title: Successful treatment of treatment-resistant laser-induced pigment darkening of a cosmetic tattoo.
abstract: OBJECTIVE
  Cosmetic tattoo removal has a reported risk of immediate pigment darkening when treated with a high energy, nanosecond pulsed-laser system. Surgical treatment options for this reaction are limited and carry significant risk of scarring and permanent pigment alterations. This report describes the response of a resistant Q-switched ruby laser-induced cosmetic tattoo ink darkening to multiple treatments with the Q-switched alexandrite laser and Q-switch Nd:YAG laser and textural improvement with the UltraPulse CO(2) laser.
  
  
  METHODS
  A woman with Q-switched ruby laser-induced pigment darkening of a cosmetic tattoo of the upper lip resistant to four further treatments with the ruby laser and two chemical peels received a total of 26 treatments with the Q-switched alexandrite and Nd:YAG lasers and a single treatment with the UltraPulse CO(2) laser, most treatments being done at monthly intervals.
  
  
  RESULTS
  Treatment of the affected areas with the Q-switched alexandrite and Nd:YAG lasers resulted in complete clearing of the pigment without scarring, but revealed some preexisting textural changes. Use of the UltraPulse CO(2) laser smoothed the surface irregularities.
  
  
  CONCLUSIONS
  The Q-switched pigment lasers are a useful modality for treating this pigment darkening reaction. As in this case, multiple treatment sessions with the laser may be necessary but the pigment can be expected to clear eventually without scarring. Any textural changes may be blended with the UltraPulse CO(2) laser with further improvement.
authors.affiliation: Clinical Dermatology Associate of San Diego County, Inc., Encinitas, CA 92024, USA. dadee7@cts.com
authors.forename: R E
authors.initials: RE
authors.lastname: Fitzpatrick
authors.forename: J R
authors.initials: JR
authors.lastname: Lupton
mesh_terms: D000328:Adult; D002615:Chemexfoliation; D005260:Female; D005290:Ferric Compounds; D006801:Humans; D053685:Laser Therapy; D007834:Lasers / Q000009:adverse effects*; D010859:Pigmentation Disorders / Q000209:etiology* / Q000628:therapy*; D013653:Tattooing; D013997:Time Factors
chemical_list: D005290:Ferric Compounds; C000499:ferric oxide