Vitamin D: What, if any relevance does it have with Laser Tattoo Removal procedures?

Vitamin D: What, if any relevance does it have with Laser Tattoo Removal procedures?

Introduction

Skin health and immune function are vital to successful, trouble-free, and scar-free tattoo removals.  

We at City Tattoo Removal DO NOT treat our clients at a level where the tattoo is likely to blister. Blisters for us are an abnormal reaction and we alter a person’s treatment plan should blisters occur. 

From time to time, however, blisters have been known to form, even if the treatment has been well within therapeutic levels. 

We recently had a patient start to develop blisters on the treatment site, which is located on her ankle. Our client had previously been treated on multiple occasions with no ill-effects or reported issues during the aftercare period. We changed our client’s treatment plan accordingly, which involved leaving longer periods between treatments and treating at lower levels than previously used. Notwithstanding these efforts, blisters continued to form on the treatment site. 

We took a break from treatment to study what could be causing these issues for her. Our client has had medical investigations undertaken with her GP.  She has now been diagnosed with a significant vitamin D deficiency.  

This got us asking: “What, if anything, does vitamin D have to laser tattoo removal and treatment outcomes?” 

Well, as it turns out, could be extremely influential to laser tattoo removal aftercare procedures. Interested? Read on for more!!!

The traditional understanding of Vitamin D

Vitamin D, ironically, is not actually a vitamin. It is “fat-soluble prohormone which has endocrine, paracrine and autocrine functions”(1).

Traditionally vitamin D is associated with muscle-skeletal health. It helps to keep bones strong and healthy and decreases the risk of muscle weakness (2).  It is oftentimes also associated with calcium because one of its primary roles is to control the levels of calcium found in the bloodstream by facilitating its absorption in the body (3).

The understanding of vitamin D in the new millennium

Studies have now shown there is a vitamin D receptor in a multiplicity of cells throughout the human body, including in adipose tissue, brain tissue, adrenal glands, bladder, colon, fibroblasts, kidney, liver, lung, lymphocytes, pituitary glands, and skin, to name a few (4). 

Vitamin D deficiencies have been linked with significant health complications such as cardiovascular events, obesity, bone metabolism, metabolic syndrome, type 2 diabetes, various types of cancer, immune disorders, increased mortality, and adverse pregnancy outcomes (5).  

Modern medicine now acknowledges vitamin D actions and interactions are not confined to the skeletal system.

Vitamin D and its role within the immune system

The body’s immune system is designed to protect individuals from foreign substances, vectors, and invaders. Simply put, when an individual’s immune system recognizes something in the body which is not its natural DNA, for example, a virus, the immune system mounts an attack against the foreign substance to rid the body of it (6). These immune responses also apply to dead cells or any other foreign body, such as bacteria, even ink particles which make up tattoos. 

In the past 20 years, the medical community has investigated more into the understanding of vitamin D and its interactions within the body. One of the most important activities recently observed is the role of vitamin D “to enhance and bring to a completion the inflammatory reaction after injury (7).”

There is also increasing data linking vitamin insufficiency with common immune disorders. Published clinical observations suggest vitamin D is a key factor linking innate and adaptive immunity, both of which may be compromised in the cause of vitamin D deficiency (8). 

Rene F. Chun et al. noted vitamin D mediated responses that may occur following a pathogen challenge (9) and can influence the body’s innate immune responses to pathogens. Innate immunity can be defined as the rapid activation "following exposure to foreign agents (e.g., bacteria and viruses), and represents a first line of defense, but lacks specificity" (10). The second line of defense is supplied adaptive immunity, which unsurprisingly is engaged at a later time and involves receptors with the capacity to rearrange and recognize an almost infinite number of non-self antigens" (11).

Vitamin D’s importance to immune function is being discovered to the point it is now clear that macrophages (12) and dendritic cells (13) act as messengers between the innate and the adaptive immune systems and are able to respond to the major circulating vitamin D metabolite, thereby “providing a link between the function of these cells and the variations in vitamin D status common to many humans” (14). 

Vitamin D also affects the body’s ability to activate T cells which play a crucial role in helping to fight off infections. 

The effects of vitamin D on the immune system perhaps cannot be understated in the understanding of an increasing body of literature which suggests a link between vitamin D levels, immune disorders, risk of cancer and cancer-associated mortality (15).

Vitamin D and skin diseases

Vitamin D deficiency has been linked with a multitude of cutaneous disorders including skin disorders, including blistering disorders and infections (16).

It is unclear, however, whether vitamin D deficiency “primarily contributes to disease pathogenesis” or whether it “merely represents a consequential event to the inflammatory processes involved” (17).

What is clear, however is that vitamin D deficiency appears to be a clear marker of ill health, whether it be the cause, or by association. 

Vitamin D and thermal injuries

Vitamin D levels have been shown to decrease following thermal injury (18). Al-Terrah et al opined “This may be both as a primary effect of the injury or a secondary response to the injury itself and/or the clinical management initiated such as fluid resuscitation and use of pressure garments” (19).  

A study conducted by Rousseau et al. showed et al. improved muscle recovery and strength in burn patients supplemented with vitamin D and implied that the vitamin D supplementation had positive effects on muscle health and may play a role during rehabilitation. This is the only study thus far investigating the possible therapeutic benefits of vitamin D following a thermal injury.

A study conducted by Cho YS et al. sought to investigate the association between vitamin D deficiency and the biomechanics properties of hypertrophic burn scars. The study was conducted over 486 patients and found that vitamin deficiency was significantly related to post burn issues including slow interstitial fluid movements in burns patients (20). Interstitial fluid aids in bringing oxygen and nutrients to cells and to remove waste products from them.  Old interstitial fluid is replaced by new fluid. The old fluid drains towards the lymph vessels where it can then be processed and secreted via the body’s waste systems (21). One wonders whether the slowing of interstitial fluid in these cases increases the risk of patients developing blisters after a burn injury. The article did not specifically address this issue. 

Professor Janet Lord and Mir. Khaled Al-Tarrah, at the Institute of Inflammation and Aging in Birmingham, assessed the recovery progress over one year, in patients with severe burns. Professor Lord found “Low vitamin D levels were associated with worse outcomes in burn patients including life-threatening infections, mortality and delayed wound healing.” It was also associated with worse scarring outcomes (22).

A curious finding in the Birmingham study was the apparent rapid loss of vitamin D in patients immediately following a burn injury. The amount of vitamin D reduction did not seem to be related to the severity of the burn, so levels may also be decreased in more minor burn injuries (23). The phenomena of low vitamin D levels following thermal injury was also noted in a study published in 2018 (24).  As yet, the medical community appears to be unaware of the long term and short term health outcomes from low vitamin D levels (25). 

Vitamin D and wound healing

Vitamin D may have many effects which may be advantageous to burns patients, including immune regulation, promotion and wound healing. Additionally, vitamin D has antibacterial properties which help combat infection and aid in wound healing to burns patients“ (26).

Critical to our particular considerations in relation to tattoo removal is this passage from a review article published in 2015: 

…Dihydroyvitamin D3 regulates the expression of cathelicidin (27) …, an antimicrobial protein that appears to mediate innate immunity in skin by promoting wound healing and tissue repair. One human study found that cathelicidin expression is up-regulated during early stages of wound healing. Other studies have shown that cathelicidin modulates inflammation in skin, induces angiogenesis, and improves reepithelialization (the process of restoring the epidermal barrier to reestablish a functional barrier that protects underlying cells from environmental exposure). The active form of vitamin D and its analogs have been shown to up-regulate cathelicidin expression in cultured keratinocytes. However, more research is needed to determine the role of vitamin D in wound healing and epidermal barrier function, and whether oral vitamin D supplementation or topical treatment with vitamin D analogs is helpful in healing surgical wounds” (28)

Vitamin D and photo-protection

It has long been recognized that skin may be damaged by UV light. Mouse studies conducted found that when vitamin D was topically applied to the skin before or immediately following irradiation it provided a photo-protective effect with documented effects being decreased DNA damage, reduced apoptosis (the death of cells which occurs as a normal and controlled part of an organism's growth or development) ,increased cell survival and decreased erythema (superficial reddening of the skin, usually in patches, as a result of injury or irritation causing dilatation of the blood capillaries) (29).

Is there an issue with Vitamin D levels in the general population? 

Australian statistics show approximately 30% of the population display mild, moderate or severe forms of vitamin D deficiency (30). This is much better than data extracted in relation to the United States where it showed more than 90% of dark-skinned and 3/4 of the white-skinned population had a vitamin D deficiency (31).

How long does it take for a vitamin D insufficient person to build up their vitamin D levels sufficiently? 

Traditionally, after 2 courses of 4 to 5 weeks, the patient builds up their vitamin D levels. Thereon vitamin D supplements are taken orally on a monthly basis to maintain healthy vitamin D levels (33). Dosage levels are checked annually to ensure healthy levels of vitamin D are maintained (33).

Can vitamin D be taken topically on the skin with effective results? 

Randomized control studies conducted by Mir Sadat-Ali et al. showed vitamin D could, in fact, be delivered effectively via the dermal route. Of course, medical supervision is recommended and required for the recommended treatments of vitamin D, however it may, in fact, be very beneficial to apply vitamin D cream after laser treatment to assist vitamin D depletion which may occur after a laser tattoo removal treatment (34).

Conclusion 

Vitamin D deficiency is linked to the health of the immune system, which plays a vital role in clearing away the ink particles fractured during a tattoo removal treatment session. 

The observed phenomenon of slowed interstitial fluid in vitamin D deficient individuals could go a long way to explaining the occurrence of blisters after a laser tattoo removal treatment, (conducted within therapeutic guidelines), especially if the treatment is conducted on the distal limbs, which are located the furthest away from the body’s regional lymph nodes. 

Extrapolating from the available data, we think vitamin D levels could be affected by laser tattoo removal treatment and consideration could be given (under medical guidance, of course) to supplementing vitamin D levels throughout the course of the laser tattoo removal treatment period. 

Vitamin D could also have a significant role to play in the healing and recovery of a treatment site after a laser tattoo removal treatment, therefore consideration could be given to using topical vitamin D creams before and after laser tattoo removal treatments to assist in the healing of the site after treatment. 

Details about this article: 

Author: Natasha D Collings for City Tattoo Removal

Tuesday 13 August 2019

ENDNOTES:

1. “Vitamin D and the skin: Focus on a complex relationship: A review” Wedad Z. Mostafa, Rehab A Hegazy, Journal of Advanced Research (215) 6, 793-804, page 794

2. "Vitamin D status and its influence on outcomes following major burn injury and critical illness”, Al-Tarrah et al Burns and Trauma (2018) 6:11, page 2

3. "Vitamin D and the skin: Focus on a complex relationship: A review” Wedad Z. Mostafa, Rehab A Hegazy, Journal of Advanced Research (215) 6, 793-804, page 794

4. Vitamin D status and its influence on outcomes following major burn injury and critical illness”, Al-Tarrah et al Burns and Trauma (2018) 6:11, page 2

5. Clinical implications of vitamin D deficiency”, Beata Matyjaszek-Matuzek et al, Prz Menopauzalny 2015; 14 (2) 75- 81 page 75 and “Vitamin D status and its influence on outcomes following major burn injury and critical illness”, Al-Tarrah et al Burns and Trauma (2018) 6:11, page1

6. For an interesting article in relation to the immune system, what it does and how it does it, see: https://www.medicalnewstoday.com/articles/320101.php

7. "The role of Vitamin D in the Immune System as a Pro-Survival Molecule”, Clinical Therapeutics/ Volume 39, number 5, 2017, p902

8. “Vitamin D and immune function: an overview”, Hewson M, Proc Nutr Soc 12 Feb;71(1);50-61, page 50

9. "Impact of Vitamin D on immune function: lessons learned from genome-wide analysis”, Rene F. Chun et al, Frontiers in Physiology 21 April 2014, volume 5, Article 151, page 9

10. https://www.novusbio.com/research-areas/immunology

11. https://www.novusbio.com/research-areas/immunology

12.  "A type of white blood cell, of the immune system, that engulfs and digests cellular debris, foreign substances, microbes, cancer cells, and anything else that does not have the type of proteins specific to healthy body cells on its surface^[2] in a process called phagocytosis,”- https://en.wikipedia.org/wiki/Macrophage

13. "Antigen-presenting cells of the mammalian immune system. Their main function is to process antigen material and present it on the cell surface to the T cells of the immune system.”- https://en.wikipedia.org/wiki/Dendritic_cell

14.  “Impact of vitamin D on immune function: lessons learned from genome wide analysis”, Rene F. Chun et al, Frontiers in Physiology, 21 April 2014, volume 5, ArticleArticle 151 1-15, page 1
13.  “Vitamin D and immune function: an overview”, Hewson M, Proc Nutr Soc 12 Feb;71(1);50-61, page 50

15.  Vitamin D and the skin: Focus on a complex relationship: A review” Wedad Z. Mostafa, Rehab A Hegazy, Journal of Advanced Research (215) 6, 793-804, page 798

16.  Vitamin D and the skin: Focus on a complex relationship: A review” Wedad Z. Mostafa, Rehab A Hegazy, Journal of Advanced Research (215) 6, 793-804, page 798

17. “Vitamin D status and its influence on outcomes following major burn injury and critical illness”, Al-Tarrah et al Burns and Trauma (2018) 6:11, page 4, Vitamin D may be a simple treatment to enhance burn healing”: https://medicalxpress.com/news/2017-11-vitamin-d-simple-treatment.html, page 1

18. “Vitamin D status and its influence on outcomes following major burn injury and critical illness”, Al-Tarrah et al Burns and Trauma (2018) 6:11, page 4

19. https://www.ncbi.nlm.nih.gov/pubmed/30806461

20. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/interstitial-fluid

21.  “Vitamin D may be a simple treatment to enhance burn healing”: https://medicalxpress.com/news/2017-11-vitamin-d-simple-treatment.html, page 1

22. Vitamin D may be a simple treatment to enhance burn healing”: https://medicalxpress.com/news/2017-11-vitamin-d-simple-treatment.html, page 1

23. “Vitamin D status and its influence on outcomes following major burn injury and critical illness”, Al-Tarrah et al Burns and Trauma (2018) 6:11, page1

24. “Vitamin D status and its influence on outcomes following major burn injury and critical illness”, Al-Tarrah et al Burns and Trauma (2018) 6:11, page1

25.  “Vitamin D in burn-injured patients”, ˆBurns” Issue 45 (2019) 32 - 41, page 39

26. “Vitamin D may be a simple treatment to enhance burn healing”: https://medicalxpress.com/news/2017-11-vitamin-d-simple-treatment.html, page 1

27. “Cathelicidin-related antimicrobial peptides are a family of polypeptides primarily stored in the lysosomes of macrophages and polymorphonuclear leukocytes (PMNs).Cathelicidins serve a critical role in mammalian innate immune defense against invasive bacterial infection.” https://en.wikipedia.org/wiki/Cathelicidin

28. Vitamin D and the skin: Focus on a complex relationship: A review” Wedad Z. Mostafa, Rehab A Hegazy, Journal of Advanced Research (215) 6, 793-804, page 798

29. Vitamin D and the skin: Focus on a complex relationship: A review” Wedad Z. Mostafa, Rehab A Hegazy, Journal of Advanced Research (215) 6, 793-804, page 798

30.  https://www.osteoporosis.org.au/vitamin-d

31. “Update in Vitamin D”, John S. Adams and Martin Hewson, Clin Endocrinol Metab, February 2010, 95(2):471-478, page 471.

32. “Update in Vitamin D”, John S. Adams and Martin Hewson, Clin Endocrinol Metab, February 2010, 95(2):471-478, page 475

33. “Update in Vitamin D”, John S. Adams and Martin Hewson, Clin Endocrinol Metab, February 2010, 95(2):471-478, page 475

34. “Topical Delivery of Vitamin D3: A Randomised Controlled Pilot Study”, Mir Sadat-Ali et al, International Journal of Biomedical Science, 2014 Mar; 10(1): 21–24, page 21

Tattoo ink: Advanced Part 2: Do ink particles vary in size and does this effect treatment?

It may surprise you to know that a lot is not known about the ink which gets impregnated into your skin. There are some studies out there which examine the size and chemical constituents in tattoo ink and we have been sharing these findings with you through our "Tattoo Ink: Advanced" series. We have previously blogged about the chemical makeup of tattoo ink. Today we examine the size of tattoo ink particles and question whether or not size matters when it comes to laser tattoo removal. 

Do tattoo inks contain nanoparticles? 

Virtually all tattoo inks, except white inks, contain nanoparticles.

Particle size varies enormously from tiny black ink particles at 30nm to white ink particles, measuring 300 to 450nm in diameter. The size of pigment cells in colours, such as blue, red, orange and yellow,  usually fall in between the black and the white particle sizes.

Particles containing titanium white tend to be the largest. A recent study found a particular brand of white ink was made up of 98.55% of titanium dioxide and 1.45% aluminum.

Many inks contain titanium dioxide, as this is what is used to lighten and mix with darker colours. Of the inks containing titanium dioxide, the Emerald Green had the lowest amount of this element, measuring at just 5.45%.  Of all 29 inks Timko et. al. studied, there were only 10 which did not contain any titanium dioxide. They were the  2 black inks tested, as well as, Fire Red, Crimson Red, Venetian Red, Florida Orange, Black, Permanent Green, Blue Green, Tulip Red, and India Ink.

It would not surprise you to know that black ink, which contains the smallest particles is the easiest to treat vial laser tattoo removal, whilst the largest particles, that is the inks containing titanium dioxide are harder to treat and take longer to break the particles down. White ink takes the longest to remove, perhaps because they contain the largest tattoo ink particles. It is also perhaps due to the fact titanium dioxide has a habit of darkening after the first treatment. This darkening is reduced and eliminated via subsequent treatments, however, it does add one or two sessions to the treatment regime. 

Given the difference in particle size, it stands to reason some inks will take longer than others to remove. White ink has the largest particles and commensurately, it takes us the longest to remove. Black ink particles are the smallest and hence takes fewer treatments to achieve a full removal. 

If you have a tattoo you want to remove you should check out City Tattoo Removal. The clinic is in the centre of Brisbane’s CBD. City Tattoo Removal uses Fotona’s QX MAX which is simply one of the best tattoo removal lasers in the world. They are able to treat all common tattoo inks including white and black and all the colours in between. 

Give Tash a call to arrange a consult or a treatment anytime! You can call Tash on 3003 0358 or email at contact@citytattooremoval.com.au

What happens to tattoo ink once it has been placed in your skin?

This article seeks to explain what exactly happens to ink once it has been inserted into your skin to form a tattoo. 

But first, we need to discuss how it is tattoos are made.  We will then discuss what happens to the ink once it has been placed into your skin and your options should you choose to remove your ink. 

How are tattoos made? 

The simple explanation: 

Tattoos are created by using needles to insert pigment under the skin, eventually forming a permanent image.

The more detailed explanation:  

On a tattoo machine, the needles are really working like a combination of a plough and a seed drill - there is an element of tearing the skin, as well as creating multiple punctures. As the needle drags across the skin, it creates a channel beneath the surface for the ink to be “seeded” in. 

Since this is a process which is traumatic to the skin, artists have to be careful not to “overwork” the needle - too much action will create a lot of scarring. This explains the warped appearance of pieces by inexperienced tattooists.

So what happens when the needle is inserted into your skin (other than it stings)?

But first a bit of science: 

Your skin comprises multiple layers, the epidermis, the dermis, and the hypodermis. 

Image courtesy of http://archives.evergreen.edu/webpages/curricular/1999-2000/humanbio/TattooInk.htm

The epidermis is the outer layer of skin and is made up of several different strata (or sublayers), which together create the waterproof seal we all come wrapped in. The cells of the epidermis are created at the lowest stratum basale and gradually work their way upwards and outwards. The topmost layer is dead skin cells which are constantly shedding. 

At what level in the skin is your tattoo ink situated?  

Tattoos are inserted between the epidermis and the dermis. The pigment sits below the stratum basale in the epidermis. This is why the tattoo does not peel away with the dead skin cells from your epidermis. Once the pigments have been put into place,  they find themselves trapped amongst the architecture of the lower skin, which includes hair follicles subcutaneous glands and various lymphatic vessels. 

Image courtesy of http://archives.evergreen.edu/webpages/curricular/1999-2000/humanbio/TattooInk.htm

What parts of the ink remain in your skin and what happens to the other parts?

Tattoos take advantage of your body’s natural defence systems in order to hold them in place. Your body recognizes the ink particles as being a foreign body not made up of your DNA and will send troops, white blood cells, if you want to be particular, to clear off the new particles. 

Soluble substances such as water and isopropanol, which are in virtually all tattoo inks, get distributed locally into tissue and the bloodstream within a short period of time: (1) Other particles, which are not so soluble, will also move into local tissue and towards your lymph vessels. Ink is known to travel by this method to reach the nearest regional lymph node to the tattoo (usually in your groin or armpit). Animal experiments on rabbits show that approximately 1/3 of ink disappears from the skin within 6 weeks of tattooing.  This finding was also confirmed by pigment extraction from long-existing tattoos: (2)

However, if your immune system encounters a pigment which is inert and non-toxic, a particular kind of white blood cell (macrophages) will begin to form scar-like granulation tissue. The dermis gradually heals thanks to collagen growth, while the battle-scarred epidermis simply flakes away; meanwhile, the ink pigments settle into a single layer and the tattoo is held in place by fibroblast cells.

It is presumed that some ink particles are too large to be transported into the local tissues and/or lymph nodes: (3) Applied correctly, if the tattoo will look sharp and bright for some time, however, it will inevitably fade and look a little worse for wear as the pigment layer sinks further into the base of the dermis. This process also causes the tattoo to lose its definition which is why old tattoos take on a softened appearance. 

To date, there is very little information as to how or whether tattoo inks travel to other organs of the body, as most studies done in this area have been done on small animals, such as rabbits. It is therefore questionable as to whether there is a similar traveling processes in humans.  

Inks, lymph nodes and tattoo removal: 

Your lymph nodes act as an important first pass organ before ink travels into the bloodstream and is then excreted through body processes such as urination or defecation. 

Several studies have found that ink can coalesce in the lymph nodes nearest the tattoo. This is particularly so for heavily inked people or for older tattoos. One study examined a patient who had his tattoo for 40 years. Examination showed the ink had settled deeper in the dermis and also travelled into the regional lymph nodes. It is thought that tattoo ink is naturally dispersed to the lymph nodes to process, however it can get caught in the node if the particle is too big to pass through. 

Laser tattoo removal takes advantage of the lymphatic system to pick up and process ink which has been fractured into tiny fragments during the treatment session. These particles are so small the lymphatic system is able to identify them and process them from the body via normal extortion methods. 

At City Tattoo Removal we use Fotona’s QX MAX, which is one of the best machines in the world for laser tattoo removal. The QX MAX shatters ink into fragments so small they are easily and naturally excreted from your body. 

If you are curious about removing a tattoo, why not contact City Tattoo Removal today and make a consultation booking to discuss your removal needs in person. 

Contact points: 

Email: contact@citytattooremoval.com.au

Phone: 07 3003 0358

Endnotes: 

(1) The Council on Health and Disease Prevention “Tattoos - Health, Risks and Culture: With an Introduction to the “Seamless Prevention; Strategy”, Jorgen Serup et all p102

(2) www.karger.com/Article/Pdf/369222

(3)  www.karger.com/Article/Pdf/369222; http://archives.evergreen.edu/webpages/curricular/1999-2000/humanbio/TattooInk.htm

Tattoo Ink: Advanced: Part 1

Tattoo Ink: Advanced: Part 1: 

Tattoos are extremely popular, however, we are concerned people really don’t know what is being placed in their bodies. 

This article will explore what is in your tattoo ink and the possible consequences. 

What is tattoo ink? 

Tattoos contain a lot of metallic salts and organic dyes. You would be surprised to find out what exactly is in your ink. 

Tattoo ink is made of largely insoluble nanoparticles and microparticles. The insolubility of these particles is what makes tattoo ink last for decades under the skin. Inks also contain soluble particles and contaminants, such as foreign bodies and bacteria. 

What is in my ink? 

On the whole lack of labeling or correct information on tattoo ink labeling is a big problem: (1)

It is almost impossible for the tattoo industry in any given country, or across the world for that matter, to control the ingredients and safety of tattoo ink as the industry is already internationally established, albeit somewhat scattered and discombobulated. Countries may try to enact legislation which enforces strict guidelines on ink manufactured within their borders, however, nefarious operators would be able to avoid such guidelines by purchasing their ink from any one of the multitudes of suppliers on the worldwide market. 

There are various publications outlining the types of pigments and ingredients which make up popular inks. 

Various bodies have studied the makeup of ink in recent years. We have collated the research performed by The Council on Health and Disease Prevention (“the Council”), and Leonardo Marini, Beatrice Bocca et al. and have complied the findings in the table below: (2)

Table 1: 

Colour	Ingredients and Elemental composition	QX MAX Laser wavelength for treating pigments	Other wavelengths used in clinics without the QX MAX
Black	Ingredients: India ink, carbon, iron oxide, logwood extract, magnetite, graphite, ash  Elements: Aluminum, Iron, sulfur, oxygen	1064nm	1064
White	Ingredients: Titanium dioxide, zinc oxide, corundum Elements: Titanium, aluminum	1064nm
Red	Ingredients: Mercury sulphate, cadmium selenide, Sienna (red ochre, ferric hydrate and ferric sulphate), azo dyes, hematite Crimson red: Elements: Silica, carbon, oxygen, magnesium Fire red: Elements: Aluminum, chlorine, sulfur, carbon, oxygen,  Devil’s red: Titanium, aluminum, silica, carbon, oxygen.  Lotus red: Titanium, aluminum, carbon, oxygen Cerise: Titanium, aluminum, iron, carbon, oxygen	532nm	532nm
Flesh	Iron oxides	1064nm
Yellow	Cadmium sulphide, ochre, cur cumin yellow, azo dyes, limonite, anthraquinone Lemon yellow: Elements: Titanium, aluminum,  carbon, oxygen s2`
Brown/. Orange	Ochre Venetian Brown: Elements: Aluminum, silica, iron, oxxygen Florida Orange: Elements: Carbon, oxygen	1064nm	755nm and 1064nm
Violet	Magnanese violet, indigold	532nm
Green	Chromium oxxide, hydrated chromium sesquioxide, malachite green, lead chromate, ferro-ferric cyanide, cur cumin green, phythalocyanine dyes. Permanent green: Aluminum, copper, chlorine, carbon Emerald Green: Titanium, aluminium, chromium, chlorine, carbonoxygen Parrot green: Titanium, aluminium, chromium, chlorine, carbonoxygen Misty green: Titanium, aluminium, chlorine, carbon oxygen	650nm	755nm and 695nm
Blue	Cobalt aluminate, phthalocyanine, ferric ferrocyanide, cur cumin green, phthalocyananine dyes. Sky blue:Titanium, aluminium, copper, chlorine, carbon, oxygen. Blue green: Aluminium, copper, chlorine, carbon, oxygen Misty blue: Titanium, aluminium, chlorine	585nm	755nm and 695nm

The Council also performed physical inspections and microbial studies in opened and unopened tattoo ink stock bottles. Surprisingly, 6 of the 58 stock bottles (10%) were contaminated with bacteria and 1 of 6 samples (17%) of open stock bottles were contaminated. The bacteria found in the samples included those considered pathogenic in humans as well as non-pathogenic environmental bacteria: (3)

31% of manufacturers only provided the brand name on the packaging of their ink. 42% of manufacturers claimed their ink was sterile. There was no information in respect of content, sterility, risks or expiry date. 28% of the seals on unopened inks were leaking. 54% of labeled inks indicated a use by date of 2 to 3 years after manufacture: (4)

So, all in all, the information about the purity and makeup of tattoo ink appears to be a little concerning. Before you get too concerned about the make up of ink and what it may be doing to your health, it is worth remembering that any connection between tattoos and cancer are so low as to be judged coincidental by the medical profession. 

If, however, you were looking to remove some of your colourful ink, it is definitely worth doing your homework when it comes to treatment providers. 

If you have black or red ink, your selection of service providers for removal will be large. This is because all as all Q-Switched Nd:YAG lasers used to treat tattoo ink should have the 1064nm and the 532nm wavelengths. The 1064nm wavelength treats black ink, whilst the 532 treats red ink. 

Where your selection of tattoo removalist becomes a little more complicated is when you have a tattoo which is colourful, with say, blue, green, yellow, tan or pink inks in it. Most tattoo removalists will be able to treat the black ink particles in these tattoos,  however, they do not have a powerful enough laser or alternative wavelengths in their machine to treat whites, blues, greens, pinks and the like. 

These treatment providers either have to restrict the colours they can treat or they have to use an additional laser or lasers to treat colourful ink. The most common are the Ruby laser and the Alexandrite laser. Care needs to be taken when being treated with these machines. Firstly, they are their own specialist laser and hence your laser operator needs to be familiar with and conversant with all the features and risks inherent with using each laser. This requires specialist knowledge. Such knowledge is usually not found in beauty store chains. Particular care must be taken when using these lasers as they have been known to leave scars and pigmentation changes. 

City Tattoo Removal is different because we are a one-stop shop for all your tattoo removal requirements. We can treat all common tattoo inks, including black, red, navy, brown, red, pink, yellow, tan, light green, dark green, light blue. We use Fotona’s QX MAX laser which is one of the best lasers in the world for tattoo removal. The QX MAX is one of the only lasers in the world which can treat all common tattoo inks. 

If you have a tattoo you want to remove, you can’t go past the professionalism and results you will get at City Tattoo Removal. Call Tash on 3003 0358 or email contact@citytattooremoval.com.au to book your consultation or removal appointment today!

Check our our website at:

www.citytattooremoval.com.au

You can also find us on:

Facebook: @citytattooremovalbrisbane

Instagram: @citytattooremoval

Endnotes: 

(1) The Council on Health and Disease Prevention “Tattoos - Health, Risks and Culture: With an Introduction to the “Seamless Prevention; Strategy”, Jorgen Serup et all p95.

(2) Leonardo Marini: www.prime-journal.com/tattoo-removal-using-a-multilayer-q-switched-laser/\

Re particle size: Beatrice Bocca et al “Size and metal composition characterization of nano- and Microparticles in tattoo inks by a combination of analytical techniques’, https://pubs.rsc.org/en/content/articlelanding/2017/ja/c6ja00210b/unauth#!divAbstract.

(3) The Council on Health and Disease Prevention “Tattoos - Health, Risks and Culture: With an Introduction to the “Seamless Prevention; Strategy”, Jorgen Serup et all p95 to 100.

(4) he Council on Health and Disease Prevention “Tattoos - Health, Risks and Culture: With an Introduction to the “Seamless Prevention; Strategy”, Jorgen Serup et all p95 to 100.