Question from practice: Can you help with tattoo aftercare?
A. The word “tattoo” originally came from the Tahitian word “tattau” which means to “mark”. The practice of using dyes and pigments to produce a design on the skin has been an integral part of various cultural and religious ceremonies and been practised for thousands of years.
It is thought that the past 10 to 20 years has seen an increase in the number of individuals who have a tattoo. The modern day process involves the deposition of various dyes or pigments into the dermis to produce a permanent design. The process of tattooing involves the use of a needle attached to a machine that punctures the skin between 50 and 3,000 times per minute, delivering a drop of insoluble ink with each puncture. The process is normally performed without an anaesthetic and can last several hours, particularly if the tattoo is large. The huge number of puncture wounds to the skin increases the potential risk of infection and there is invariably some degree of bleeding, especially if the artist goes too deep into the skin. The risks of infection are minimised by ensuring that all equipment is sterile before use and the tattooist wears gloves.
Tattoo studios are regulated by local government (it is an offence to trade without a licence) which has responsibility for ensuring that such premises are registered and have procedures in place to minimise the risk of infection. Although all tattooists will have undergone some level of training, there are no formally recognised, minimum training requirements. Consumers do also have some level of protection under the 1982 Sale of Goods Act” should they experience any problems with a tattooist and the level of work performed. Furthermore, under the 1969 Tattooing of Minors Act” it is illegal to tattoo anyone under 18 years of age, even with parental consent.
Because a tattoo is a wound the skin undergoes a healing process. The timescale varies depending on the size of the tattoo, but in general the skin will be healed after about four weeks. Although tattoo after care will vary between practitioners, it normally involves application of cling film immediately after the tattoo is finished. This is left in place for several hours and once removed the area is washed with lukewarm water and mild soap. Some tattooists recommend washing the area up to five times a day to keep it clean.
Tattoos should not be allowed to dry out because this creates a scab, which can lead to loss of ink. Furthermore, a good deal of clinical evidence suggests that moistened wounds heal faster. Many tattooists, therefore, advise that an emollient cream is applied to the tattoo several times a day.
In the first two weeks after a tattoo, it is recommended that people avoid prolonged contact with water (eg, bathing, swimming and saunas etc), which is a potential source of infection and may cause any scab to come off too quickly. Some tattooists recommend covering the tattoo with an occlusive agent ,such as petroleum jelly when showering (although, anecdotally, petroleum products are said to fade the tattoo colour and so should be removed after a shower).
It is advisable to avoid intense sunlight or the use of sunbeds because UV radiation can cause the colour to fade — even once the tattoo is fully healed — so it is also worth using high factor sunscreens on a tattooed area. As the tattoo heals there is often some slight degree of scabbing or scaling of the skin. The urge to scratch the skin should be resisted since this can also lead to loss of colour and infection. Tattooists will also advise people to keep a tattoo covered in the early weeks, particularly if it is in contact with clothing.
Bepanthen (Bayer) is a cosmetic product marketed for the treatment of nappy rash. However, studies suggest that a main ingredient, dexpanthenol, is effective in the treatment of injured and irritated skin: when used topically, it is converted into pantothenic acid, which is a component of co-enzyme A, which in turn serves as a co-factor for various enzyme catalysed reactions.
Skin regeneration after an injury requires activation and proliferation of fibroblast cells and several studies suggest that pantothenic acid is able to enhance fibroblast activity during the process of wound healing. Although there are no formal studies assessing Bepanthen in the after care of tattoos, its use and recommendation has grown through anecdote and experience.
Other topical treatments which are suggested include Preparation H and various commercial after-care products. Although none of these products has been formally assessed as adjuncts in tattoo healing, they have become recommended based on the experience of the tattooist. Bepanthol is a cosmetic range from Bayer that contains dexpanthenol but it is not available in the UK.
One recent survey of people with tattooed skin, found that 67 per cent experienced skin problems such as bleeding, crusting, itching, oedema and pain directly after having had the tattoo and 6 per cent still experienced skin problems four weeks later. Although uncommon, there are various reports in the literature of dermatological problems arising from tattoos, including infections and inflammatory reactions (including hypersensitivity to the inks). There are even reports of tumours, such as melanomas and basal cell carcinomas, developing at the site of a tattoo although these are uncommon and possibly coincidental.
Advice to patients
The key to successful healing of a tattoo is to ensure that the wound has a moistened environment. This can be achieved through the use of a moisturiser applied two to three times a day. Although there is no formal evidence to recommend a particular product, anecdote and experience suggest that Bepanthen cream is a useful adjunct and there is a little evidence which makes this a reasonable first choice. However, pharmacists should be aware that this is not what this cosmetic product is marketed for.
People who have been tattooed should be alert to the typical signs of hypersensitivity to ink which include tenderness, swelling and itchy papules. Treatment with topical corticosteroids would be a suitable first line approach. However, patients should also be advised to consult their GP if signs of infection such as inflammation, swelling and tenderness develop at the site of a tattoo.
About the author
Rod Tucker is a pharmacist with an interest in dermatology
Citation: The Pharmaceutical Journal URI: 11104659
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