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Tattoo Darkening and Nonresponse After Laser Treatment
A Possible Role for Titanium Dioxide
E. Victor Ross, MD;
Sharam Yashar, BS;
Norm Michaud, MS;
Richard Fitzpatrick, MD;
Roy Geronemus, MD;
Whitney D. Tope, MPhil, MD;
R. Rox Anderson, MD
Arch Dermatol. 2001;137:33-37.
Objective To examine relationships between chemical composition, biopsy findings, and clinical outcome in laser-treated tattoos.
Design Observational nonblinded retrospective study.
Settings University-based dermatology clinic and private practice.
Participants Twenty patients who underwent biopsy of laser-treated tattoos.
Main Outcome Measures Biopsy specimens were analyzed after laser treatment, and the depths of changed particles were recorded. Ultrastructure of the changed particles was examined by electron microscopy. Presence of inorganic chemicals was determined by x-ray diffraction. Correlation between x-ray diffraction, microscopy, and clinical response was attempted.
Results Of the 20 tattoos, 7 lightened, 9 failed to change, and 4 darkened after laser treatment. There was a significant association between presence of titanium dioxide and poor response to laser therapy. Microscopic studies showed variable changes in the ink particles, but there was a trend toward residual deep green pigment in the resistant tattoos. Also, round dark stippling was observed superficially in the darkened specimens.
Conclusions Titanium is overrepresented in tattoos that respond poorly to laser treatment. Further studies are necessary to show whether this metal is the primary cause of this poor response.
From the Department of Dermatology, Naval Medical Center San Diego, San Diego, Calif (Dr Ross and Mr Yashar); Wellman Laboratories of Photomedicine, Massachusetts General Hospital, Boston (Mr Michaud and Dr Anderson); Dermatology Associates, Encinitas Calif (Drs Fitzpatrick and Tope); and Laser and Skin Surgery Center of New York, New York, NY (Dr Geronemus). Dr Tope is now with the Department of Dermatology, University of Minnesota, Minneapolis.
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