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WAO Medical Book Reviews

Posted: February 3, 2017

Tattooed Skin and Health
Edited by: Serup J., Kluger N., and Bäumler W.
ISBN: 978-3-318-02776-1
eISBN: 978-3-318-02777-8
$232.00 USD / €184.00 EUR / 197.00 CHF (eBook)
$232.00 USD / €184.00 EUR / 197.00 CHF (Hardcover)
Available from: Karger


Pankaj Salphale, MD
Department of Dermatology, RIPAS Hospital
Bandar Seri Begawan, Brunei


Tattoos on human skin have been a part of cultural heritage for many millennia with an increase in their prevalence in recent years. They are performed as expressions of body art and individuality.  Tattooing spans all socioeconomic groups and ethnicities. Approximately 10-20% of the European adult population has at least one tattoo.  Medical professionals increasingly encounter the tattoo-related issues in their practices. With a proliferation of unlicensed tattooists, hygiene and safety aspects of the procedure have been compromised. There is also a lack of resources that can provide authentic information on tattoos to the public. Physicians and certified tattoo artists can serve to bridge the knowledge gap and promote healthy practices.


“Tattooed Skin and Health” is a collaborative effort of expert dermatologists, veteran tattoo artists, sociologists, public health professionals and ink industry experts who have provided their valuable inputs. With their contribution, the book aims to provide the target reader an overview of the art, the individual profile of the tattooed and the motivation to get a tattoo, adverse reactions and the concerns of safety and hygiene. There is a need for physician proficiency on the subject to address the issues of concern faced by tattooed individuals.


The book commences with a section on the social environment relating to tattoos, and provides an interesting overview of cultural heritage emphasizing that the practice goes beyond a mere expression of body art. Tattoos are weaved into the social fabric of the community and are an expression of individuality, self-realization, and a symbol of genealogy. It is interesting to know that tattoos found their use to relieve rheumatism, to improve longevity and as an apotropaic medium. This section provides an understanding of the epidemiology of tattoos in industrialized countries. Individuals in their 20s to 40s are the most tattooed, with almost equal prevalence in both genders, but a general profile of the tattooed does not exist owing to human diversity. There are numerous motivations to both get tattooed and also to get rid of them at a later date. There is a lack of a formal training of tattoo artists; most are self-educated by being an apprentice of an experienced artist. There is a growing concern on the prolific rise of amateur tattooists through the internet who provide cheap tattoos at home.

Experienced tattoo artists share their experiences in the section, “The Practice of Tattooing”.  They discuss the equipment used in a tattoo studio, the craftsmanship, the client –tattooist relationship and realistic expectations of the customer. They present the real life scenarios of four individuals and their purpose for a tattoo acquisition.

Expert dermatologists have written the section on “Tattoos and Adverse Events”. They discuss the contraindications for and the allergic and infectious complications of tattoos. They lay an emphasis on the quality of life (QOL) issues of people with chronic tattoo reactions. The QOL scores of these individuals compare with those with chronic skin diseases such as psoriasis and eczema. As the human mind is versatile, change of life circumstances may lead to a tattoo regret necessitating its removal. The chapter on laser tattoo removal elaborately describes the use of Q-switched lasers for tattoo removal but also warns that such a removal may be far from satisfactory, and that post-laser risks of scarring and pigmentation exist. The authors envisage the development of tattoo inks with well-known absorption wavelengths that would dictate the choice of a particular laser thereby minimizing the risk of adverse events. This section describes a scientific study that has used the novel atomic force microscopy to understand the nano-particle size of tattoo inks. Interestingly, the nano size is found to be more chemically reactive leading to a hypothesis that these particles could be responsible for allergic tattoo responses and that their size makes them potentially cytotoxic due to ease of cellular permeability.

The authors have called for stringent national regulations for manufacture and control of tattoo inks and their toxicological assessment. They also draw attention to good manufacturing practices. These legal methods ultimately aim to make tattooing safer.  The book enlightens the reader on the benefits of layer-by-layer encapsulation technology for improvement of tattoo pigments. As the long-term systemic effects of the colorants are unknown, more studies are required to clarify the impact of tattooing on human health.

Assessment and Audience

Family medicine practitioners, nurses, physicians, dermatologists, laser surgeons and cosmetologists are the likely target readers. However, other specialists with an interest in the subject are sure to benefit from the book with its easy language, illustrations and the flow of the subject. The editors have aligned the author contributions flawlessly, and this helps the reader grasp the concepts well. I feel that a layperson summary of sections “The Practise of Tattooing” and “Tattoos and Adverse events” would serve well for an individual opting for a tattoo in making an informed decision.

Why read this book? How will it impact my practice?

The comprehensive account on tattoos acts as an easy reference. It provides an excellent overview of the subject. A physician is likely to consult the book when faced with a dilemma. It would serve as a fantastic resource for a broad range of physicians.  With all-inclusive, basic and advanced clinical information for an office –based practice or a tattoo studio, the book is a must read.

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