Current problems in dermatology最新文献

Medical tattooing aims to restore the normality of skin structures in patients who have skin diseases or suffer sequelae after surgical interventions or hazards. There are numerous applications, with tattooing of vitiligo and the nipple areola complex after breast cancer surgery as leading fields. The use of 3D or realistic tattoo techniques has increased the potential of medical tattooing and improved the aesthetic results. The tattooist must have good technical training combined with artistic and creative talents. In this chapter, two innovative applications of medical tattooing will be presented as examples, i.e. tattooing of the nailbed and the gingiva. Nailbed tattooing reconstructs the normal perception of the nailbed and the nail plate when the nails have previously been removed though a surgical procedure. Tattoo of the gingiva performed after a connective tissue implant of the gum is a new application. These treatments, approved by a physician and performed by a tattooist with proven experience in medical tattooing, also involve the use of specific color nuances that produce an extremely realistic outcome.

Cosmetic tattooing dedicated to beautifying the normal anatomy such as the eyebrows, the eyelines, or the lips is in a remarkable growth all over the world. Medical tattooing with reconstruction of the areola and the nipple after breast surgery, correction of the lost color of vitiligo and scars is a spin-off, which has made tattooing cross the barrier and become accepted and used in clinics and hospitals in service of the quality of life of patients. The last years have seen a major development of machinery, inks, techniques, experiences, and services. The overwhelming rise of the activity created by client pressure and business opportunity, however, also has its cons: amateur work and even malpractice. The development is driven by elite technicians, but competence is little transparent to clients, and there is no distinct authoritative recognition of practitioners based on a recognized educational curriculum. National regulations of the industry are highly variable and scattered. Some countries have no restriction and in others cosmetic tattoos shall be performed by medical doctors. The challenge of the coming decades is to parallel the success of the industry with quality assurance to better control practices and safeguard clients, and the patients.

Cosmetic tattoos may cause burning sensation during magnetic resonance imaging (MRI) and interrupt the procedure, and thereby any diagnostic workup. Tattoos also may cause disturbing artefacts in MRI images. The sensation, which can be painful, is due to magnetic elements in the tattoo ink deposited in the tattooed skin. It is not a thermal burn but a subjective sensation of burning. Tattoo ink bottles can be tested for magnetic properties by the artist in the studio, before cosmetic tattooing is performed, using a simple magnet test. This test and the pitfalls of the test are described. Hospital departments and clinics should be aware of the problem, and patients assessed prior to MRI regarding their tattoos, particularly eyebrows and eyeliners made in brown and dark colors. Red tattoos exemplified by tattooed lips are not prone to MRI-induced burning sensation. The problem is related to inorganic pigments with ferromagnetic properties.

Microblading is a rapidly expanding technique in cosmetic and medical tattooing, used for eyebrow correction and conditions of hair loss. Tattooing is performed by hand using a special blade; tiny cuts in the outer skin are filled with dark pigment to simulate a natural hair. Indications, the technique, and the microblading procedure step-by-step are considered in what follows. Details on client selection and a range of pitfalls are discussed. The leading application of microblading is cosmetic tattooing of the eyebrows adding pigmented "hairstrokes" to the natural brow area. Tattooed "hairstrokes" fade in color over months and a repeated "touch up" procedure may be required. Pretreatment with laser removal of tattoos of the past may be indicated when a client requests a "touch up" with another brow in another style, shape, or extension. Microblading carries the risk of scarring. The combination with conventional machine-driven needle tattooing for background shading the skin of the brow is also discussed. Microblading is also used as a corrective intervention in a range of dermatological and medical conditions. Having grown exponentially for cosmetic purpose in the first phase of microblading parallel to acquired refinement, the method is now mature and ready to make further progress on medical indication in the coming second phase. The medical community should welcome this opportunity for supplementary correction with restoration of the normal brow anatomy added to other achievements in dermatological and medical therapy.

Perception of skin color in the natural state, or with tattoo pigment installed in the dermis is highly complex and includes both optical requisites and eye and brain functions connected to advanced cognitive and psychological functions. Permanent makeup (PMU) is miniaturized tattooing on critical anatomical location aiming at fulfilment of a person's esthetic ideal. It is a special challenge since a satisfactory outcome depends on perfectionated technique and very critical selection of pigments. The eye can be compared to a digital camera, and the center of central vision in the brain to a computer and color integrator. Color perception is the end product of a complicated brain function. The background theory of color physics and perception is reviewed with emphasis on aspects related to changed skin color created by pigment installed in the dermis with the purpose to tattoo eyebrows, eyeliners, lips, and other locations. The delicate dosing of pigment relative to the natural skin tone is highlighted. The review is relevant for all aspects of PMU including medical tattooing, e.g., areola tattooing after breast cancer surgery. A detailed guidance to PMU artists and medical tattooists on selection and use of tattoo inks and pigments is provided. The guidance is also relevant to laser surgeons and technicians performing tattoo removal.

A characteristic feature of the anatomy of the human face is its arrangement in layers. The main layers include, from outside to inside: (i) the skin; (ii) the subcutaneous fat; (iii) the superficial musculoaponeurotic system; (iv) the deep fat, and (iv) the periosteum overlying the bony structures of the skull. Herein, the facial bones provide the basis for the ligaments and other facial structures that are attached to them. In contrast, the muscles control the mimics and movements, hence the dynamic anatomy of the face. The skin represents the outermost structure of the body and protects the organism from external physical, chemical, and biological stresses. The strive for facial attractiveness and beauty is a strong motivation for cosmetic and aesthetic procedures, including (permanent) makeup, minimal-invasive up to invasive surgical interventions, which have dramatically increased in numbers over the past decades. A youthful appearance is regarded as one of the essential characteristics of an attractive face. The characteristic features of the aging face are a downward migration of the facial soft tissues, a loss in volume of the fat compartments, the formation of mimic wrinkles, a decrease in dermal hydration, and others. Modern anti-aging treatments aim to reverse these alterations with the least possible side effects. However, effective and safe cosmetic, aesthetic, and medical treatments presume a profound knowledge of facial anatomy.

Cosmetic tattooing of eyebrow and lips has become very popular and is expected to be paralleled by more frequent complications. We present 4 cases of granulomas in cosmetic tattoos complicated by regional or systemic manifestations of sarcoidosis including affection of the lungs in 2 cases, the activity triggered by the tattoo. Three cases of traditional decorative tattoos on extremities serve as reference. It is noteworthy that cosmetic tattoos despite small size and thereby low relative dose of pigment injected in the skin can trigger fully developed systemic sarcoidosis. It is hypothesized that iron oxide pigments popular in cosmetic tattoo inks of red or brown color may be prone to elicit sarcoid reactions and thus carry a special risk of granuloma. In decorative tattoos, carbon black is the commonest trigger. It is emphasized that the finding of granulomas in tattoos shall be followed by search of other manifestations of sarcoidosis through patient history and diagnostic examinations to exclude pulmonary, ocular, and other organ manifestations. Patients with granulomas in tattoos shall be informed that active sarcoidosis, if not already present, can become manifest later with a latency of months or years and often with abrupt debut when the triggering tattoo may be overlooked by the doctor who is unfamiliar with this less common type of sarcoidosis.

Medical tattoos are used for camouflage of a wide range of disfiguring skin pathologies and conditions. Recently, tattooing of the nipple and areola of the breast has been introduced as a corrective treatment of sequelae from breast cancer surgery and radiotherapy. The psychologic impact of a disfigured nipple and areola can invalidate self-esteem of the sufferer lifelong with major consequences for social life. Medical tattooing can often restore the visual appearance of the nipple-areolar complex back to normality and even improve the 3D impression of the entire breast. High skills of the operator are needed. The article reviews the theoretical background, patient selection and information, technical performance, and aftercare. Close cooperation between surgeon, dermatologist, and medical tattooist is essential. Medical centers treating breast cancer should routinely have access to corrective medical tattooing.

The purpose of this chapter is to provide an account of the value granted to the oncologic medical tattoo by those women who have just finished their surgical and plastic breast reconstruction process following a mastectomy. To this end, we conducted in-depth interviews with the beneficiaries of the Aesthetical, Paramedical and Oncologic Micro-Pigmentation Foundation's (FEMPO) free program. Medical tattoos are positively evaluated in connection with post-breast cancer physical reconstruction; they are granted a high value due to the aesthetic effect and the simplicity of the intervention, both in the reconstruction of the areola-nipple complex and the reduction of scars and adverse effects from the adjuvant treatment on hair and eyebrows. Additionally, psychical meanings are granted that add value to the process; it is considered to be the end of a painful process, the recovery of a part of the body that had been lost, and the return to a healthy state. The above is seen as a landmark full of psychological and emotional reparation meanings. Finally, the empathic and close relationship with the team is also positively evaluated, as it helps women feel confident, promoting a caring environment beyond aesthetic considerations.