Vitiligo is a dermatological condition characterized by the appearance of white patches on the skin. Although some areas of uncertainty still remain, the underlying mechanisms of the disease are better understood today. Do tattoos or laser hair removals trigger vitiligo? Let's explore this question together.
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Can a tattoo or laser hair removal trigger vitiligo?
Summary
- A Connection Between Tattooing and Vitiligo?
- Laser Hair Removal: A Possible Trigger for Vitiligo?
- Sources
Published November 18, 2024,
updated on November 18, 2024,
by
Pauline, Head of Scientific Communication
—
6 min read
A Connection Between Tattooing and 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.
Case of vitiligo following a tattoo (A: initial lesion in 2007; B: progressive extension in 2010).
Source: KLUGER N. & al. Vitiligo on Tattoo. Annals of Dermatology and Venereology (2011).
Laser Hair Removal: A Possible Trigger for Vitiligo?
Another practice that has been singled out and considered as a potential trigger for vitiligo is laser hair removal. As a reminder, this hair removal technique, considered to be permanent, relies on the emission of a light beam that is absorbed by the melanin present in the hair. This energy is then transferred along the hair to the hair bulb, causing their apoptosis, or cell death. While people with vitiligo can theoretically undergo laser hair removal, most practitioners warn them about the risk of developing a Koebner phenomenon, which, as previously explained, is characterized by the appearance of new white patches following skin trauma.
For individuals who initially do not have vitiligo, there is a risk of hypopigmentation. However, this is most often a temporary whitening of the skin, not actual vitiligo. While, as with tattooing, scientific evidence establishing a direct link between laser hair removal and the onset of vitiligo is rare, a case of vitiligo following hair removal with an Alexandrite laser (755 nm) has been reported. This involved a 28-year-old woman who, following her laser session, had persistent white spots on her legs. After three months of treatment with tacrolimus, an immunosuppressant, and regular UVB laser sessions (308 nm), the spots were still present.
The persistence of lesions three months after treatment suggests that this is not a simple case of transient hypopigmentation, but a genuine case of vitiligo. Although the patient has never been diagnosed with vitiligo before, it can be assumed that she had a genetic predisposition to this disease, and that the laser session has triggered the onset of the dermatosis. However, this is not certain and it raises the question again as to why so few cases have been reported in the scientific literature.
Again, more scientific evidence would be necessary to definitively assert that laser hair removal is likely to cause vitiligo in individuals who initially show no signs of the disease.
Case of vitiligo following laser hair removal.
Source: ALKHALIFAH A. A Case Report of Vitiligo Induced by Alexandrite Hair Removal Laser. Case Reports in Dermatology (2021).
Sources
SELLHEYER K. Mechanisms of laser hair removal: could persistent photoepilation induce vitiligo or defects in wound repair? Dermatologic Surgery (2007).
KLUGER N. & al. Vitiligo sur tatouage. Annales de Dermatologie et de Vénéréologie (2011).
KLUGER N. Vitiligo on a tattoo: association rather than cause. International journal of dermatology (2013).
MAVILIA L. & al. Koebner's phenomenon induced vitiligo following Nd: YAG laser epilation treatment in a woman with a past history of a Sutton nevus. Dermatologic therapy (2014).
EZZEDINE K. & al. Vitiligo: A Review. Dermatology (2020).
ALKHALIFAH A. A Case Report of Vitiligo Induced by Alexandrite Hair Removal Laser. Case Reports in Dermatology (2021).
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