The efficacy and the adverse reactions of laser‐assisted tattoo removal – a prospective split study using nanosecond and picosecond lasers

Abstract

Background Laser pulses with nanosecond duration (NSL) have been the golden standard to destroy the pigment particles in skin. It is still controversially discussed whether picosecond pulses (PSL) are superior for tattoo removal.Objectives To compare the efficacy and the adverse reactions of nanosecond and picosecond laser pulses in a comparative study.Methods The prospective study included 23 subjects with 30 black or coloured tattoos, which were split into two halves treated with either a new PSL (532, 1064 nm) or standard NSL (694 nm). The lasers were applied at regular time intervals of 4 weeks for up to eight treatments. Tattoo clearance (primary endpoint), pain and adverse reactions (secondary endpoints) were appraised by physicians, blinded observers, and by subjects. The extent and duration of adverse reactions were additionally assessed by using a questionnaire and photo-documentation after each treatment session. ResultsThe tattoo clearance appeared to be more effective for PSL compared to NSL but without statistical significance (P > 0.05). Pretreated tattoos responded better to laser treatments than previously untreated tattoos. Subjects felt significantly less pain with PSL than with NSL (P < 0.001). Transient adverse reactions were statistically less pronounced lasting shorter for PSL as for NSL, especially blistering, pruritus, and burning sensation. Hypopigmentation appeared after NSL treatments only, whereas hyperpigmentation was caused by both lasers. No scarring was detected with either laser.Conclusions Both laser systems enable acceptable clearance of most tattoos in the present study. PSL cause less collateral skin damage as compared to NSL.

Highlights from the Journal of the European Academy of Dermatology and Venereology in 2022

“…12 Remarkably, artificial pigmentations like tattoos can be removed using laser-assisted procedures, with picosecond lasers appearing to be more effective and better tolerable than nanosecond laser devices. 13…”

Nd:YAG Laser Tattoo Removal in Individuals With Skin Phototypes IV-VI: A Case Series

“…1,2 However, there is a significant percentage of regret and desire for the removal of the tattoo in individuals from several countries. 1,3,4 According to the American Society for Dermatologic Surgery, more than 160 000 tattoo removal procedures were performed in 2019 in the USA for a variety of reasons. 5 Several techniques such as salabrasion, dermabrasion, electrocautery, cryosurgery, and chemical peeling have been developed to remove pigments from the skin since then, although they are accompanied by unsatisfactory results and adverse events, such as scar formation and skin dyspigmentation.…”

“…1 In this way, the ink particles that are present within the lysosomes of the resident dermal cells are released into the extracellular space and phagocytosed, with the subsequent transfer through the lymphatic system and elimination. 1,4,8 Although safe and effective, Nd:YAG laser tattoo removal in patients with ethnic skin, for instance, with Fitzpatrick skin phototypes from IV to VI, is still challenging since dyspigmentation and scarring are of greater risk. These effects may be due to existing biological characteristics in the darkly pigmented populations, namely an increased epidermal melanin content, especially enriched in DHIeumelanin (black) 9 together with larger melanosomes that are more singly dispersed (non-aggregated) and widely distributed throughout the entire epidermis.…”