Case Presentations
A 28-year-old man presented with multiple skin-colored papules within a black colored tattoo. The papules were mostly asymptomatic but occasionally were itchy.
A 32 year old man presented with multiple asymptomatic papules restricted to the tattoo area on the forearm. See image below.
What causes warts?
Warts are commonly caused by viruses in the Human Papillomavirus (HPV) family. If the virus is able to penetrate the skin barrier, it can infect the skin cells and cause a skin growth, known commonly as a “wart”. HPV can be transmitted through direct and indirect contact from an infected individual (i.e., door knobs, razors, needles or a used towel). In order for HPV to be transmitted from one individual to another, it must enter the uninfected person through an opening or area of broken skin (i.e., a cut or scratch). Scientists have identified over 100 different versions of the human papillomavirus. Some HPV types are associated with common warts of the hands and fingers (HPV-2,4), while some are associated with plantar warts (HPV-1) and genital warts (HPV-6,11).
How are Tattoos created?
Tattooing is a very popular sign of expression in western culture and many other cultures around the world. In tattooing, the needle, along with the ink being used, penetrates the dermal layer of the skin.
Due to the invasive technique, there have been several cases of HPV infections associated with tattooing. Tattoos can sometimes be complicated by skin infections or even allergic reactions.
How can Tattoos and Warts be connected?
If a tattoo is given in an area where a wart is present, the penetration of skin may spread HPV to all areas the needle touches. This phenomenon occurs because the needle pierces the dermal layer of skin, where the virus is located, picks up the virus and implants it in all areas the needle comes into contact with. When this happens, warts will be grown throughout the tattooed area, which will ultimately distort the image; as pictured above. It is recommended that individuals do not receive tattoos on any area of skin that may have wart, due to the invasive technique used.
Treatment options?
Developing warts along areas that are tattooed can distort the image of the tattoo and cause a patient to become self-conscious about the affected areas. When considering treatment options it is important to contact a dermatologist to receive a thorough evaluation before jumping into any treatment options. Lastly, while it is easier to treat skin that does not have artwork on it, it is important to know treating tattooed skin may damage the integrity of the artwork.
Liquid Nitrogen Cryotherapy
The Liquid Nitrogen Cryotherapy should be conducted by a qualified healthcare provider. The treatment process entails spraying cold liquid nitrogen to the affected area for about 10-20 seconds. The purpose of this treatment is to destroy the affected tissue along with freezing the wart. If the treatment is successful the patient should notice the warts flatten 2-3 days after treatment and fall off in the following 1-3 weeks. This treatment may affect the integrity of the tattoo and thus should be done with caution.
Electrodessication and Curettage (ED&C)
Electrodessication and Curettage treatment is a procedure used to treat warts. The treatment should be conducted by a qualified healthcare provider. The procedure entails local anesthesia to the area, followed by the use of a sharp instrument known as a curette to scrape off the affected skin until healthy tissue is found. An electrocautery tool is then used to send small amounts of electricity to stop the bleeding. This procedure may affect the integrity of the tattoo.
Prescription Treatments
Topical prescription options include 5-fluorouracil, tretinoin or 5% imiquimod, which all may be prescribed under the supervision of a medical doctor. These options may be best since they are less likely to alter the artwork compared to the destructive forms of wart treatment like ED&C and liquid nitrogen therapy.
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