Tattoo removal among Ethiopian Jews in Israel: tradition faces technology

Abstract

Background: Many Jews in Ethiopia adopted the Christian custom of tattooing various parts of the body, either after conversion or to hide their Jewish origin. After emigrating to Israel, they sought to remove these foreign symbols to better blend with society. The aim of this study was to describe the use of laser technology for tattoo removal in a high-risk dark-skinned population and to highlight one way in which the interaction of modern medical communities with people from developing countries can open new avenues of research.

Patients and methods: The study sample consisted of 401 women and 3 men of Ethiopian origin with Fitzpatrick skin type V or VI. Ages ranged from 15 to 53 years. All tattoos were blue/black and had been made by injecting charcoal into the skin. Most (n = 392, 97%) were located on the forehead or the forehead and temples (n = 312); 69% were cross-shaped. Patients underwent 3 to 6 laser treatments (average 3.6) with the Q-switched Nd:YAG (n = 380, 94%) or ruby (n = 24) laser at intervals of at least 8 weeks. The percent of clearing was scored by two independent investigators as follows: 1 = 0%-25%; 2 = 26%-50%; 3 = 51%-75%; 4 = 75%-100%. Pigmentary and textural changes were classified as none, mild, moderate, or severe. The duration of follow-up after the last treatment was 6-8 months.

Results: At the last follow-up, the clearance score was 4 in 92% of the patients and 3 in the remainder. Transient (2-4 months) mild hyperpigmentation was noted in 177 (44%) patients, and mild textural changes in two, both treated with the Q-switched laser. There were no cases of scarring or permanent pigmentary changes.

Conclusion: Laser removal of carbon-based tattoos in an Ethiopian population yielded an excellent to good aesthetic outcome with no complications, similar to results in light-skinned patients. These findings have important implications for improving the quality of life of Ethiopian immigrants in Israel.