title: Treatment of gunpowder traumatic tattoo by Q-switched Nd:YAG laser: an unusual adverse effect.
abstract: BACKGROUND
  The Q-switched Nd:YAG laser can completely eliminate traumatic tattoos.
  
  
  OBJECTIVE
  We report the results of the unsuccessful removal of traumatic tattoos among three patients with dermal inclusions of gunpowder who were shot at close range.
  
  
  METHODS
  Treatment was tried in each patient with a Q-switched Nd:YAG laser at a medium fluence (4-6 J/cm2).
  
  
  RESULTS
  During treatment of our patients, each pulse provoked sparks and the immediate formation of bleeding trans- epidermal pits. After the healing process was completed, we observed poxlike scars and the spreading of pigments in the skin around the initial points of the tattoo.
  
  
  CONCLUSIONS
  We hypothesize that the rapid transfer of high-energy pulses to powder particles creates microexplosions of these fragments resulting in cavitation and provoking transepidermal holes and subsequent scars. This adverse effect was only produced if the tattoo resulted from gun powder being shot at a short distance from the skin.
authors.affiliation: Plateforme Laser, Clinique de Turin, Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Fusade
authors.forename: G
authors.initials: G
authors.lastname: Toubel
authors.forename: C
authors.initials: C
authors.lastname: Grognard
authors.forename: J M
authors.initials: JM
authors.lastname: Mazer
mesh_terms: D000328:Adult; D005151:Facial Injuries / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D053685:Laser Therapy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D008297:Male; D013653:Tattooing; D014948:Wounds, Gunshot / Q000150:complications / Q000601:surgery*