Paul Gillum, M.D.
Aurora/Parker Skin Care Center
Aurora, Colorado
What is a tattoo?
A "tattoo" refers to any permanent mark made by placing colored material ("pigment")
under the skin surface. The pigment can be nearly any substance, including ink,
dye, carbon, or metal. Most decorative tattoos are made by intentionally injecting
pigment under the skin surface to create permanent artistic designs. Sometimes,
tattoos are made when the pigment is accidentally pushed into the skin. For example,
ear piercing, a gunpowder explosion, or a "road rash" could make an accidental tattoo.
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Who gets a tattoo?
Decorative tattoos are by far the most common. Tattoos are an artistic expression
of individual taste and style. In the last few years, tattooing has become a popular
way to apply permanent "make-up," such as eyeliner. Not all tattoos are decorative.
Sometimes, doctors use small tattoos to permanently mark the skin to help give medical
treatments at exactly the same spot every time. Tattoos also are used to identify
members of a group, such as prisoners, social groups, or gang members.
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What are the medical risks of a decorative tattoo?
Because needles and injections are used in tattooing, improperly sterilized equipment
can spread viruses. Getting a tattoo significantly increases a person's risk of
contracting viral hepatitis. Although possible, there are no documented cases of
HIV linked to tattoo needles. Since tattoos create a wound in the skin, there is
a small risk of bacterial infection, scar formation, or a keloid.
Allergic reactions to the ink or pigment are possible, and the allergy may not stop
unless the tattoo is removed. There are many reports of skin cancer occurring in
a tattoo. Tattooing can spread warts and molluscum (a skin disease that is characterized
by soft, round masses).
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What are the non-medical risks of a decorative tattoo?
Many people get tattoos impulsively and without much thought. Later, some people
regret getting them or regret the location or design. Several articles document
that it is harder to leave a gang lifestyle once the members are tattooed. A recent
study surveyed individuals responsible for hiring new employees and found that many
of them would not hire a person with visible tattoos.
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How is a tattoo removed?
In most decorative tattoos, the pigment is found in the upper part of the skin,
called dermis. The earliest methods of tattoo treatment simply removed the top layers
of skin where the pigment was located.
Salabrasion uses salt particles to rub away the upper skin and the pigment. Immediately
after treatment, the skin looks and feels like a "road rash." Although this method
is inexpensive, it always leaves a significant scar, and it can be quite painful.
Dermabrasion is a similar technique that uses a high-speed rotating sanding bit.
Small tattoos can be cut out surgically and then stitched closed. This leaves a
surgical scar. Some locations, like the face, heal very well. If the tattoo is located
on an area of the skin with a lot of movement or tension (e.g., hips, knees, or
shoulders), the surgical scar will usually widen, or there may be stretch marks
around the incision. Sometimes, large tattoos are cut out in stages over several
sessions. Again, there is often a significant surgical scar.
The dermaplane is a tool that shaves off the top layer of the skin. This tool is
often used to harvest skin for skin grafting. Amateur tattoos are frequently placed
irregularly and deeper, so this technique may not go deep enough to remove all the
color. As with the other surgical techniques, this often leaves a scar.
Several different LASER systems are now available for tattoo removal. The carbon
dioxide (CO2) LASER simply burns off the top of the skin, one layer at a time, until
all the color is gone. There is always scarring, resembling other kinds of burn
scars.
Newer LASER systems use special types of light energy to instantaneously heat and
destroy the tattoo pigment without damaging the surrounding skin. Some systems even
have a device attached that keeps the surface of the skin cool to avoid a heat injury
or burn. Some LASER systems work best for black pigment, while other systems work
better for red or green pigments. This method of treatment is much less likely to
cause pain or scarring. However, most LASER systems require multiple treatment sessions,
and it may cost several hundred dollars per session.
When considering tattoo removal, discuss all of the methods, risks, costs, and alternatives
with us.
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Links to other information
For medical articles about tattoos, log on to: http://www.ncbi.nlm.nih.gov/PubMed/medline.html">
As an alternative to permanent tattoos, consider Henna:
http://dir.yahoo.com/Business_and_Economy/Companies/Arts_and_Crafts/Visual_Arts/Body_Art/Tattoos/Henna_Tattoos/
Yahoo search results on henna tattoos
For the history of tattooing, go to: http://tattoos.com/jane/steve/toc.htm
History of Tattooing
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About the Author
After finishing medical school and dermatology training at the University of Oklahoma,
Dr. Gillum came to Colorado to further his knowledge in this specialty. He is board
certified in Dermatology and Dermatopathology.
He works at a busy private practice with offices in Aurora and Parker, Colorado.
He also teaches at the University of Colorado Department of Dermatology and volunteers
his time working with gang members to have their tatoos removed.
Copyright 2012 Paul Gillum, M.D., All Rights Reserved
