title: Permanent make-up colorants may cause severe skin reactions.
abstract: BACKGROUND
  In recent years, cosmetic tattoos [permanent make-up (PMU)] on eyelids, eyebrows and lips have become increasingly popular. However, most colorants are manufactured for non-medical purposes, without any established history of safe use in humans.
  
  
  OBJECTIVE
  To investigate severe adverse reactions, such as swelling, burning, and the development of papules, of the lips and the surrounding area in 4 patients who had had at least two PMU procedures on their lips.
  
  
  METHODS
  Adverse skin reactions were examined with patch and prick testing of the colorants. In addition, skin biopsies were taken in the centre of the prick test for histology. One patient declined prick testing.
  
  
  RESULTS
  Beauticians tended to use various PMU products, but all contained Pigment Red 181 (CI 73360). All patients tested showed a clear delayed reaction to Pigment Red 181 or the tattoo ink, or both, after prick testing. Histology indicated an allergic reaction. Each lip lesion slowly abated after several months of topical or systemic therapy with steroids in combination with tacrolimus, but none has yet completely resolved.
  
  
  CONCLUSIONS
  In light of the severe and often therapy-resistant skin reactions, we strongly recommend the regulation and control of the substances used in PMU colorants.
authors.affiliation: Department of Dermatology, Regensburg University Medical Centre, Regensburg 93053, Germany.
authors.forename: Sabrina M
authors.initials: SM
authors.lastname: Wenzel
authors.forename: Julia
authors.initials: J
authors.lastname: Welzel
authors.forename: Christian
authors.initials: C
authors.lastname: Hafner
authors.forename: Michael
authors.initials: M
authors.lastname: Landthaler
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Bäumler
mesh_terms: D000368:Aged; D004396:Coloring Agents / Q000008:administration & dosage / Q000009:adverse effects*; D003357:Cosmetic Techniques / Q000009:adverse effects; D003358:Cosmetics / Q000009:adverse effects; D017449:Dermatitis, Allergic Contact / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology* / Q000473:pathology; D008875:Middle Aged; D012867:Skin / Q000473:pathology*; D013653:Tattooing / Q000009:adverse effects*; D013876:Thiophenes / Q000009:adverse effects*
chemical_list: D004396:Coloring Agents; D003358:Cosmetics; D013876:Thiophenes; C555803:pigment red 181