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Tattoo removal affected by colors, size, patients’ smoking habits

The colors and size of tattoos, along with whether a patient smoked and other factors, influenced response rates to removal treatments using Q-switched lasers, according to study results.

Researchers evaluated 352 patients (median age, 30 years; 201 men) with tattoos at a referral center in Milan, Italy, from 1995 through 2010. Patients were treated with Q-switched 1064/532-nm Nd:YAG and 755-nm alexandrite lasers according to tattoo colors. Sessions were scheduled at 6 weeks or longer. Other than hypochromia or skin darkening, tattoo removal without additional adverse effects was considered successful. Tattoos had a median age of 4 years, were 50.5 cm2 and had a median of one color (range 1-7). They were located on the limbs (48%), trunk (44.9%), or face and neck (7.1%).

 

Luigi Naldi

Cumulative removal success rates were 47.2% (95% CI, 41.8%-52.5%) after 10 sessions and 74.8% (95% CI, 68.9%-80.7%) after 15 sessions. Investigators said the chance of achieving removal after 10 treatments declined by 69.7% for smokers compared with nonsmokers and by 79.5% for tattoos other than black or red. Other factors associated with reduced clinical response were a tattoo larger than 30 cm2, tattoos located on the feet or legs, tattoos older than 3 years, high color density, an interval between treatment sessions of 8 weeks or less and development of a darkening phenomenon.

“The clinical results of tattoo removal may vary greatly from one patient to another,” researcher Luigi Naldi, MD, director of Centro Studi GISED in Bergamo, Italy, told Healio.com.“Learning about factors affecting outcome is crucially important.

“Two findings may be surprising and point to the cellular mechanisms involved with tattoo removal, the less satisfactory results obtained in people who smoke cigarettes and the better results obtained with long intervals between treatment sessions [intervals longer than 8 weeks],” Naldi said. “Once fragmented by the laser, pigment particles are cleared by cells … . These cells need time to work properly, and substances contained in cigarette smoke may affect their activity.”