Dermatography

Tattoo
removal

Ad stigmata tollenda medicamentum

Removing tattoos through the ages

As long as tattooing exists, men are already looking for ways to remove tattoos again. In fact, less is known from Roman times about how they tattooed than about removing them.

The personal physician of Emperor Claudius, Scribonius Largus, is the author of the earliest work on this subject. In his "Ad stigmata tollenda medicamentum” (A medicine for removing tattoos) he gives several recipes. After long research he discovered the perfect remedy.

Emperor Claudius

Alexandrian cantharides or Spanish fly

It consisted of 'white cloves of garlic, crushed with Alexandrian cantharides ("Spanish fly") and a decoction of sulfur, bronze coins, beeswax and oil. The effects of this curious mixture undoubtedly rests on the vesicant properties of cantharides, which make the pigments on the surface disappear. Because of the almost unavoidable inflammations that occur, also a large part of the underlying pigments will disappear. So in fact it really did not matter much what ingredients were used, as long as they were irritating. After this, doctors started experimenting like crazy. They used all kinds of not immediately obvious substances: the foam from the inside of the piss-pot mixed with strong vinegar; butter flowers mixed with leaves of the caper, grinded pigeon-do mixed with vinegar. Later they used the stronger acids, such as sulfuric or nitric acid.

In the first six centuries of our era the tattoo removal was a separate medical specialty. There must have been quite a lot of tattooed people then. After the 11th century, tattooing is apparently less popular in our regions, given the few text sources. Only from the beginning of the 19th century there has again been a resurgence.

In 1888 the French dermatologist Variot introduced a new method to remove tattoos. Variot used a combination of tannin with silver tannate. Despite the occurrence of high fever and many other side-effects, the method appeared to be effective in one way or the other. Briault preferred zinc chloride.

In 1928, in the US similar fashion tattoos are removed by Shie. Others have developed methods that did not last long because of the negative side effects and poor results. For example, the use of zinc chloride often led to disfiguring scars.

Lacassagne and Rousset were in favor of the use of potassium permanganate crystals as an abrasive. This method was recommended in 1957 by Zierz and Reidenbach a simple, safe and reliable method.

Lacassagne

An overview of the current methods for removing tattoos

Regularly colleagues ask me (EM van der Velden) if they can remove a tattoo with trichloroacetic acid and/or phenol. I tell them that they can try out this method the best on their mother-in-law, especially when they persist telling me that the method is described highly positive in literature. Tattoo removal requires knowledge of tattooing techniques, pigments, many methods with their own pros and cons, and finally a very specific knowledge of the skin, where it finally all is happening.

The present methods to get rid of tattoos are dermabrasion, surgical shaving off of layers of skin, the manipulation and abrasion of the skin with table salt, the trimming of the skin, the tissue-expander method, or skin grafting. It goes without saying that the latter method in relation to the medical necessity is rather expensive.

Attempt to remove tattoos with a tattoo machine by means of dilute hydrochloric acid, and battery acid. Result: severe pain, scars and the pigments are still present.

An attempt to remove with liquid nitrogen.

tattoo removed by partially cutting away skin (excision)

cutting away tattoos and then skin grafts are applied

tattoo after tissue expander

tattoo after tissue expander and laser treatment

excision tattoo

excision tattoo

skin grafts after removal tattoo

This tattoo was recently treated with lasers in the AMC and the Medical Laser Center in Amsterdam. The picture above shows how it looks after 15 X Nd: YAG - laser and X 7 Ruby - laser.

As you can see, these patients are maimed forever by these conspicuous scars.

A new tattoo

It also happens that the dissatisfied customer goes back to the shopkeeper who has foisted him the product, the tattooist. A common reason for dissatisfaction is, that the beloved 'Marie' that has been immortalized on the arm, already has been replaced by a Mary or Jane.

When the tattoo artist combines a deep psychological insight with a fine business sense, the customer leaves the tattoo shop with a new tattoo put over the old one. At first this seems to give an acceptable result, because the tattoo artist has applied a neat skin color. This trick has been used since the beginning of the 19th century, but offers only a temporary respite. Sooner or later, the underlying darker color shines through again. The smarter practitioner does only do it with a different picture with as many black in it as possible.

With a mist of mystery

Less pleasant it is when it comes to tinkering with questionable methods from old books. The tattooists profession is surrounded by a shroud of secrecy, and all kinds of "recipes" are only passed to insiders - so they keep popping up with amazing tenacity. Often it comes to strong acids, which act on the skin too strong.

The tannin method of Variot has been used, forgetting that there are hundreds of types of tannins, so there are serious potential consequences: the concentrations of tannin acids that are often described are certainly harmful, as first author has been demonstrating in studies. Possible consequences include high fever, vomiting, liver abnormalities and heart palpitations.

Real inventors in white coats

In brief, we can say that all the removal methods which make use of chemical substances have been risky. In all the cases we examined, tattooists are not hindered by any pharmacological knowledge or understanding of the used substances at all, and they happily continue tinkering.

Thus we regularly meet true inventors in white coats, who work in the hospitals using converted electric toothbrushes, Braun Lady shaves or bogies of electric trains. Beside that those doctors try to treat the skin of unsuspecting patients with a wide assortment of potentially harmful substances in uncontrolled concentrations.

a Braun Ladyshave converted into a tattoo machine by dr. M. Carpentier Alting in 1994

Dr. M. Carpentier Alting

Unbridled desire to amateurism

Another phenomenon is the unbridled desire to amateurism of some confreres who want to spend their free time useful. We mention only the man who thought he could let wine stains disappear under a white pigment, using a bunch of sixty needles. The patient was lucky that the man used full anesthesia.

This amateur had no clue of any basic understanding regarding the mechanics of the skin. Underutilized equipment is an issue too. In the early days of the laser you had to search for the right applications, and the removal of tattoos was a hot issue in the 70s and 80s. It is now clear to the serious user that there are also limits to the use of the equipment.

69 bundled needles, which doctors used in the 60s and 70s to camouflage skin disorders

The magic of the laser beam


Also within medicine the magic of the laser beam has its limitations. See the file laser.

excision tattoo

excision tattoo

skin grafts after removal tattoo

excision tattoo

skin grafts after removal tattoo

The method with the steam iron

I have to tell you about the method with the steam iron. Late 80s the police in Indonesia found it necessary to kill tattooed people without trial. Tattooed people in Indonesian society are labeled as criminal scum. The poor man from the dessa, where there was no trace of crime whatsoever, was the victim. Hundreds of non-criminals were stripped of their tattoos by friends using a hot iron that was put on the arm for 1,5 minute!.The slabs of skin tissue thereby sticked mostly on the iron. Apart from risky infections, many suffered also from extensive hypertrophic scars of burns. For some, it seemed like they were brand marked. It is not known by the way, whether those who were marked with these severe burns were not arrested and executed later on.

In our country, The Netherlands, brand marking regularly took place to dispose individuals from society. In many cultures, a brand mark is as stigmatizing as a tattoo.

The punishment of brand marking has been abolished as last of all European countries in The Netherlands in 1854. In our country is the biggest and best-stocked collection of brand marking irons in the world. For more information see http://www.gevangenpoort.nl.

The last couple of years, we see the next great interest in removing tattoos, yet again a renewed interest in the application of tattoos.