oil. Photographs (Jenoptik Gryphax RGB camera) were taken of each ink sample and analysed by ImageJ software; count, area, width, height, circumference and circularity index were measured. Agglomerates were defined as width and height of objects above 800 nm. Twenty‐one new unopened black inks and 17 new unopened red inks were compared. Furthermore, five old black inks and five old red inks, that had been opened and stocked for over 2 years, were compared with new products of the same brands. Results: Black agglomerates were area wise and with respect to width, height and circumference significantly larger compared with red agglomerates and more circularly shaped. Count of agglomerates was lower in black inks than in red inks, in accordance with bigger dimensions of black agglomerates. Comparison of old and new inks indicated old inks have larger agglomerates but variable bottle size and storage conditions may have confounded results. Conclusion: Pigment agglomerates in black tattoo ink stock products were sized larger than agglomerates in red inks. Agglomerates found directly in black inks may predispose to granuloma formation in black tattoos causing sarcoid reaction. [ABSTRACT FROM AUTHOR]

Background: Black tattoo reactions are suggested to be foreign body reactions manifested as papulo‐nodular inflammation that is associated with active sarcoidosis. Aim: To study the morphology of black and red pigment agglomerates in skin biopsies from tattoo reactions, referenced to clinical diagnoses. Method: Agglomerate count, area, width, height, circumference and circularity were measured in 161 patients by light microscopy (Olympus BX51™); 161 unstained skin biopsies from 64 black tattoo reactions and 97 reactions in red tattoos with allergy. Images (Jenoptic Gryphax RGB camera) were taken through a 40× objective using immersion oil. Computerised analysis of agglomerates was performed using ImageJ software. Student t test, chi‐square test, Fisher Exact test, ANOVA and Bonferroni tests were applied. Results: Comparison of black and red pigment agglomerates showed no overall differences in count, area, width, height or circumference. However, in black tattoo reactions, the count of agglomerates was higher in patients with sarcoidosis (P =.009) vs no sarcoidosis. Black agglomerates were more circular shaped as compared to red, P =.023. In red tattoo reactions, agglomerates in patients with allergic cross‐reactivity were slightly more circular (P =.036) vs patients with milder allergy. The count of red agglomerates was lower in patients clinically typed excessive hyperkeratosis (P =.041) compared with other clinical types of allergy. Conclusion: Patients with reactions in black tattoos associated with sarcoidosis have increased count of pigment agglomerates vs those without associated sarcoidosis indicating that black pigment agglomeration is one among a number of factors triggering sarcoid tattoo complication. Circular shape of agglomerates may code for bioactivity. [ABSTRACT FROM AUTHOR]

Background: High‐intensity focused ultrasound (HIFU) operating at 20 MHz is new and applicable to skin. Details of use and instrumentation are not documented. Materials and Methods: A GLP compliant 12‐week study of Göttingen minipigs (n = 3) was undertaken. Effects of HIFU treatment at different focal depths, energy levels and field size (single shot vs 5 × 5 multiple shots) were studied. Clinical scoring and histology of treated sites were made. Results: High‐intensity focused ultrasound showed instant and initial effects with wheal and flare responses followed by delayed inflammatory reactions associated with outer skin necrosis, depending on energy dose. HIFU treatment was tunable in the range 0.3‐1.5 J, ablative at higher energy level. Transducers with deeper focal points gave more profound effects, while epidermal effects were comparable. Multiple doses of 5 × 5 shots produced stronger reactions than single dose indicating that nearby applied shots were synergistic. Recovery from single doses was faster than in multidose areas. Clinical scarring at the end point was not seen despite occasional fibrous change of dermis. Findings illustrated intended therapeutic use; no special safety issues of concern were raised. Conclusion: The new 20 MHz HIFU was reproducible, tunable and produced targeted effects in the outer skin, for example instant wheal and flare followed by inflammation and possibly necrosis depending on energy setting. Reactions recovered during the study with only minor findings at study end. No special safety concerns were raised. The method can be controlled and modulated, and it is ready for clinical testing of dermatological disease indications including conditions presently treated with lasers. [ABSTRACT FROM AUTHOR]

Background: Red tattoos are prone to allergic reactions. The identity of the allergen(s) is mostly unknown. Objectives: Chemical analysis of human skin biopsies from chronic allergic reactions in red tattoos to identify culprit pigment(s) and metals. Material and methods: One hundred four dermatome biopsies were analyzed by matrix‐assisted laser desorption/ionization tandem mass spectrometry (MALDI‐MS/MS) for identification of commonly used organic pigments. Metal concentrations were assessed by inductively coupled plasma (ICP)‐MS and x‐ray fluorescence (XRF). Fourteen patients had cross‐reactions in other red tattoos. Results: In total, the identified pigments were mainly azo Pigment Red (P.R.) 22 (35%), P.R. 210 (24%), P.R. 170 (12%), P.R. 5 (0.9%), P.R. 112 (0.9%), and Pigment Orange (P.O.) 13 (11%). P.R. 122 (0.9%) and Pigment Violet (P.V.) 23 (8%) were also common. P.R. 22, P.R. 170, and P.R. 210 also dominated in patients with cross‐reactions. In 22% of the biopsies, no red pigment was detected. Element analysis indicated the presence of the sensitizers nickel and chromium. Conclusions: P.R. 22, P.R. 170, and P.R. 210 were identified as the prevailing pigments behind chronic allergic reactions in red tattoos. The epitope causing the reaction might be a pigment‐degradation product. Metal contamination may derive from different sources, and its role in red tattoo allergy cannot be ascertained. [ABSTRACT FROM AUTHOR]

Background: Initially after tattooing, the skin barrier function is broken. However, the long‐term impact of clinically healed tattoos on this has never been studied. The aim was to investigate the long‐term effect on the skin barrier function in normal tattoos and examples of tattoos with chronic inflammatory complication. Methods: Participants were recruited from the "Tattoo clinic" of the Dermatological Department on Bispebjerg Hospital in Denmark, where patients with complicated tattoo reactions are treated. Transepidermal water loss (TEWL), conductance, capacitance, and pH were measured in tattooed skin with regional control measurements in normal non‐tattooed skin. Natural moisturizing factor (NMF) was measured in collected tape strips. Results: Twenty six individuals with 28 tattoos were included, that is, 23 normal tattoos without any pathologic reaction and 5 tattoos with chronic inflammatory complications. No significant differences were found in tattooed versus non‐tattooed skin with respect to TEWL (median values 6.6 vs 7.2 g/m2/h), conductance (76 vs 78 a.u.), pH (5.94 vs 5.79), and NMF (0.58 vs 0.59 mmol/g protein). Capacitance (64 vs 57 a.u.) was higher in tattooed skin compared to non‐tattooed skin (P = 0.006). Similar results were found in tattoos with inflammatory reactions. Conclusion: Overall, skin tattoos do not affect the long‐term skin barrier function markedly. The skin capacitance was, however, affected in tattooed skin areas compared to non‐tattooed skin areas. [ABSTRACT FROM AUTHOR]

Background: High‐intensity focused ultrasound (HIFU) for non‐invasive treatment of a range of internal pathologies including cancers of major organs and cerebral pathologies is in exponential growth. Systems, however, operate at relatively low frequencies, in the range of 200‐2000 kHz as required for deep axial penetration of the body. HIFU utilizing frequencies in excess of 15 MHz has so far not been explored, but presents an opportunity to extend the HIFU modality to target specific dermal lesions and small animal research. Materials and methods: A new 20‐MHz HIFU system (TOOsonix ONE‐R) with narrow focus corresponding to the dermis was studied in acoustic skin equivalents, for example, in a tissue‐mimicking gel and in bovine liver. HIFU lesion geometry, depth, and diameter were determined. The temperature increase in the focal point was measured as a function of acoustic power and the duration of HIFU exposure. Results: The system produces highly reproducible ultrasound lesions with predictable and configurable depths of 1‐2 mm, thus corresponding to the depth of the human dermis. The lesion geometry was elongated triangular and sized 0.1‐0.5 mm, convergent to a focal point skin deep. Focal point temperature ranged between 40 and 90°C depending on the chosen setting. Observations were confirmed ex vivo in bovine liver and porcine muscle. Variation of acoustic power and duration of exposure produced linear effects in the range of the settings studied. Thus, effects could be adjusted within the temperature interval and spatial field relevant for clinical therapy and experimental intervention targeting the dermal layer of human skin. Conclusion: The tested 20‐MHz HIFU system for dermal applications fulfilled key prerequisite of narrow‐field HIFU dedicated to cutaneous applications regarding reproducibility, geometry, and small size of the applied ultrasound lesions. Controlled adjustment of acoustic lesions within the temperature range 40‐90°C qualifies the system for a range of non‐ablative and ablative applications in dermatological therapy. [ABSTRACT FROM AUTHOR]

Ultraviolet radiation (UVR) induces skin cancer. The combination of UVR and red tattoos may be associated with increased risk of skin cancer due to potential carcinogens in tattoo inks. This combination has not been studied previously. Immunocompetent C3.Cg/TifBomTac hairless mice (n=99) were tattooed on their back with a popular red tattoo ink. This often used ink is banned for use on humans because of high content of the potential carcinogen 2-anisidine. Half of the mice were irradiated with three standard erythema doses UVR thrice weekly. Time to induction of first, second and third squamous cell carcinoma (SCC) was measured. All UV-irradiated mice developed SCCs. The time to the onset of the first and second tumor was identical in the red-tattooed group compared with the control group (182 vs 186 days and 196 vs 203 days, P=ns). Statistically, the third tumor appeared slightly faster in the red-tattooed group than in the controls (214 vs 224 days, P=.043). For the second and third tumor, the growth rate was faster in the red-tattooed group compared with the control (31 vs 49 days, P=.009 and 30 vs 38 days, P=.036). In conclusion, no spontaneous cancers were observed in skin tattooed with a red ink containing 2-anisidine. However, red tattoos exposed to UVR showed faster tumor onset regarding the third tumor, and faster growth rate of the second and third tumor indicating red ink acts as a cocarcinogen with UVR. The cocarcinogenic effect was weak and may not be clinically relevant. [ABSTRACT FROM AUTHOR]

Aim: Tattoo pigments are deposited in the skin and known to distribute to regional lymph nodes. Tattoo pigments are small particles and may be hypothesized to reach the blood stream and become distributed to peripheral organs. This has not been studied in the past. The aim of the study was to trace tattoo pigments in internal organs in mice extensively tattooed with 2 different tattoo ink products.Material/methods: Three groups of mice were studied, i.e., 10 tattooed black, 10 tattooed red, and 5 untreated controls. They were tattooed on the entire back with commercial tattoo inks, black and red. Mice were sacrificed after 1 year. Samples were isolated from tattooed skin, lymph nodes, liver, spleen, kidney, and lung. Samples were examined for deposits of tattoo pigments by light microscopy and transmission electron microscopy (TEM).Results: TEM identified intracellular tattoo pigments in the skin and in lymph nodes. TEM in both groups of tattooed mice showed tattoo pigment deposits in the Kupffer cells in the liver, which is a new observation. TEM detected no pigment in other internal organs. Light microscopy showed dense pigment in the skin and in lymph nodes but not in internal organs.Conclusion: The study demonstrated black and red tattoo pigment deposits in the liver; thus, tattoo pigment distributed from the tattooed skin via the blood stream to this important organ of detoxification. The finding adds a new dimension to tattoo pigment distribution in the body, i.e., as observed via the blood in addition to the lymphatic pathway. [ABSTRACT FROM AUTHOR]

Background and Objective: Tattoo ink stock products often contain potential carcinogens, which on large-scale population exposure may be clinically relevant. The aim of this autopsy study in mice was to screen major organs for clinical and subclinical cancers.Methods: Mice were tattooed on their backs. In total, 48 mice were included and divided into 4 groups; 11 mice tattooed black, 10 tattooed red, and 5 mice serving as untreated controls. A group of 22 mice with black tattoos and exposed to ultraviolet radiation (UVR) were also studied. The black and red inks were both stock products banned on the Danish market due to the measured contents of potential carcinogens; benzo(a)pyrene and 2-anisidine, respectively. The mice were housed for 1 year after tattooing, and autopsy study on internal organs was performed. Tissue samples were systematically taken from major organs for screening of subclinical changes, not detected by visual examination. Any observed deviation from normal structure was subject to biopsy and light microscopy.Results: All mice survived the 1-year observation period. Autopsy revealed no macroscopic signs of cancer. Microscopic search of internal organs showed no subclinical or clinical cancer.Conclusion: Despite extensive tattoos with 2 banned inks, the long-term observation in mice showed no internal cancers nor was the combination of carcinogen and UVR associated with cancer. Lack of observed malignancy might be explained by the fact that tattooing is only a single dose exposure. Registered data on carcinogens relies on repeated or chronic exposures. The study does not support the hypothesis that tattooing causes cancer. [ABSTRACT FROM AUTHOR]

Background/aims: Tattooing is a global trend. Clinical knowledge of complications is based on case reports collected over a century. Larger cohorts reflecting complications associated with contemporary trends are lacking.Methods: The study was a retrospective review of a consecutive cohort of patients with tattoo complications diagnosed in the "Tattoo Clinic" of Bispebjerg University Hospital in Copenhagen, Denmark, from 2008 to 2015, based on patient history and systematic clinical examination.Results: A total of 493 tattoo complications in 405 patients were studied. Overall, 184 (37%) presented allergic reactions with plaque elevation in 32.2%, excessive hyperkeratosis in 3.7%, and ulceration in 1.4%, predominantly observed in red tattoos and nuances of red; 66 (13%) presented papulo-nodular reactions, mainly observed in black tattoos (considered non-allergic) and due to pigment agglomeration; 53 (11%) had bacterial infections; 46 (9%) were psycho-social complications; 144 (30%) belonged to several specific diagnostic entities, including photosensitivity, pain syndrome, and lymphopathy. We found no cases of cutaneous or other malignancies. Sarcoidosis was primarily seen in black tattoos and was a common associated disease, found in 23 reactions (5%), compared to the background population.Conclusion: The study introduces a new concept of classification of tattoo complications based on simple tools such as patient history and objective findings supplemented with histology. The study reflects complications originating from presently used tattoo inks, often with organic pigments. The introduced classification has been submitted to the World Health Organisation (WHO) as a proposal to the 11th revision of the International Classification of Diseases. [ABSTRACT FROM AUTHOR]

Background/aims: Sarcoidosis is, from historical data, suggested to be more prevalent among patients with tattoo reactions. We aimed to evaluate this association in a systematic study.Methods: This is a consecutive study of patients with tattoo complications, diagnosed in the "Tattoo Clinic" at Bispebjerg University Hospital in Copenhagen, Denmark, from 2008 to 2015, based on clinical assessment and histology. From the overall group of 494 tattoo complications in 406 patients, 92 reactions in 72 patients showed a papulo-nodular pattern studied for local and systemic sarcoidosis, since sarcoidosis is expected to be nodular.Results: Of the 92 reactions with a papulo-nodular pattern, 27 (29%) reactions in 19 patients were diagnosed as cutaneous or systemic sarcoidosis, supported by histology; 65 (71%) were diagnosed as non-sarcoidosis due to histology and no clinical sarcoid manifestations. "Rush phenomenon" with concomitant reaction in many other black tattoos, triggered by a recent tattoo with a papulo-nodular reaction, was observed in 70% in the sarcoidosis group and 28% in the non-sarcoidosis group, indicating a predisposing factor which may be autoimmune and linked with sarcoidosis. Agglomerates of black pigment forming foreign bodies may in the predisposed individual trigger widespread reaction in the skin and internal organs.Conclusion: Black tattoos with papulo-nodular reactions should be seen as markers of sarcoidosis. Papulo-nodular reactions may, as triggers, induce widespread reactions in other black tattoos - a "rush phenomenon" - depending on individual predisposition. Sarcoidosis is estimated to be 500-fold increased in papulo-nodular reactions compared to the prevalence in the general population, and the association with black tattoos is strong. [ABSTRACT FROM AUTHOR]