Iatrogenic Deep Dermal Wound Due to Chemical Do-It-Yourself Tattoo Removal

Dear Editor,

We read with interest the article by Khunger et al. entitled “Complications of Tattoos and Tattoo Removal: Stop and Think Before you ink”.[1] We believe that this article will raise the awareness of complications of tattoos and tattoo removal. In this regard, we would like to contribute to the same topic by presenting another case highlighting a different complication of tattoo removal.

Tattoo removal procedures are expensive and are not usually covered by health services.[2] Laser tattoo removal often requires long and repetitive visits to clinics. When patients seek cheaper and faster ways for tattoo removal, they search websites that often belong to over-the-counter devices and products or sometimes patient forum websites. Strict regulation of product marketing in the internet is almost impossible. This obstacle provides endless opportunity for manufacturers of various over-the-counter tattoo removal devices and products. These products and devices have some risks including iatrogenic deep dermal wound, hypertrophic scarring, hypopigmentation, etc.

A 37-year-old woman presented to our clinic with a third-degree burn wound on her right lower leg. She had tattoo on her leg 21 days ago [Figure 1]. Soon after tattooing, she regretted having it. She had been offered Q-switched laser tattoo removal in an esthetic clinic. But she could not afford the price of the laser therapy. After a web search, she read from a patient forum website that acetic acid (CH₃ COOH) could be used for tattoo removal instead of laser or surgical tattoo removal. She applied CH₃ COOH on her tattoo. After experiencing pain, she applied silver sulfadiazine 1% cream (Silverdine, Deva ilac San. ve Tic. AS, Istanbul, Turkey) as advised on the patient forum website. On examination, she had a third-degree burn on her [Figure 2]. Eschar tissue was debrided with both surgical and chemical (Novuxol, Abbott, Collagenase SF, Uetersen, Germany) ways. Complete epithelization was achieved seven days after treatment.

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Figure 1

Flower designed tattoo

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Figure 2

Postburn picture at 21^st day

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The use of cheaper over-the-counter tattoo removal creams and devices may lead to more expensive wound care procedures including, chemical or surgical debridement, skin grafting and even flap surgery.[3] National health services all over the world face lead to more funding problems arising from serious complications after do-it-yourself tattoo removal creams and devices freely advertised on the internet. Should the removal of unwanted tattoos be considered as a cosmetic procedure? Legislative regulations of internet marketing especially for medical devices and products are another important aspect of this problem. Serious complications after misuse of chemicals for tattoo removal should be widely highlighted.