Comparing the efficacy and safety of laser treatments in tattoo removal: A systematic review - 23/10/20

Doi : 10.1016/j.jaad.2020.07.117

Pooja Gurnani, BS ^a,^b,^⁎ , Natalie Williams, BS ^a, Ghadah AL-Hetheli, MD ^a,^c, Olivia Chukwuma, BS ^a, Rebecca Roth, MLIS ^b, Francisco Fajardo, PhD ^b, Keyvan Nouri, MD ^a
^a Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
^b Florida International University Herbert Wertheim College of Medicine, Miami, Florida
^c Department of Dermatology and Cutaneous Surgery, College of of Medicine, Qassim University, Saudi Arabia

^∗Correspondence to: Pooja Gurnani, BS, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Dermatology Research Clinic, 1150 NW 14th St, Miami, FL 33136.Department of Dermatology and Cutaneous SurgeryUniversity of Miami Miller School of MedicineDermatology Research Clinic1150 NW 14th StMiamiFL33136

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Abstract

Background

Although lasers have been the criterion standard for tattoo removal, selecting the best modality can be challenging because of the varying efficacies and adverse effects.

Objective

To evaluate all lasers used to remove tattoos and assess their efficacies and adverse effects.

Methods

Our systematic review searched PubMed, MEDLINE, Embase, Scopus, CINAHL, Cochrane Central Register of Trials, and ClinicalTrials.gov for all laser treatments. The outcomes measured included laser parameters, treatment methods, patient and tattoo characteristics, clearance rate, and adverse effect rate. The quality of the included articles was appraised by using specific assessment tools and given a high, moderate, or low risk of bias.

Results

Our search led to 3037 studies, with 36 being included in the systematic review (7 randomized controlled trials, 2 nonrandomized controlled trials, and 27 case series). Although quality-switched neodymium-doped yttrium-aluminum-garnet lasers are safe and effective, picosecond lasers have shown superiority with blue, green, and yellow tattoo pigments. Both are safe and effective for black tattoos.

Limitations

Variability among studies.

Conclusions

Picosecond lasers show superiority when treating blue, green, and yellow tattoos. The R20 and R0 novel techniques can effectively reduce treatment time. Further randomized controlled trials are required to make a more definitive recommendation.

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Key words : ablative, laser(s), picosecond, Q-switched, tattoo(s), tattoo color, tattoo pigment

Abbreviations used : CS, Er:YAG, Nd:YAG, NRCT, Q-switched, QSAL, QSNL, QSRL, PSL, RCT