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Tattoo-removal procedures have increased during the past years for various reasons: embarrassment; lowered body image; and professional motivations.1 Laser, currently the most popular treatment, is generally a painful, expensive, and long process. Therefore, some individuals may seek alternative removal methods that would be naturally well-tolerated, faster, and cheaper. The Internet provides the perfect ground for finding “do-it-yourself” tattoo-removal treatments, claiming efficacy and safety.2 However, such treatments may be associated with chemical burns and hypertrophic scarring due to their components.3–7 In addition, licensed medical local treatments may be misused for such purposes. Herein we report two patients who developed second-degree burn injuries after applying a local treatment for wart removal on their tattoos.

A 25-year-old woman and a 26-year-old man presented for surgical treatment of hypertrophic scars located on their tattoos. Tattoos were located on the right upper quadrant of the breast and the left third finger, and were seven and several years old, respectively. Both had read from Finnish Internet pages that Verruxin® gel (Den norske Eterfabrik, Oslo, Norway), a topical wart ointment, could be used efficiently for tattoo removal. They applied Verruxin® directly on their tattoos and experienced immediate burning sensation and severe pain. According to the Internet, they were advised to repeat the procedure the next or every other day, which they did with increasingly severe pain. Within several days, the epidermis started to peel off and exudates oozed from the treated area. Within two to three weeks, a hypertrophic scar became slowly visible on the treated area. The patients presented to us approximately two and one-half months after the initial trauma. They described tingling, itching, and painful sensations typical of untreated burn scars in the treated areas. Hypertophic scars restricted to the treated areas were observed with redness extending to the surrounding tattooed skin. The skin was thick, indurated, and warm to the touch (Fig. 1). Surgery was denied at that point as tissues were damaged, skin was indurated, and scar maturation process was incomplete. Elasto-Gel® (Southwest Technologies, Baltimore, MD, USA) silicone pads were applied for three months (Fig. 2). Six months later, tattoo surgical excision was performed for the female patient. The male patient was lost to follow-up.

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Figure 1.  Hypertrophic scar following a chemical burn after Verruxin® application on tattoos of the third finger

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Figure 2.  Scar of the breast tattoo after Elasto-Gel® treatment

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The main tattoo-removal methods include Q-Switched laser therapy and surgical excision.1 Chemical methods, based on the introduction of caustic products such as tannic acid in the dermis by puncturing the skin, used to be performed during the 19th century.8,9 Numerous techniques were developed and have known a short reappraisal during the 1990s in the literature.8,9 Chemical and mechanical techniques8 are less expensive and time-consuming compared with laser, but expose the patient to a higher risk of scarring.1,9 Unfortunately, some patients use the Internet to look for easier, quicker, more efficient, safer, and cheaper removal treatments. Various local treatments are available on the Internet market. They can be either applied directly on the skin or introduced with a puncturing technique.2 However, hypopigmentation, hypertrophic scar, and chemical burns have been reported with such devices.3–7 In our case, patients accessed directly to a medical treatment that can be bought without a receipt from pharmacies in Finland. Verruxin® gel contains salicylic acid, lactic acid, copper acetate and ethanol (http://www.yliopistonapteekki.fi/fi/apteekkipalvelut/tuotteet/pages/product.aspx?catalog=yasalescatalog&productid=715938(yabasecatalog)&category=jalatkadetjanivelvaivat(yasalescatalog)/syylatjakansat(yasalescatalog), accessed 16 March 2011.), and patients applied it on thin skin areas. The caustic local effect of the treatment was followed by a chemical burn and hypertrophic scarring process that led to unnecessary, more complicated surgical procedure. Better information for tattooed customers is mandatory to prevent them from either trying unlicensed “do-it-yourself” tattoo-removal devices available on the Internet or misusing medical treatments that are intended for other purposes.

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