Traumatic Tattoos: Prevention and Treatment

Traumatic tattooing occurs when insoluble pigmented particles are deposited within the dermis after abrasive, explosive, or penetrating injuries. The result is irregularly shaped blue-black skin discoloration(s) with a variable distribution. Patients may wish to seek treatment for several reasons including symptoms secondary to inflammatory changes, emotional distress from the reminder of a traumatic event, and/or for cosmetic reasons. A comprehensive review on traumatic tattoo prevention and treatment is lacking.

Review the available strategies for traumatic tattoo prevention and treatment.

PubMed and Medline searches were performed to identify studies examining intervention strategies for traumatic tattoo prevention and studies examining treatment options for established tattoos.

Forty-six studies were identified, including 14 prevention-related studies and 34 treatment-related studies. Prevention strategies included various surgical and microsurgical techniques for the removal of superficial and deep deposits. Treatment strategies also included several surgical and microsurgical approaches, but nonablative laser-based modalities were most common.

Traumatic injuries can result in disfiguring tattoos if foreign debris is not thoroughly removed within 24 hours. For established tattoos, the treatment of choice is a nonablative nanosecond or picosecond device in most cases, but alternatives should be considered for combustible debris given the risk of laser-induced ignition.