Can a tattoo or laser hair removal trigger vitiligo?

Vitiligo is characterized by the selective loss of melanocytes, leading to the appearance of white patches on the skin. This dermatosis is currently classified as an autoimmune disease, associated with genetic and environmental factors.

Does tattooing contribute to potential environmental factors causing vitiligo ? This is what some scientists suggest, reporting the case of a 43-year-old woman with no history of dermatosis who developed a vitiligo lesion on her tattoo that was done four years prior. The lesion was accompanied by itching, leading researchers to suspect seborrheic keratosis within the tattoo, a benign skin condition characterized by brownish spots and itching. No other signs of vitiligo were observed on the rest of the body. The vitiligo spot then gradually expanded, as shown in the photos below.

Researchers have concluded that the vitiligo macule may have spread due to a Koebner phenomenon. This is a skin reaction in which new lesions appear on areas of the skin that have been traumatized or injured in individuals with an underlying dermatological disease. They thus suspected that the vitiligo spot had spread due to scratching caused by seborrheic keratosis, but that the tattoo could have been the triggering element of vitiligo.

This hypothesis, however, is not universally accepted within the scientific community. Some researchers have expressed surprise that a technique so widely used worldwide, including for camouflaging vitiligo spots, could cause a skin disease in an individual, especially when no other similar cases have been reported despite its popularity. For these individuals, it is not a direct pathophysiological link between tattooing and vitiligo, but rather a unveiling of an underlying vitiligo in a predisposed patient. Furthermore, the delay in onset is relatively intriguing, as the spots only manifested four years after the tattoo was applied.

The evidence we currently have is not sufficient to assert that tattooing can cause vitiligo. It would be interesting to conduct additional studies to determine if the pigments used in tattoos can act as immunogenic agents capable of triggering vitiligo.