Forum for Nordic Dermato-Venereology Nr 1, 2018 | Page 13

Simon Francis Thomsen, et al. – Bispebjerg Hospital, Department of Dermato-Venereology: Current and Future Research Activities
useful for measurements of biomarkers/proteins in the skin
(10). The method has the advantage to skin biopsies in that
the sampling can be repeated over time, and leaves no injury
or scar on the skin.
At a clinical level our studies have focused on patient educa-
tion directed at patients with eczema. All patients with hand
eczema are given an individual guided talk about prevention
of hand eczema, also comprising practical demonstrations
regarding gloves, hand-washing and disinfection. Patients
with atopic dermatitis receive individual guidance, and are
also invited to participate in the eczema school, which is a
3-hour group education with shifts between one-way teaching,
group discussions and workshops. Patient education offered
to patients with eczema has proven effective to reduce ecze-
ma severity in the patients; however, it is also immediately
rewarding for the healthcare workers in the eczema clinic.
Tattoos and tattoo complications
Tattoos and tattoo complications are an expanding research
field in dermatology and toxicology (11, 12). With over 70
million Europeans and approximately 500 million world
citizens being tattooed, the issue is highly relevant. The
tattoo clinic at Bispebjerg Hospital was set up in 2008. Our
clinical research, presently based on a material of 700 tat-
too complications, have resulted in the delineation of new
diagnostic entities, including patterns of plaque-elevation,
excessive hyperkeratosis, ulcero-necrosis, papulo-nodular,
neuro-sensitive and other distinct patterns of reaction, each
with a specific causation leading to treatment. It is a novel dis-
covery that the association between papulo-nodular reactions
in black tattoos and sarcoidosis is 500-fold higher compared
with non-tattooed persons. The new classification system for
tattoo complications is reported to the 11 th revision of the
WHO International Classification of Diseases.
Our studies of mice have addressed the biokinetics of tattoo
pigments and the risk of cancer. It is known that tattoo pig-
ment is often found in regional lymph nodes. Studies of mice
by histology and electron microscopy have demonstrated
that tattoo pigments are distributed from the skin to the
liver, and are found in the Kupffer cells, but not traced in
other organs. Kupffer cells are considered part of the clearing
system of particles reaching the blood. Our studies of mice
showed that, even though particles reach the bloodstream,
no cancer of internal organs occurred after one year. Also,
the tattooed skin showed no relevant increase in skin cancer
occurring in tattoos, and no photocarcinogenesis after one
year of UVB exposure. The studies in mice were performed
using inks banned on the Danish market due to containing
potential carcinogens according to register data. The studies
supported recent observations that tattoos and skin cancer
are not associated, except by coincidence.
Our biokinetic studies of the local breakdown of organic tat-
too pigments in human skin have attempted to identify the
allergen(s) behind sensitivity towards red tattoo inks. Prelim-
inary results have indicated that a limited number of red azo
pigments are responsible, with one chemical being candidate
as the epitope. Further studies including patch tests of patients
with allergic tattoo reactions are ongoing. Light exposures
can boost chemical breakdown of tattoo pigment and laser
removal of allergic tattoo reactions is contraindicated (Fig. 3).
Research activities also include a number of dedicated studies
exemplified by evaluation of so-called magnetic resonance
imaging (MRI)-burn in tattoos, with emphasis on the role, or
not, of iron oxide and other pigments in the sensation of burn,
which is not driven by measureable temperature increase of
MRI-exposed pigments.
Fig. 3. Allergic reaction in a red tattoo with worsening following
laser removal.
Forum for Nord Derm Ven 2018, Vol. 23, No. 1
The tattoo clinic puts emphasis on social networking among
clinicians and researchers. Recently, tattoo c linics were estab-
lished at university hospitals in Amsterdam and New York, and
a consultation was settled in Paris. The tattoo clinic is initiator
of the European Society of Tattoo and Pigment Research; www.
estpresearch.org.
D ermato -V enereology in the N ordic C ountries
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