Iatrogenic tattoos after acupuncture: successful outcome after treatment with QS Ruby Laser: A case report and review of literature.

Background and aims: Acupuncture has become a substantial part of medical practice in Switzerland. So far, only few cases of accidental tattoo after acupuncture have been reported, which were all caused by acupuncture needles that had been left in the skin and led to local argyrosis.

Case: We report the case of a 31-year-old female who developed gray-brown macules after acupuncture. Over 5 months, she had received acupuncture on the same spots one to two times per week and the macules had gradually become darker and had increased in size. The needles used were disposable, contained nickel and were not left in the skin for over 30 minutes. The patient was of Fitzpatrick skin phototype II and showed several grayish-brown macules with an average diameter of around 5mm in the region of glabella, nucha and dorsum pedis. We treated the lesions with a quality-switched ruby laser (694 nm) with a fluence between 3 and 5.5 J/cm², a spot size of 4 or 6 mm and in intervals of 8 to 23 weeks up to a complete elimination of the hyperpigmentation within 11 laser sessions.

Conclusion: In synopsis with the anamnesis, the clinical aspect and the therapeutic course, we interpreted the hyperpigmentary spots as a combination of iatrogenic tattooing with nickel and deposition of hemosiderin as well as melanin due to repeated mechanical manipulation and UV exposure of the skin. Furthermore, we hereby show the validity of the quality-switched ruby laser in the removal of accidental hyperpigmentation in skin phototype II.