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by Burkhart and Burkhart demonstrated that tacrolimus has International Cosmetic Dictionary) such as deionized water, superior efficacy to alclometasone dipropionate which, zinc oxide, magnesium oxide, calcium oxide, isopropanol, according to several classifications, is a mid-potent cortico- triethanolamine and benzoic acid. This composition has low steroid similar to hydrocortisone butyrate.
skin toxicity and is also quite antiseptic. The Rejuvi Tattoo Finally, the authors write that in a 3-week study, topical Remover has a great chemical affinity to most tattoo steroids were found to be more effective than topical pigments: it is capable of mobilizing tattoo pigments from immunomodulators, but fail to mention that the comparator the skin and blends well with them. The Rejuvi Tattoo used in that study was pimecrolimus cream. To discuss our Remover forms a scab with tattoo pigments on the treated results in the context of pimecrolimus is not relevant due to skin area, which then peels off in 10–20 days. It is recom- the clear differences in potency between tacrolimus ointment mended to perform the treatment on a tattoo area not greater and pimecrolimus cream. In conclusion, while patient satis- than 15 cm2 in order to control the discomfort level after faction is of major importance, the study setting of Burkhart treatment. If needed, a second treatment should be performed and Burkhart was not satisfactory with respect to evaluating on the same area after sufficient skin healing (usually about the efficacy of treatment.
In approximately 5 years of study and practice, Rejuvi Department of Dermatology, Helsinki Tattoo Removal has been found to be noncolour-selective (it University Central Hospital, removes all tattoo pigments). In the initial study (98 Meilahdentie 2, Helsinki, SF-00250 patients), the success rate was 100% for removal of cosmetic facial tattoos (tattooed eyebrows) and 92% for body tattoos.
The scarring rate was 0% for cosmetic facial tattoos and 6%for body tattoos. No pigmentary change was found for eithertype of tattoo.5 Compared with all other tattoo removal techniques, Rejuvi Tattoo Removal appears to be effective, 1 Reitamo S, Harper J, Bos JD et al., for the European Tacrolimus safer, simple and cost-effective.6 Rejuvi Tattoo Removal can Ointment Group, 0Æ03% tacrolimus ointment applied once or twice be used independently or together with laser techniques (pre- daily is more efficacious than 1% hydrocortisone acetate in children or post-treatment). Some typical results from Rejuvi Tattoo with moderate to severe atopic dermatitis: results of a randomized Removal are shown in Figures 1 and 2.
double-blind controlled trial. Br J Dermatol 2004; 150: 554–62.
2 Reitamo S, Leent EJM, Ho V et al. Efficacy and safety of tacrolimus ointment compared with that of hydrocortisone acetate ointmentin children with atopic dermatitis. J Allergy Clin Immunol 2002;109: 539–46.
3 Reitamo S, Rustin M, Ruzicka T et al. Efficacy and safety of tacrolimus ointment compared with that of hydrocortisone buty-rate ointment in adult patients with atopic dermatitis. J Allergy ClinImmunol 2002, 109: 547–55.
Chemical extraction technique for tattoo removal SIR, I write in response to the correspondence ‘Adverseside-effects following attempted removal of tattoos using anon-laser method'.1 Laser treatment is a modern technique fortattoo removal. Various lasers such as the Q-switched rubylaser, Q-switched Nd:YAG laser, CO2 laser and Q-switchedalexandrite laser are popularly used to remove tattoos. Theadverse effects including textural change, scarring, hypopig-mentation, hyperpigmentation, partial removal and tattoocolour darkening have been well addressed in the literature.2–4 The Rejuvi Tattoo Removal chemical extraction method was developed recently as a new modality for both facialcosmetic tattoos and body tattoos.5 The technique involvesapplication of the Rejuvi Tattoo Remover on the unwantedtattoo area using normal tattooing or a micropigmentationmethod. It is very close to a tattoo-over procedure.
The Rejuvi Tattoo Remover contains only cosmetic ingre- Figure 1. (A) The patient had two tattooed eyebrows. (B) The upper dients (International Nomenclature Cosmetic Ingredient or eyebrow was removed by chemical extraction technique.
 2004 British Association of Dermatologists, British Journal of Dermatology, 151, 1272–1288 Rejuvi Tattoo Removal has been successfully and widely used by many permanent make-up artists, tattooists, derma-tologists and plastic surgeons in the U.S.A. Extensive tattoo-ing experience and good training are the keys for suchsuccess.
Rejuvi Laboratory, Inc., South San Francisco, CA 94080, U.S.A.
E-mail: [email protected] 1 Veysey E, Downs AMR. Adverse side-effects following attempted removal of tattoos using a non-laser method. Br J Dermatol 2004;150: 770–1.
2 Kuperman-Beade M, Levine VJ, Ashinoff R. Laser removal of tat- toos. Am J Clin Dermatol 2001; 2: 21–5.
3 Varma S, Swanson NA, Lee KK. Tattoo ink darkening of a yellow tattoo after Q-switched laser treatment. Clin Exp Dermatol 2002;27: 461–3.
4 Levine VJ, Geronemus RG. Tattoo removal with Q-switched ruby laser and the Q-switched Nd:YAG laser: a comparative study. Cutis1995; 55: 291–6.
5 Cheng W. A non-laser method to reverse permanent makeup and tattoos. Cosmet Dermatol 2001; 14: 47–50.
6 Varma S, Lanigan SW. Reasons for requesting laser removal of unwanted tattoos. Br J Dermatol 1999; 140: 483–5.
Figure 2. (A) The patient had a deep tattoo on the upper arm. (B)The tattoo was removed by chemical extraction technique; the lettersremaining were kept at the request of the patient.
Chemical extraction technique for tattoo removal:reply from authors Similar to laser techniques, the success of tattoo removal (all techniques) very much depends upon the original tattoo condition including depth of tattoo pigment in the skin,uniformity of pigment depth (amateur or professional), SIR, Very few manufacturers take the opportunity to respond location and skin type, as well as the removal skill.2 to comments made about their products or devices in medical Compared with laser techniques, Rejuvi Tattoo Removal journals. Dr Cheng's response provides more insight and may need more skill or experience, particularly for the knowledge to the readership about a medical device ⁄ treat- removal of body tattoos. The primary requirement is that a ment that lies at the fringes of dermatology practice. We technician must have good experience in tattooing or merely reported two adverse incidents with the Rejuvi micropigmentation. For the removal of facial cosmetic tattoo removal method and summarized past and present tattoos, most permanent make-up artists can perform a good tattoo removal treatments.1 and safe treatment because the tattoo pigments are at a It is far too easy for a wide range of medical devices to be shallow depth in the skin (epidermis or upper dermis). For used by nonmedical personnel in the U.K. with disastrous removal of body tattoos (usually quite deep, mid-dermis or consequences. Doctors without proper training and care, and below), training and procedures become very important in practising outside the scope of their expertise, can also do minimizing adverse effects such as hypertrophy and pigmen- much harm. We agree that Q-switched laser tattoo removal tary change. It is found that adverse effects consistently occur systems are not without their problems and are unhelpful for with a technician who does not have proper training or skill many types of tattoos. More articles published in peer- reviewed medical journals are needed to help see where In the last 5 years of practice a conservative application chemical extraction tattoo removal systems best fit into procedure has been developed for body tattoo removal, and mainstream cosmetic dermatology practice.
the rate of adverse events is below 1% (after good training).
The key to the procedure is to avoid deep and prolonged Department of Dermatology, Royal puncturing to the skin (do not intend to remove all tattoo Devon and Exeter Hospitals, Exeter colours in one treatment). The detailed procedures can be EX2 5DW, U.K.
provided upon request (E-mail address at the end of this  2004 British Association of Dermatologists, British Journal of Dermatology, 151, 1272–1288

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