BACKGROUND Over the past 30 years, painful reactions during magnetic resonance imaging (MRI) in tattooed individuals have been sporadically reported. These complications manifest as burning pain in tattooed skin areas, occasionally with swelling and redness, often leading to termination of the scanning. The exact cause is unclear, but iron oxide pigments in permanent make-up or elements in carbon black tattoos may play a role. Additionally, factors like tattoo age, design, and color may influence reactions. The existing literature lacks comprehensive evidence, leaving many questions unanswered. CASE REPORT We present the unique case of a young man who experienced recurring painful reactions in a recently applied black tattoo during multiple MRI scans. Despite the absence of ferrimagnetic ingredients in the tattoo ink, the patient reported intense burning sensations along with transient erythema and edema. Interestingly, the severity of these reactions gradually decreased over time, suggesting a time-dependent factor contributing to the problem. This finding highlights the potential influence of pigment particle density in the skin on the severity and risk of MRI interactions. We hypothesize that the painful sensations could be triggered by excitation of dermal C-fibers by conductive elements in the tattoo ink, likely carbon particles. CONCLUSIONS Our case study highlights that MRI-induced tattoo reactions may gradually decrease over time. While MRI scans occasionally can cause transient reactions in tattoos, they do not result in permanent skin damage and remain a safe and essential diagnostic tool. Further research is needed to understand the mechanisms behind these reactions and explore preventive measures.

Tattoo pigment is expected to migrate beyond the skin to regional lymph nodes and the liver. Modern tattoo ink commonly contains metals that may pose a clinical problem during MRI examinations. This study aimed to investigate the biodistribution of iron oxide pigment to internal organs in mice. Moreover, when exposed to a static magnetic field, we studied whether any reactions followed in the tattooed skin. Twenty-seven hairless C3.Cg-Hrhr/TifBomTac mice were included; 20 were tattooed with iron oxide ink in a rectangular 3 cm2 pattern; seven were controls. Ten of the tattooed mice were exposed to a 3 T MRI scanner's static magnetic field. Following euthanasia, evaluations of dissected organs involved MRI T2*-mapping, light microscopy (LM) and metal analysis. T2*-mapping measures the relaxation times of hydrogen nuclei in water and fat, which may be affected by neighbouring ferrimagnetic particles, thus enabling the detection of iron oxide particles in organs. Elemental analysis detected a significant level of metals in the tattooed skin compared to controls, but no skin reactions occurred when exposed to a 3 T static magnetic field. No disparity was observed in the liver samples with metal analysis. T2* mapping found no significant difference between the two groups. Only minute clusters of pigment particles were observed in the liver by LM. Our results demonstrate a minimal systemic distribution of the iron oxide pigments to the liver, whereas the kidney and brain were unaffected. The static magnetic field did not trigger skin reactions in magnetic tattoos but may induce image artefacts during MRI.

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BackgroundPersons with cosmetic tattoos occasionally experience severe pain and burning sensation on magnetic resonance imaging (MRI). ObjectiveTo explore the culprit magnetic substances in commonly used permanent makeup inks. Material and methods20 inks used for cosmetic tattooing of eyebrows, eyeliners, and lips were selected. Ink bottles were tested for magnetic behavior with a neodymium magnet. Eight iron oxide inks qualified for the final study. Metals were analyzed by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). The magnetic fraction of inks was isolated and analyzed by X-ray fluorescence (XRF). Magnetic iron compounds were characterized by Mossbauer spectroscopy and powder X-ray diffraction (XRD). ResultsICP-MS showed iron in all magnetic samples, and some nickel and chromium. Mossbauer spectroscopy and XRD detected ferromagnetic minerals, particularly magnetite, followed by goethite and hematite. ConclusionThis original study of cosmetic ink stock products made with iron oxide pigments reports magnetic impurities in inks for cosmetic tattooing, e.g., magnetite, goethite, and hematite. These may be the main cause of MRI burn sensation in cosmetic tattoos. The mechanism behind sensations is hypothesized to be induction of electrical stimuli of axons from periaxonal pigment/impurity activated by magnetic force. Magnetite is considered the lead culprit.

Cosmetic tattoos may cause burning sensation during magnetic resonance imaging (MRI) and interrupt the procedure, and thereby any diagnostic workup. Tattoos also may cause disturbing artefacts in MRI images. The sensation, which can be painful, is due to magnetic elements in the tattoo ink deposited in the tattooed skin. It is not a thermal burn but a subjective sensation of burning. Tattoo ink bottles can be tested for magnetic properties by the artist in the studio, before cosmetic tattooing is performed, using a simple magnet test. This test and the pitfalls of the test are described. Hospital departments and clinics should be aware of the problem, and patients assessed prior to MRI regarding their tattoos, particularly eyebrows and eyeliners made in brown and dark colors. Red tattoos exemplified by tattooed lips are not prone to MRI-induced burning sensation. The problem is related to inorganic pigments with ferromagnetic properties.

Adverse reactions in tattooed skin during magnetic resonance imaging (MRI) are rare but well known. Previous reports describe sudden burning pain in tattooed skin, sometimes accompanied by mild erythema and oedema when entering MRI scanners. The pathophysiology remains unclear, but simple direct thermal heating can be excluded. It has been hypothesized that MRI-triggered torque and traction create neural sensations from magnetic pigment particles. However, this case enlightens yet another possible mechanism. We present a 35-year-old woman experiencing reoccurring stinging sensations in three decorative black tattoos just seconds after the initiation of the MRI. Single-blind tests with handheld power magnets or a dummy could reproduce painful subjective feelings in her tattooed skin. Similar events were provoked during re-evaluation with MRI. Surprisingly, chemical analyses and electron microscopy of skin samples revealed carbon black as the colouring agent – no iron-based solids were detected. Our case demonstrates that MRI tattoo reactions are not limited to magnetic contaminants alone. More distinct subgroups of MRI-induced reactions may occur. We hypothesize that radiofrequency induction of surface currents in black carbon particles adjacent to sensory axons in the dermis may lead to neurosensations.

Background Positive influence of the sun on psoriasis is a common assumption in dermatology. Other season-related factors such as mental health may interfere. However, the role of seasonal effects on psoriasis needs to be clarified. This review aims to systematically analyze the literature on seasonal variation on psoriasis with emphasis on Northern and Central Europe representing temperate climate conditions. Materials and methods Enrolled literature was identified through PubMed, EMBASE, and BIOSIS. An additional manual search of old reports before the introduction of efficient modern therapies, which can interfere with the spontaneous disease, was performed. Results Thirteen studies were enrolled. About 50% of psoriasis patients were stable and showed no seasonal difference between seasons. Approximately 30% improved in summer, and 20% performed better in winter, some with marked summer worsening. European results matched international reports from different continents and hemispheres with climate extremes. The psychological effects could not be ruled out. Conclusion About 50% of psoriasis patients experience a season-independent disease, however, with a subset of patients who do better in summer. Others again do better in winter, with a few of these having marked worsening in warm periods. Individual season-related activity records should be paid proper attention to when considering light therapy or climatotherapy as a treatment.

Dear Editor In the latest issue of Dermatology, Guillem et al. [1] presented a hidradenitis suppurativa (HS) cohort of 209 patients and explored how HS influenced body art practice (body piercings and tattoos). Ultimately, they concluded that HS led to an increase in tattooing in affected French women, as 44% of women in their cohort had one or more tattoos, as compared to the 9–24% of women reported in other French cohorts [2–4]. We read this article with great interest, as we believe it highlights interesting aspects of HS. The fact that 5% of the cohort abandoned the idea of getting a tattoo due to fear of infection, flare or scarring reveals yet another area where HS negatively impacts quality of life and/or opportunities of the afflicted. In contrast, the fact that 7% got a tattoo to hide HS scars, draw away the focus from HS lesions or regain control of pain and/or their bodies shows a heartening way where body art can help individuals cope with or ameliorate HS-related suffering. In psoriasis, another chronic inflammatory skin condition, tattoos have been associated with a positive effect on body image [5]. Body art can be a way for some to show individuality, physical endurance, and may even help some who have experienced traumatic experiences to overcome these and counter possible alienation/victimization [6, 7]. However, the conclusion that body art is more prominent amongst HS patients may be faulty. For one Guillem et al. [1] state that 65% of those with tattoos and 90% of those with body piercings had these performed/placed before disease onset. Secondarily as they themselves note, tattooing is more prevalent in smokers and workers (as compared to managers) [1]. They however omit to state that in industrialized countries the tattoo prevalence is highest for those with low educational and socioeconomic status (SES) [8], and that across a multitude of cultures tattoo prevalence is greatest amongst the young (ages 25– 34) [9]. This is relevant as HS is associated with a low SES [10, 11], a higher frequency of smoking [10–12] and as both mean and median ages of HS onset are reported as the early twenties [13, 14]. It is therefore conflicting that the HS cohort of Guillem et al. [1], with a mean age of 33 years, is mostly compared with studies that have been sampled to match the age, sex and profession quotas of the French population in gen-

Background Twenty megahertz ultrasound is the preferred method for in vivo measurement of skin thickness. This study on methodology aimed to compare operator-managed or "manual" measurement of skin thickness (MM) with measurement by automatic border detection (ABD). Methods The skin thickness of the flexor mid-forearm was measured in 48 subjects (subgroups 32 and 16) with the DermaScan C(R) (Cortex Technology). MM and ABD were performed on the same scans by two experienced operators. MM is measured on the peak of interface A-mode echoes representing the epidermal surface and the dermis-subcutis interface, while ABD measures on the slope of the echoes, for example, the acoustic contour. Result Automatic border detection measured the skin about 20% thicker (mean: 0.94/0.89 mm, SD: 0.09/0.11) in comparison with MM (mean: 1.25/1.22 mm, SD: 0.09/0.12), P < .001. The two methods correlated, r = .9443 and .8663. Two individual researchers reached very close results using MM, that is, mean 0.91 and 0.93 mm, and the interobserver variation was nonsignificant. Conclusion MM and ABD for ultrasound skin thickness measurement rely on different principles and consequently measure skin thickness differently, with ABD overestimating the thickness with about 20%. MM measures anatomically more correct and is preferred in research. MM has been validated against area-based thickness measurement without contour artifact and produced identical results. ABD is less operator-dependent and applicable to field studies, and useful in the beauty industry to characterize aged skin. The two methods of recording each have a scene of use.

Tattooed patients undergoing magnetic resonance imaging (MRI) can develop cutaneous complications during the procedure. Our aim was to review all published case reports on MRI-induced tattoo complications to identify a possible pattern. So far, 17 cases have been reported. Five (29%) of the cases were in cosmetic tattoos. Symptoms are abrupt and painful with fast onset during MRI, sometimes requiring termination of the procedure. Clinical signs are absent or manifested as inflammation sensed as burning. No thermal skin burns have been recognized. Full recovery is fast, with no sequelae. MRI-induced tattoo complications are uncommon. Patients with cosmetic and traditional tattoos can undergo routine MRI.

Tattooed persons examined with magnetic resonance imaging (MRI) can develop burning sensation suggested in the literature to be thermal burn from the procedure. MRI‐induced thermal effect and magnetic behavior of known tattoo pigments were examined ex vivo.