To Tattoo or not to tattoo

laser tattoo removal

So you’ve noticed that your favourite footballer or cricketer has donned a trendy, colourful tattoo on his arm, or your favourite actor has one on the small of her back, and they look just stunning!

Body art is in vogue (again), and you just can’t to have one (or more) yourself?

But behind those colourful artistic designs and displays impregnated into the skin lie some dark secrets. Let me unravel them and ask the same questions again, if I may.

Let me start by looking back into the history of tattoos. Tattooing into the skin is hardly a new phenomenon. My earliest recollection of a tattoo is seeing one with the Hindi equivalent of ‘my father is a thief’ engraved on the legendary Indian cinema’s superstar’s Amitabh Bacchan’s forearm in the movie ‘Deewar’. I had since thought that tattoos are a form of punishment! Well, I still think that it is in a way. Why would one otherwise pay a small fortune to have thousands of needle pricks in their skin? Is what they get in return, worth the pain?

With time I learnt that history of tattoos predates the release of ‘Deewar’ by a few thousand years. According to Wikipedia tattooing has been a Eurasian practice at least since Neolithic times. Ötzi the Iceman, dating from the fourth to fifth millennium BC, and many Egyptian  mummies bearing tattoos and dating from the end of the second millennium BC have been discovered. Tattoos formed their identities and still do for several indigenous tribes. They also formed identities of prisoners of wars, sociopaths, and cattle and livestock in which they still do.

Tattoos are not just ‘decorative’ or ‘professional’ which some argue are an art form. Other types of tattoos include ‘amateur’ tattoos, ‘cosmetic’ tattoos, ‘traumatic’ tattoos and ‘medicinal’ tattoos.

Amateur tattoos are simple, usually blue- black in colour, performed by an amateur on themselves or on whom they can lay their hands (usually after a night out under the influence of ‘spirits’). They can fade with time but if not, can be removed with relative ease.  Some women prefer to have permanent makeup to define their eye or lip lines. Some balding men would prefer having black ink tattooed into the scalp to hide the baldness. These are called cosmetic tattoos and are quite commonly performed by tattoo and beauty therapists.  Penetrating injury to the skin may lead to deposition of substances such as asphalt or graphite resulting in traumatic tattoos. When tattoos are deliberately made for medical reasons such as before cancer radiotherapy these are called radiotherapy tattoos. The most complex of all however are professional tattoos. This is so because of a range of different colours which are used.

So far so good, but why am I recommending caution before having professional tattoos. For several reasons, I’d say. As these tattoo inks are delivered into the skin using needles there is potential for infections. As a doctor, when I see someone with many tattoos and liver problems I would think of Hepatitis C infection. This is a very contagious (infectious) viral infection which is easily transmitted via contaminated needles. Other infections such as Hepatitis B or HIV (which causes AIDS) are also possible if the tattooist (tattoo artist) is not careful with disinfecting their equipment and using non sterilised needles. Sometimes we see quite weird infections such as TB of the skin at sites of tattoos. The tattooist must wash their hands and must also wash and clean the area to be tattooed. Gloves must be worn at all times and the wound must be wiped frequently with a wet disposable towel of some kind. The equipment must be sterilized in a certified autoclave before and after every use.

It is a prerequisite that every tattooist uses disposable or single use needles. If you have any doubts about the hygiene in the tattoo parlour, make sure you find the quickest way out. You wouldn’t go to a shabby clinic to receive unclean injections, would you?

A wide variety of inks are used in colourful and elegant looking decorative professional tattoos. Some of these can cause problems. If one considers removal of their tattoo at a later date, some inks are more difficult to remove than others. Certain inks more specifically red ones can cause skin reactions and allergies. These can not only distort the shape of the original tattoo but can also be very itchy and difficult to treat. Another thing to remember when having black tattoos containing iron pigments is that if one has to undergo an MRI scan, these inks can pose problems in interpretation of results and may even cause burns!

Injury or trauma to skin results in scarring, and this scarring is quite variable and differs from person to person. Whilst most people will get perfectly fine tattoos, some people may scar quite badly and this may be irreversible. So if you have a tendency to bad scarring such as that after surgical procedures, think carefully before having a tattoo. 

Some times people come to me seeking tattoo removal for psychological reasons. Having an ex partner’s name tattooed on sensitive areas can be quite distressing if one wants to move on in life. Some life events can be quite traumatic and if one had a tattoo nearer the time, looking at the tattoo can bring back bad memories.

So what can be done if one wants to get rid of their tattoo for whatever reason? In the days when lasers were unavailable, procedures such as rubbing salt or similar into the tattoo, cutting out the tattoo or surgical scraping were the only available options. All these resulted in variable and unpredictable levels of scarring.  Since we have excellent lasers that can improve tattoos of varying colours, such treatments are rarely used now. The advantage with lasers is the very low risk of scarring. However, lasers are not magic and may not be suitable for certain tattoo colours such as yellow.  Additionally, complete clearance of multicoloured tattoos is unlikely and currently available lasers work better of amateur and blue/black tattoos. If performed incorrectly, they can also be associated with certain side effects such as burning of skin and scarring. Of course, the treatments can be quite painful and expensive.

If all this has put you off having a tattoo on your next birthday, why not try a temporary tattoo made from vegetable dyes? This way you can have the pleasure of having your desired body art, without having to endure the pain of having to remove it should you so wish.

Or if you’re like me, just appreciate the beauty and art of the perfect tattoo on someone else’s skin!

Learn more about Laser Tattoo Removal.

Mole Awareness – Spotting the ugly duckling

Mole mapping . Mole clinic manchester

As summer approaches and the sun comes out of its hibernation, it’s the time of year when we will be taking off the extra layers of clothing to allow the sunshine on our skin. For dermatologists this is a busy time when those funny looking moles grab the attention of patients and their partners. The ‘ugly duckling sign’ refers to identification of moles which stand out as being distinctly different in appearance. This is an important sign which dermatologists use to identify ‘melanoma’, which is a type of skin cancer, in patients who have many moles. Some patients may have hundreds of moles and are referred to as having the ‘atypical naevus syndrome’ where the ‘ugly duckling sign’ is of particular relevance.

How frequently should I undergo a mole check?

For those who have only a few moles and low risk of melanoma (no personal or family history of melanoma, no history of sun bed use or excessive sun exposure, dark skin) a self-skin examination once every few months would suffice. On the other hand, patients who have the atypical naevus syndrome, previous history of skin cancer/s, strong family history of skin cancers, fair skin, suppressed immunity or history of excessive sun exposure, I would recommend once monthly self-skin examination. Good quality digital pictures of the moles should be taken at baseline.

How do you differentiate an innocent mole from one which is melanoma?

The popular ‘ABCDE’ method comes in handy when assessing moles against baseline photos.

A= Asymmetric. Each one half of the mole differs from the other.

B= Border. A mole with uneven or notched border.

C= Colour. A mole with different shades of grey, black, brown, red, white or blue.

D= Diameter. A mole which is 6mm or more in its diameter.

E= Evolution. A mole which appears larger than the baseline pictures.

I also add an ‘F’ to this mnemonic.

F= Funny symptoms of itching, bleeding, crusting and discomfort in a mole are unusual and should never be disregarded.

What to expect when you see a dermatologist?

If you have any of the alarming signs, you should seek advice from your GP who can refer you to a dermatologist. Any suspicious mole should be examined by a dermatologist who would undertake a full-body skin examination and a dermatoscopic examination of the moles to look for signs of melanoma. Dermatologists are trained to use these hand held illuminated magnifiers which highlight specific signs of melanoma which may not be apparent to the untrained eyes.

Dr Vishal Madan is a Consultant Dermatologist at The Wilmslow Hospital, 52 Alderley Road., Bridgewater Hospital Manchester, BMI The Beaumont Hospital. For more information or to book an appointment with Dr Madan please email:

Red Nose Day- Time to get rid of that stubborn Rosacea Redness

red nose dermatology clinic UK Manchester

Very often my patients who have suffered with rosacea for number of years will be distressed at the persistent redness that plagues their noses and cheeks. It is not uncommon for them to have unwelcoming comments and many will have been subjected to perception bias related to excess alcohol intake. Now we know that having a red nose has nothing to do with alcoholism. Most commonly it is rosacea that gives that persistent redness to faces and noses.

My patients will have had some antibiotics which would have been helpful for the spots of rosacea- the papules and pustules of the so called ‘papulopustular rocasea’. But the redness is unlikely to respond to this measure alone. This is where lasers are very effective. I use the pulsed dye (PDL) and KTP lasers to treat facial and nose redness.

The old(er) generation PDL’s caused bruising lasting a week to 10 days and whilst very effective the downtime was unacceptable by most patients. Now we have a choice of non bruising treatments which enables patients to go back to work next day without any tell-tale signs of laser treatment. In my experience this is a very effective technique and has been quite popular with my professional patients who lead busy working lives.

Some patients will have ‘telangiectases’ or red blood vessels which can be very effectively targeted without bruising the skin. This is achieved using the KTP laser. I particularly like this laser and combine it with the PDL for patients who may have both background redness and broken capillaries.

Both laser treatments are surprisingly very well tolerated in the absence of any anaesthesia. I recommend 2 paracetamol tablets 30 mins before laser treatments and 2 tablets 4-6 hours later. This helps reduce the swelling which may be more obvious with the non bruising PDL session. Ice packs or ‘frozen peas’ may be also useful in this context.

Another important recommendation is to avoid sun exposure during the course of treatments. Any tan is likely to result in complications and an astute practitioner will defer laser treatments till the tan has resolved.

Patients may require 3-6 treatments spaced at 4-6 week intervals.

So this Red Nose Day- by all means participate in charity events but remember that help is at hand and every day of the year doesn’t have to be a Red Nose day. All the best.