SAN DIEGO – results from a novel study demonstrated.
Dr. Yakir Levin
“The laser plume is known to contain possible hazards,” Yakir Levin, MD, PhD, said at the annual Masters of Aesthetics Symposium. “Intact human papillomavirus DNA has been demonstrated in the CO2 laser plume of common wart treatments,” he noted, and transmission of bovine papillomavirus has been shown in a bovine model of CO2 laser treatment (Arch Dermatol 2002;138[10]:1303-7). “In addition, aerosolized human cells have been demonstrated in laser tattoo removal.”
In a more recent study, Gary S. Chuang, MD, and his colleagues demonstrated hazards in the laser hair removal plume (JAMA Dermatol 2016;152[12]:1320-6). “These include ultrafine particles that become lodged in pulmonary alveoli and cause long-term respiratory problems, as well as volatile organic compounds, which can be carcinogens and environmental toxins,” said Dr. Levin of the Massachusetts General Hospital department of dermatology and the Wellman Center for Photomedicine, both in Boston. “They showed that this can be improved but not cured by proper use of a smoke evacuator; they also emphasized the importance of wearing a mask.”
Dr. Levin and his colleagues chose to study laser tattoo removal plume because more than 40 million Americans have tattoos, especially younger adults. In addition, 17% regret having their tattoo and 11% are undergoing or have undergone tattoo removal procedures. In what is believed to be the first study of its kind, the researchers performed a study in ex vivo pig skin and in humans undergoing routine laser tattoo removal. They measured the concentration of nanoparticles as well as the presence of heavy metals, volatile organic compounds, and airborne bacteria.
For the swine study, the excised pig skin was tattooed with several differently colored inks. Dr. Levin and his colleagues found that the concentration of airborne nanoparticles measured during laser tattoo removal was elevated and varied with different inks and different lasers used. Fine metals were measured in mcg/m3 air and were below safe occupational exposure limits. The same effect was seen for volatile organic compounds.
Next, the researchers analyzed the laser plume in humans undergoing removal of blue, black, and multicolored tattoos. “Here, the results were a little bit different,” Dr. Levin said. “Airborne particle concentrations were higher in the dermatologist’s breathing zone and near the tattoo removal site than in the remainder of the room or outside of the room. However, concentrations were 30 times lower for human skin than for pig skin. That’s because the pig study was somewhat artificial in that the tattoos were done when the pig was dead.”
Metals were detected in the plume in the human study, but they were all below occupational exposure limits. The same effect was seen for volatile organic compounds.
Dr. Levin said that airborne nanoparticle concentrations for laser tattoo removal of ex vivo tattooed swine skin were comparable to those reported for hair removal, while airborne nanoparticle concentrations for laser removal of in vivo human skin were much lower than those reported for laser hair removal. “So it’s probably true that the potential health hazards from laser tattoo removal are lower than for laser hair removal, but we did not study viral particles or the presence of viable human cells in the plume,” he said.
Current methods to limit laser plume exposure include suction of the plume with a smoke evacuator, use of a barrier device placed over the skin, and wearing a face mask constructed to filter nanoparticles, such as an N95 mask.