Immediate cutaneous hypersensitivity after treatment of tattoo with Nd:YAG Laser:: a case report and review of the literature

Background: To our knowledge this is the first reported case of an immediate cutaneous reaction to Q-switched neodymium: yttrium-aluminum-garnet (Nd:YAG) laser tattoo removal. A 26-year-old female presented with two 6-year-old tattoos placed at different times. These were of different colors and had remained entirely asymptomatic since placement. There was a Mardi Gras mask on her thigh and a Tasmanian devil on her chest. With laser treatment of the Tasmanian devil, she experienced no untoward effects. However, with treatment of the Mardi Gras mask tattoo, she developed an extensive urticarial and indurated reaction 30 minutes posttreatment. The identical reaction occurred twice with subsequent laser treatments. Dermatology consulted allergy to provide prophylaxis against possible systemic reaction with subsequent Nd:YAG laser therapy. The patient was treated with 3 days of prednisone, cetirizine, and ranitidine before subsequent laser treatments. Prophylactic treatment suppressed all subsequent reactions to laser therapy. Results: Delayed hypersensitivity to tattoo pigments occurring days to weeks after placement is well documented. There are no previous reports of immediate hypersensitivity during placement or laser removal. However, there are two previous reports of local and systemic delayed reactions after laser therapy. Conclusions: As far as we know, this is the first case report of immediate hypersensitivity after Nd:YAG laser treatment of a tattoo. Prophylactic treatment with steroids and antihistamines prevented reactions with subsequent laser treatments. Reactions after laser removal are rare, but may increase as popularity of skin art increases with the need for subsequent removal.