MEDICAL TATTOOS FOR SKIN CAMOUFLAGE: BENEFITS, RISKS AND ALTERNATIVE OPTIONS

Medically Reviewed by Dr. Rosmy Barrios - July 24, 2024

Medical tattooing is a form of skin camouflage in which a tattoo is used to cover up or beautify unsightly skin that might otherwise detract from psychosocial well-being. The process is the same as acquiring an ordinary permanent tattoo, which involves injecting ink into the deeper layers of the skin. Micropigmentation is another name used to refer to medical tattooing.

Tattoos have been successfully used to help cover up birthmarks, scars, and areas of obviously discolored skin. However, there may be drawbacks to exposing these particularly vulnerable areas to chemical ink dyes that the average tattoo artist is unlikely to be aware of.

The article below aims to weigh the pros and cons of medical tattoos, highlighting their best uses, risks, contraindications, and possible alternatives.

Uses and Benefits of Medical Skin Camouflage

The two most common uses for medical tattoos include masking skin discoloration and baldness. Benefits are described briefly below.

Baldness. Scalp micro pigmentation is known to be one of the safest and most effective uses of medical tattoos.[1] These tattoos resemble the ‘shaved head look’ and have been promising strategies to counteract receding hairlines, eyebrow loss, male pattern baldness, and all-cause Alopecia. For serious hair loss, treatment usually demands hair or skin grafts that aim to scatter functional hair follicles (minimizing the appearance of hair loss) or replace lost hair from a donor. Tattoos may be able to help jump a waiting list or be an entirely effective stand-alone solution for such patients.

Skin Blemishes and Discolouration. Medical tattoos have been used to properly color the skin and conceal cosmetic blemishes for a wide variety of conditions, including:

• Vitiligo and other pigmentation disorders
• Birthmarks
• Scarring due to injury, accidents, burns, or surgery
• Mastectomy and other breast operations

Additional Benefits

Apart from being more aesthetic, other benefits of medical tattooing include the following:

• Self-Esteem and Identity Reformation. Scars, burns, and other blemishes can sometimes affect a person’s self-image and sense of identity. This is where a medical tattoo may help. This point may be especially pertinent for women who have undergone a mastectomy, as it often leaves their bodies deformed and detracts from their self-esteem and identities[2]. This concept extends to many other cosmetic problems as well, including baldness, birthmarks, and skin disorders.
• Cost Effective. Medical tattoos are likely to be more cost-effective than other medical treatments, such as cosmetic surgery or laser ablation, that may lighten skin, remove blemishes, hide depigmentation, or overturn deformity. On the other hand, a medical tattoo may fade away after a year and require multiple appointments, especially for those with hypopigmentation disorders[3]. Supplements and medication may be more cost-effective and successful than opting for a tattoo, especially for treatable medical conditions or small scars and burns.

Tattoo Safety: Is it Worth the Risks as a Medical Treatment?

While the benefits might seem obvious to those with pigmentation disorders, skin conditions, or blemishes, it is important to weigh them against the risks involved. Unfortunately, tattoo artists are not likely to be informed about the long-term medical complications of receiving a tattoo, even if they understand the short-term side effects.

The risks of getting a tattoo for medical reasons are summarized below, alongside complications and risk factors.

Side Effects

Common side effects of medical tattoos include:

• Skin Reactions. As skin tissue gets damaged in the process, it is normal for a new tattoo to be sensitive for a short while afterward. Swelling, reddening of the skin, or bruising could result from the surrounding skin becoming inflamed. Even in people with pigmentation problems like Vitiligo, these adverse effects usually go away after a few days.
• Infections. Despite hygiene practices, skin infections are still common after receiving a tattoo. Common infections arising from tattoos include Staphylococcus Aureus, Hepatitis and viral infections,[4] Many countries have banned blood donation from those with a tattoo for 4-12 months after the procedure to avoid the risk of transmission of infection.
• Dissatisfaction. The competency of the tattoo artist, as well as any of the side effects or complications, can lead to patient dissatisfaction and may warrant a tattoo removal. Tattoo complications can promote social stigma, anxiety, and a lower sense of self-esteem, which may be worse for the individual than living with the original blemish that the tattoo was intended to mask in the first place. Some reviews report that overall satisfaction rates for medical tattoos vary between 80 and 100%.[5]

Complications

In addition to short-term effects that frequently resolve, evidence reveals that tattoos are notorious for posing long-term health risks and complications that may detract from the point. The main ones are discussed below.

• Discoloration. Medical tattoos for those with skin pigmentation disorders may backfire and lead to further skin discoloration. This can be the result of mismatched tattoo inks that fail to camouflage the blemish adequately or due to skin reactions that cause skin pigmentation disorders[6] or the dye to change color completely. This complication is common (occurring in over 20% of cases) and may detract from the purpose of medical tattooing by highlighting the problem area.
• Cancer. According to sources, there is currently no conclusive evidence suggesting that tattoos alone increase the risk of skin cancer or lymphoma. However, it is worth noting that tattoo inks can sometimes contain ingredients that are considered carcinogenic, which warrants caution. Therefore, it is essential to check with your tattoo artist on the types of inks they use, their ingredients, and where they are sourced from. Some reports point to tattoos hiding moles on the skin, thereby making it difficult to evaluate them. Cases of melanoma ‘hidden’ by a tattoo have been recorded. [7][8] In addition, it is advisable for those with a history of melanoma to avoid getting a tattoo since a second melanoma can potentially develop, which, if hidden by the tattoo, could be delayed in being diagnosed. If you are young and have a family history of melanoma, many moles, or unusual skin moles, it is wise to consult a dermatologist before getting a tattoo. They can assess your skin, advise on safe tattoo placements, and remove any unusual moles before you get inked. For those with cancer or undergoing associated treatments such as chemotherapy or radiation, it is best to hold off on getting a tattoo. Furthermore, cancer can compromise the immune system and lead to side effects from tattooing. Therefore, it is vital to have a conversation with your oncologist before deciding to get a tattoo.[9] Every individual's response to tattoos and how they affect them over time will differ, so it is important to practice good tattoo hygiene, including selecting a reputable tattoo artist and providing proper aftercare to reduce any hazards.
• Organ Deposition. The chemical dyes used in tattoos contain a variety of particle sizes, some of which are small enough to pass through cell membranes. These nanoparticles can make their way to the bloodstream as well as other organs and tissues, eventually accumulating there. The lymph nodes, brain, and nervous system are particularly vulnerable. Lymph node depositions are occasionally confused for metastatic cancer and unnecessarily raise alarm.[10] Depositions of heavy metals and other chemicals found in tattoo inks may increase the risk for other types of cancer or systemic inflammatory diseases. Studies also reveal that most of the ink from tattoos cannot be excreted and that laser tattoo removal promotes the systemic spread and deposition of tattoo ink all over the body.
• Late or Chronic Reactions. When the skin attempts to remove tattoos from the body, potentially allergenic materials can pass into the bloodstream or to the lymph nodes, which can lead to chronic or delayed allergic reactions. These can sometimes be expressed even up to several years after receiving the tattoo and can substantially contribute towards inflammatory illness.[11] Those with tattoos may also find that the tattooed skin is much more sensitive to sunlight and may experience skin reactions in the area upon exposure to the sun[12].

Risk Factors

Limiting the below risk factors where possible may help increase the chances of success.

• Skin Disease and Immune Disorders. Skin diseases and immune disorders are likely to exacerbate both side effects and the risk of complications in those receiving a tattoo due to heightened sensitivity and chronic inflammation or immune suppression.
• Dye Color. The risk for adverse reactions and cancer may be worse for inks that make use of color as opposed to black ink. This is thought to be ascribed to heavy metals that impart color, such as Chromium in green ink, Cobalt in blue ink, and Cadmium in yellow ink. This is one of the largest drawbacks for those wanting to opt for skin camouflage. If at a higher risk of skin cancer (i.e. sensitive or light skin, comorbid skin condition, chronic infections, etc.), it may be best to opt for a medical tattoo that does not attempt to match skin tones and instead makes use of a cover-up image in black ink.
• Chemical Formula Used. The chemicals used in the inks were initially regulated by tattoo artists and parlors at the local level. This led to many unnecessary adverse events and complications for those receiving tattoos. In the last couple of decades, many countries have insisted on regulating the chemicals used in tattoo inks and have put laws in place that make sure manufacturers are liable for producing unsafe products. Before opting for a tattoo, it might be advisable to find out what the ingredients of the tattoo ink are, how they are regulated in your region, and if it is possible to opt for safer or more natural alternatives. Certain ingredients are known to promote pigmentation disorders, such as Paraphenylenediamine.
• Hygiene Practices. Tattoo parlors that make use of proper guidelines and abide by standard hygiene practices often limit the risk of infections and skin reactions. These include disinfecting equipment and the skin prior to administering ink and ensuring the ink is not past its expiry date or contaminated.
• Sun Exposure. Tattoos are known to discolor in sunlight and may also promote reactivity in sensitive individuals. It is advisable to put sunblock on a skin tattoo when spending time in the sun or to cover it up with clothing.

Possible Contraindications

A medical tattoo may be contraindicated for those with the following health conditions:

• Severe Vitiligo. Medical tattooing may not be recommended for patients with Vitiligo where the condition is aggressive, severe, or non-segmental. It is possible for the inflammation induced by a tattoo to encourage rapid expansion of depigmentation over time. [13] Experts suggest that tattoo artists avoid inking on or near the edges of vitiligo spots to avoid encouraging their growth. Many individuals with vitiligo are also disappointed with the outcomes of the tattoo due to the higher potential for discoloration and unexpected results.
• Any Active Skin Conditions. Psoriasis, Vitiligo, and Lichen planus are commonly known to give rise to the “Kobner phenomenon”, where a tattoo coverup of the diseased area may result in symptom exacerbation. This can occur within days to years after receiving the tattoo. Experts warn that while these conditions are frequently known for exhibiting the Kobner phenomenon, any skin condition may be prone to this risk. Whether or not a tattoo is contraindicated may depend on the severity of the disease and whether the patient is taking immunosuppressant medications or not. As a general rule, a tattoo over an actively afflicted area should be avoided until the area has substantially calmed down or is no longer active. [14]
• Pigmented Lesions and Moles. It is advisable to avoid getting a tattoo to hide a pigmented lesion or mole in order to lower the risk of cancer. Experts recommend allowing such blemishes a space of 0.5 - 1 cm in case they grow in time.
• Skin Cancer. Those with a prior history or current skin cancer ought to avoid receiving a tattoo as it may promote either growth, resurgence, or metastasis.
• Lymphoma. Cancer of the lymph nodes may become greatly intensified as a result of receiving a tattoo, especially due to the accumulation of inks in these tissues.
• Immunocompromised Individuals. Those with disorders of reduced immunity may be at risk for infections and sepsis as a result of getting a tattoo.
• Advanced Diabetes. Those with diabetes may wish to avoid receiving a tattoo if their condition is at an advanced stage in which wound healing is compromised and may lead to gangrene.
• Bleeding Disorders. Tattoos can occasionally promote bleeding and may be an issue for those with bleeding disorders. However, this is likely to be a mild contraindication, especially for those taking coagulant medications.

Potential Alternatives to Medical Tattooing

For those whom medical tattoos are contraindicated or who do not wish to risk long-term complications, there are several alternatives one can try alongside conventional treatment. Some of these include:

Stem Cell Therapy. Stem cell deficits have been shown to contribute to a wide variety of skin conditions, including pigmentation disorders and conditions of excessive scarring. Stem cell therapy has been used to successfully treat wounds, speed up recovery and lessen the severity of scarring and burns. Several clinical trials have revealed that stem cell therapy, specifically platelet-rich plasma, can help restore pigmentation to Vitiligo-affected skin and reduce pigmentation in those with Melasma. Patients with Vitiligo also responded better to other treatment options while receiving stem cells, such as Phototherapy.[15]

Dietary and Topical Antioxidants. Many nutrients and antioxidant phytochemicals have shown promise in treating all kinds of skin afflictions, from Vitiligo to birthmarks to excessive scarring. Carotenoids, Vitamin E, Vitamin C, Resveratrol, and others appear to promote the correction of aesthetic defects by restoring pigmentation[16] and enhancing wound healing processes[17][18]. Both topical and dietary intake can increase the concentrations of these ingredients in the skin and help regulate its functions and appearance.

Conclusion

Medical tattoos have offered many patients with baldness, skin conditions, and cosmetic deformities a new lease on life. For some, they may be a more cost-effective and attractive treatment option that allows them to reclaim their self-image and identities from potential psychosocial harms. While this may be an exciting treatment option, the risks may outweigh the benefits for some. The combination of chemicals and damage to the skin during a tattoo can worsen skin disease symptoms instead of providing camouflage. Additionally, the process may contribute substantially towards the development of skin or lymph node cancer. The risks may be minimized by limiting the amount of chemicals used, tattooing smaller areas of skin, opting for a professional service from qualified personnel, and avoiding sun exposure. Stem cell therapy and antioxidant use may be better alternatives when a medical tattoo is contraindicated.

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Sources:

• [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4382144/
• [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7689823/
• [3] https://pubmed.ncbi.nlm.nih.gov/37263205/
• [4] https://pubmed.ncbi.nlm.nih.gov/25833625/
• [5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8214112/
• [6] https://cosmoderma.org/pigmented-contact-dermatitis-a-brief-review/
• [7] https://www.health.harvard.edu/blog/tattoos-moles-and-melanoma-201308056578
• [8] https://jamanetwork.com/journals/jamadermatology/fullarticle/1722816
• [9] https://www.cancercenter.com/community/blog/2023/02/what-you-should-know-about-tattoos-and-cancer
• [10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411590/
• [11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5718459/
• [12] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5868782/
• [13] https://pubmed.ncbi.nlm.nih.gov/23350817/
• [14] https://pubmed.ncbi.nlm.nih.gov/35020865/
• [15] https://karger.com/books/book/174/chapter/5110374/Contraindications-for-Tattooing
• [16] https://mednexus.org/doi/10.1097/JD9.0000000000000171
• [17] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5063591/
• [18] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8684849/

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