Can a tattoo or laser hair removal trigger vitiligo?

Vitiligo is characterised by the selective loss of melanocytes, resulting in the appearance of white patches on the skin. This dermatosis is currently classified as an autoimmune disease, associated with genetic and environmental factors.

Does tattooing form part of the potential environmental factors that could cause vitiligo ? This is what some scientists suggest, reporting the case of a 43-year-old woman with no history of dermatosis who developed a vitiligo lesion on her tattoo that was done four years prior. The macule was accompanied by itching, leading researchers to suspect seborrheic keratosis within the tattoo, a benign skin condition characterised by brownish spots and itching. No other signs of vitiligo were observed on the rest of the body. The vitiligo spot then gradually expanded, as shown in the photos below.

Researchers have concluded that the vitiligo macule may have spread due to a Koebner phenomenon. This is a skin reaction in which new lesions appear on areas of the skin that have been traumatised or injured in individuals with an underlying dermatological disease. They therefore suspected that the vitiligo spot had spread due to scratching caused by seborrheic keratosis, but that the tattoo could have been the triggering element of vitiligo.

This hypothesis, however, is not universally accepted within the scientific community. Some researchers have expressed surprise that a technique so widely used worldwide, including for camouflaging vitiligo spots, could cause a skin disease in an individual, when no other similar cases have been reported despite its popularity. For these individuals, it is not a direct pathophysiological link between tattooing and vitiligo, but rather a unveiling of underlying vitiligo in a predisposed patient. Furthermore, the delay in onset is relatively intriguing, with the macules only appearing four years after the tattoo was done.

The evidence we currently have is not sufficient to assert that tattooing can cause vitiligo. It would be interesting to conduct further studies to determine whether the pigments used in tattoos can act as immunogenic agents capable of triggering vitiligo.

Another practice that has been highlighted and considered as a potential trigger for vitiligo is laser hair removal. To recap, this hair removal technique, considered to be permanent, relies on the emission of a light beam that is absorbed by the melanin present in the hair. This energy is then transferred along the hair to the hair bulb, causing their apoptosis, that is, their cell death. While people with vitiligo can theoretically resort to laser hair removal, most practitioners warn them about the risk of developing a Koebner phenomenon, which, as previously explained, is characterised by the appearance of new white patches following skin trauma.

For individuals who initially do not have vitiligo, there is a risk of hypopigmentation. However, this is most often a temporary whitening of the skin, not actual vitiligo. While, as with tattooing, scientific evidence establishing a direct link between laser hair removal and the onset of vitiligo is scarce, a case of vitiligo following hair removal with an Alexandrite laser (755 nm) has been reported. This involved a 28-year-old woman who, following her laser session, had persistent white spots on her legs. After three months of treatment with tacrolimus, an immunosuppressant, and regular UVB laser sessions (308 nm), the macules were still present.

The persistence of lesions three months after treatment suggests that this is not a simple case of transient hypopigmentation, but a genuine case of vitiligo. Although the patient has never been diagnosed with vitiligo before, it can be assumed that she had a genetic predisposition to this disease, and that the laser session has triggered the onset of the dermatosis. However, this is not certain and it raises the question again as to why so few cases have been reported in the scientific literature.

Once again, more scientific evidence would be required to definitively assert that laser hair removal is likely to cause vitiligo in individuals who initially show no signs of the disease.

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• KLUGER N. & al. Vitiligo sur tatouage. Annales de Dermatologie et de Vénéréologie (2011).

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• MAVILIA L. & al. Koebner's phenomenon induced vitiligo following Nd: YAG laser epilation treatment in a woman with a past history of a Sutton nevus. Dermatologic therapy (2014).

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