Operative treatment of severe allergic reactions to red tattoo dye: Presentation and comparison of possible surgical procedures in seven patients

Abstract

Context: The treatment of allergic reactions to red tattoo dye is challenging in most cases, as local therapy often does not offer long-term improvement and laser therapy is considered relatively contraindicated by many authors owing to the risk of generalized side effects. Therefore, surgical removal of these tattoos is favored; shave excision is the method of choice, particularly for the removal of the entire dye. Aims: The aim of this article was to retrospectively analyze the best post-operative outcome after surgical removal of allergic tattoo reactions using different excision techniques. Materials and Methods: We compared the different surgical procedures performed on seven patients with single and multiple allergic tattoo reactions treated between 2013 and 2018. Results: The best aesthetic results were achieved by superficial ablation of the inflammatory reaction, partially leaving tattoo remains in the skin. Conclusion: Based on our experience with this small number of patients, a superficial removal of the tattoo without complete removal of the dye is, in most cases, sufficient to achieve healing. The remaining dye residues seem to be better tolerated by the immune system afterwards. Furthermore, the tattoo is often preserved in large parts.

Hypersensitivity to permanent tattoos: Literature summary and comprehensive review of patch tested tattoo patients 1997–2022

“…43,44 In a small German case series, even superficial removal of affected tattoos was sufficient to provide cure and aesthetically acceptable results in three patients. 45 The use of neodymium-doped yttrium aluminium garnet (Nd:YAG) lasers is not recommended for removal of allergic reactions since it could release putative culprit allergens like PAAs. 46 Red and black tattoos are usually affected most frequently by inflammatory conditions.…”

“…Severe allergic reactions do usually not respond to medical treatment with corticosteroids and often need complete removal of the colorant from the skin, which can be achieved by surgical or CO 2 ‐laser removal 43,44 . In a small German case series, even superficial removal of affected tattoos was sufficient to provide cure and aesthetically acceptable results in three patients 45 . The use of neodymium‐doped yttrium aluminium garnet (Nd:YAG) lasers is not recommended for removal of allergic reactions since it could release putative culprit allergens like PAAs 46 …”

Immune Response in Laser Tattoo Removal: A Systematic Review

“…The authors acknowledge that managing allergic reactions to red tattoo dye is a complex task, as local therapy typically fails to provide sustained relief. 15 Additionally, laser therapy is often seen as relatively contraindicated by numerous experts due to the potential for adverse effects that affect the entire body. Consequently, the preferred approach for eliminating these tattoos is through surgical intervention, with the have excision being the preferred option, especially when aiming to remove the complete pigment.…”