Complications of tattoos and tattoos removal: state-of-the-art in Italy

Introduction: Modern tattoo removal began as a science approximately 20 years ago, and relatively few advances have been made since then. The aim of this study is twofold: first, to review the complications of tattoos and tattoo removal methods and second, to investigate both the epidemiology and legal issues of this phenomenon in Italy. Discussion: Complications of medical tattoos are changes in colour, leading to colour mismatch. The complications of decorative tattoos include infections and allergic and foreign body reactions. Tattoos are popular in Italy, especially among the younger generations. As these people age, the demand for tattoo removal will continue to grow. Q-switched (QS) lasers are widely considered the gold standard for tattoo removal. Although Q-switched lasers are capable of removing tattoos without harming the skin, removal often requires numerous treatments and it can still be incomplete, especially when attempting to remove multi-coloured tattoos. Moreover, complications can occur, with an incidence of about 5%. Immediate complications include pain, blisters, crusting and pinpoint haemorrhage. Delayed complications include pigmentary changes, either hypopigmentation or hyperpigmentation. Developments leading to removable tattoo inks, feedback systems to detect the absorbance characteristics of tattoo inks, dermal clearing agents and, perhaps, even shorter pulse-duration lasers should result in improvements in tattoo removal in the near future. Conclusions: In Italy there is no specific prescriptive legislation for tattooing, and there is also a great diversity in terms of regional regulatory approaches. Future educational campaigns by school counsellors and primary care physicians should also be aimed at specific groups that are more likely to get tattoos, such as minors and women. Mirko Campisi1