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Tattoos: even parting with them is not without risks

21/2015, 13.08.2015

The BfR has for the first time detected hydrogen cyanide following laser treatment of a blue tattoo pigment

As tattoos are becoming more popular, so is the trend to get them removed again. However, data on the assessment of the safety of removal methods is not available yet. Using state-of-the-art analytical methods, the BfR has now identified the fragmentation products resulting from ruby laser treatment of the copper-containing pigment phthalocyanine blue. These include 1,2-benzene dicarbonitrile, benzonitrile, benzene and hydrogen cyanide. “We have been able to prove for the first time that during laser treatment of a tattoo pigment in aqueous suspension, substances are created in concentrations which would be high enough to cause cell damage in the skin”, says BfR President Professor Dr. Dr. Andreas Hensel. The potential risks vary depending on the size of the tattoo, pigment concentration, part of the body affected, irradiation dose, and laser wavelength used. In the judgment of the BfR, further research is urgently needed in this area. Based on the data presented, the institute will have to consider the potential fragmentation products of tattoo pigments in its future risk assessments. Consumers should be comprehensively informed about both the potential risks of tattoos and tattoo removal. The results of the research on tattoo removal were published in the Nature Publishing Group magazine Scientific Reports (DOI: 10.1038/srep12915 1) on 5 August 2015. On its website, the BfR has already drawn attention to the potential risks associated with tattoos 2004. A review in English providing an overview of the topic has recently been published in the prestigious medical journal The Lancet (DOI: 10.1016/S0140-6736(15)60215-X).

Tattoos that are no longer wanted are typically removed by means of laser treatment. Possible fragmentation of pigments into toxic or carcinogenic components following removal of tattoos is currently subject of scientific investigation by BfR. The patterns of chemical breakdown products and their long-term health effects after release and systemic distribution in the human body are still largely unknown. To date, data on the laser-induced fragmentation of pigments used in tattoo inks is available for a few azo dyes only. Data on the decomposition of rather lightfast molecules such as phthalocyanines is still missing. Thus no data was available on the safety of copper phthalocyanine (also known as phthalocyanine blue or Pigment B15:3) as a tattoo ink nor on its breakdown pattern, even though copper phthalocyanine currently seems to be the only blue organic pigment used in tattoos available on the European market.

In clinical dermatology, ruby lasers are, amongst other kinds of treatment, often used to remove blue tattoos. As part of this treatment, the specific wavelength used leads to the fragmentation of the pigment due to heat generation. The BfR study conducted simulated the laser-induced and temperature-dependent breakdown of the blue pigment copper phthalocyanine. All volatile fragmentation products were identified by means of gas chromatographic (GC) separation and subsequent mass spectrometric (MS) analysis. Since pyrolysis-GC/MS (Py-GC/MS) analyses also provided evidence for the occurrence of volatile and highly toxic compounds such as hydrogen cyanide (HCN) and benzene, the BfR developed a dynamic headspace (DHS) method to avoid any significant loss of the volatile compounds during work-up and analysis. By applying DHS–GC/MS along with two-dimensional gas chromatography coupled to time-of-flight mass spectrometry (GCxGC-ToF-MS) we were then able to sensitively and specifically detect the expected compounds.

Among all of the compounds emerging upon ruby laser irradiation of copper phthalocyanine, hydrogen cyanide (HCN) is of particular relevance due to its strong cellular toxicity. It is long been known as a colorless, rapidly acting toxic gas. If the quantities of HCN detected by the BfR are transferred to the situation in the human body (in vivo), HCN concentrations of up to 30 micrograms (µg) per millilitre (ml) would emerge in certain skin layers as a result of laser treatment. Although the most common ways of cyanide poisoning are ingestion and inhalation, cases of adverse health effects resulting from percutaneous absorption have also been repeatedly described. It is therefore to be assumed that local pigment concentrations of approx. 30 μg/ml HCN which might occur in dermal layers well supplied with blood vessels pose a potential health risk, especially if extremely large tattoos are irradiated (e.g. upper arm > 500 cm2).

Several tattoo removal methods are currently used. However, successful removal cannot be guaranteed, and certain methods pose health risks such as scar formation and allergic reactions.

Whereas tattoo removal by means of laser irradiation can lead to toxic fragmentation products, surgical removal of the affected skin area entails the risk of infection. For example, in 2011 individual cases were reported to the BfR where unwanted effects occurred following application of liquid tattoo removers. In some cases this resulted in severe inflammation of the skin with subsequent scarring.

The BfR recommends that tattoo removals are only performed using procedures approved by the medical profession and only by trained personnel in properly equipped facilities. Under all circumstances, consumers must be given comprehensive information about the possible risks associated with tattoo removal.

The BfR does not hold an exhaustive list of procedures for removing tattoos. New methods are constantly developed, and there is neither any requirement to report these new procedures to the authorities nor are these methods tested by the authorities.

A description of the various methods for removing tattoos and associated health risks can also be found in the BfR Opinion No. 013/2013 “Requirements for Tattoo Inks” from 28 August 2012, Point 6.

About the BfR

The German Federal Institute for Risk Assessment (BfR) is a scientific institution within the portfolio of the German Federal Ministry of Food and Agriculture (BMEL). It advises the German Federal Government and Federal States (so-called “Laender”) on safety issues related to food, chemicals and consumer products. The BfR conducts its own research on topics that are closely linked to its assessment tasks.


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