Medical Treatment of Tattoo Complications

Tattooing is a skin trauma and involves a special vulnus punctatum (with inserted tattoo ink, a vulnus venenatum), which should heal with no infection and no local complication. Local treatment in the healing phase ideally builds on the 'moist wound' principle using plastic film, hydrocolloids, silver dressing, and compression. Bacterial infections during healing are treated with oral antibiotics, and a list of first-line antibiotics is proposed. Notice is given to severe infections with affected general condition, and it is emphasized that intravenous antibiotic treatment must be instituted as early as possible to prevent septic shock and death. Hydrophilic antibiotics shall be given in high load and maintenance dose due to increased renal clearance of such antibiotics. Chronic allergic reactions of red tattoos respond little to local corticoids and are best treated with dermatome shaving. Laser removal is contraindicated due to the risk of photochemical activation of the allergy with anaphylaxis or worsening. Chronic reactions in black tattoos can be treated with local corticoids, dermatome shaving, and lasers as well. Systemic corticoid is used in allergic reactions in red tattoos and in cross-allergic reactions of other red tattoos as well as in black tattoo reactions associated with sarcoidosis and with cutaneous 'rush phenomenon' affecting any black tattoo. Systemic corticoid is also indicated in generalized eczema due to nickel allergy or another allergy challenged through tattooing or introduced by tattooing as a primary sensitization. The use of intralesional corticoid, antihistamines, and immunosuppressive medicines is discussed. A warning against the use of lactic acid and other caustic chemicals for tattoo removal is given, since such chemicals and commercial products cannot be dosed properly and very often result in disfiguring scarring.