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Interferential current caused burn over tattoo

I have been practicing for over 20 years and never had Interferential current cause a burn. My colleague had a patient with extensive tattoos, and was treating for pain daily with interferential current . Precautions and contraindications were explained and consent was given for treatment. The third week the patient said in the last 30 seconds of a 15 minute treatment he felt an stinging sensation and pulled off the electrode prior to turning off the machine. As a result a blister developed along a thin line of the tattoo. Subsequent examinations revealed a deep burn approximately 4 mm in size. My research revealed no findings of contraindications using electric modalities over tattoos. However, I did not realize that most tattoo inks have carbon, or other heavy metals that could conduct electric currents.

Any insights would be helpful.

Terry Redmond

1 month ago

Back to General Electrotherapy

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Prof Gad Alon
Prof Gad Alon

Did you use self-adhesive electrodes???

RickPainPod
RickPainPod

Prof Tim Watson said:

thinking about this one again last night. I know that there have been some studies on the effect of tattoos (and skin colour) on laser penetration, but not seen anything on e stim. Does anybody fancy having a look at it - just a pilot to start with - say e stim on a volunteer with tatoos and compare current needed for effect X (say sensory onset) in comparable skin areas with and without skin inking - so if they had a tattoo on extensor forearm one side and not the other - for example - it might make an interesting preliminary????? just a thought

We might look into it - time and resource permitting (and a volunteer)

RickPainPod
RickPainPod

terry_redmond260 said:

luisef258 said:

Strange. Just for precaution you should check on the equipment.

Equipment was the first thing I checked, No shorts, recently replaced electrodes, Bioengineering technicians tests and certifies equipment every August, last time was checked was just one month ago. As clinic manager I also thought it was strange, so after checking the equipment I started to research the contents of Tattoo ink, it was surprising the conductive mediums in this ink, including carbon, Iron Oxide, arsenic, lead, and nickel. At my clinic we are now cautioning clients if they have tattoo's in the area of treatment.

I'll just add, that without knowing what the technicians test for and what parameters. I would not entirely rule out equipment. Depending on many output & regulation design factors, an unusual load from the tattoo factor could cause abnormal output. When we are testing new output designs we often see unusual parameters that could cause issue, that are addressed. Our products being primarily consumer based are designed with much greater safety margin on output controls than that of a professional use device.

Prof Tim Watson
Prof Tim Watson

thinking about this one again last night. I know that there have been some studies on the effect of tattoos (and skin colour) on laser penetration, but not seen anything on e stim. Does anybody fancy having a look at it - just a pilot to start with - say e stim on a volunteer with tatoos and compare current needed for effect X (say sensory onset) in comparable skin areas with and without skin inking - so if they had a tattoo on extensor forearm one side and not the other - for example - it might make an interesting preliminary????? just a thought

Dinesh Verma
Dinesh Verma

Not heard for such response to EStim as such . Only reason - I may think ....if it does REALLY relates to TATTO - that if type of color INK used increases the impedence of skin to substantial levels - thus resulting in increase in Potential difference to deliver desired amount of current output levels - may case burn.... If the device is NOT protected by high level of PD generation.... That's my wildest guess...!

Prof Tim Watson
Prof Tim Watson

Terry. Thanks for raising this one. As others have mentioned, a lot of the contraindication literature is based on a combination of 'expert opinion' and what is published. Most therapists (unlike medics for example) seem reluctant to report adverse outcomes (for whatever reason) so little of it gets into the public domain. We know there is an issue with LASER based therapies in tattoo areas, and I have heard - anecdotally - a story like the one you tell here with e stim, but never seen it anywhere in the literature

I have just checked through the most recent detailed consideration - published in the Canadian Journal and although tattoo not specifically identified under the E Stim section it does say the following: "E stim should be applied only over healthy skin; therefore the intended electrode application area should be examined for lesions, signs of irritation and/or allergic reactions" (section 4.8 of the document - which is well worth reading). I KNOW that skin with a tattoo IS healthy, but it might not behave 'normally' - which could be the critical point?????

I would be interested to hear from others who have identified or experienced this issue so that we can be sure to consider it in future contraindication documentation - the more we share, the more accurate/responsive these docs will be

I am not aware of any contraindication document published in any country which currently identifies a tattoo as an issue (contraindication, precaution or danger) in the context of elec stim - maybe we should consider its inclusion???????

Tim

fisioniki289
fisioniki289

terry_redmond260 said:

luisef258 said:

Strange. Just for precaution you should check on the equipment.

Equipment was the first thing I checked, No shorts, recently replaced electrodes, Bioengineering technicians tests and certifies equipment every August, last time was checked was just one month ago. As clinic manager I also thought it was strange, so after checking the equipment I started to research the contents of Tattoo ink, it was surprising the conductive mediums in this ink, including carbon, Iron Oxide, arsenic, lead, and nickel. At my clinic we are now cautioning clients if they have tattoo's in the area of treatment.

This an example about the metal part of the INK: Tattoo-Induced Skin “Burn” During Magnetic Resonance Imaging in a Professional Football Player https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445217/

alison.hoens229
alison.hoens229

Thank you for sharing this on the forum. This is important to share with our colleagues worldwide.

terry_redmond260
terry_redmond260

luisef258 said:

Strange. Just for precaution you should check on the equipment.

Equipment was the first thing I checked, No shorts, recently replaced electrodes, Bioengineering technicians tests and certifies equipment every August, last time was checked was just one month ago. As clinic manager I also thought it was strange, so after checking the equipment I started to research the contents of Tattoo ink, it was surprising the conductive mediums in this ink, including carbon, Iron Oxide, arsenic, lead, and nickel. At my clinic we are now cautioning clients if they have tattoo's in the area of treatment.

luisef258
luisef258

Strange. Just for precaution you should check on the equipment.

fisioniki289
fisioniki289

Atlas of Illustrative Cases of Tattoo Complications. https://www.ncbi.nlm.nih.gov/pubmed/28288465

Guide to Treatment of Tattoo Complications and Tattoo Removal. https://www.ncbi.nlm.nih.gov/pubmed/28288463

fisioniki289
lochingai197
lochingai197

Do understand that the well-recorded contraindications are based on adverse case reports. If someone did something harmfully, they may not be willing to share because of reputation or even legal concern. Therefore not many.

Now, most contraindications are based on scientific hypotheses, the true reliability is questionable. Just be as careful as possible. If you have done all the necessary screening and warning based on the best of your knowledge, then don't worry too much.

Last updated 1 month ago

terry_redmond260
terry_redmond260

Fisioniki289,

Thanks for your reply, but why is there nothing in the literature to advise us clinicians that there is a potential of burns?

fisioniki289
fisioniki289

Yes, the INK... often I warn patient and therapists about tattoo for laser, tecar, electrotherapy...

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