Definition:
Tattooing is defined as uniform implantation of minute metabolically inert pigment granules into the dermis (Microdermatopigmentation) so as to give permanent skin colour to a patch of vitiligo/leucoderma.

Indication:
Stable vitiligo, Leucoderma, to fill up the gaps in alopecia (by black pigment), to create permanent eyebrow line or areola. Area to be tattooed should be small.

Contra Indication:
Kelodial tendency, infection, allergy to pigment, active vitiligo patch.

Tattooing Equipments:

1. Mechanical Machine : Hand held pinvice with 8-10 needles.
2. Electrical Machine : 2-6 needles held on needle bar which is driven electrically.

Action:
Needles move up and down driving pigment into dermis.

Various Tattoo pigments commonly used are:

1. White - Titanium Dioxide
2. Red - Cinnabar, Mercuric Sulphate
3. Yellow - Cadmium Sulphate
4. Black, Brown - Iron Oxide
5. Camel Yellow

Mixing & Matching:
After proper sterilization of machine and pigments, various coloured pigments are mixed in such a way that a shade is produced which matches closest to the skin surrounding the tattoo site.
This powder is converted into paste by addition of sterile water and glycerine.

Method:
After taking consent and surgically preparing the site to be tattooed, local anaesthesia is given. A thick coat of prepared pigment paste is applied to the area and tattooing is done with the help of the machine. Excess pigments is wiped off. Areas where pigment has not been driven in properly are recoated with pigment paste and procedure is repeated. Haemostasis is achieved with cold sponge pressure and post operative antibiotic and anti inflammatory is given.

Sequelae:

• Usual: Swelling, pain, crusting.
• Side effects: Leaching, Clouding and change in shade of pigment.
• Complications: Mismatch colour, Secondary infection, allergic reaction to pigment etc.

Limitation:
This procedure can be used on small sized, few patches of stable vitiligo. Colour match is best obtained in dark persons.

Advantage:

1. Instant coloring so immediate results. Only method to treat vitiligo on emergency basis (e.g., just before marriage).
2. Good cosmetic match. Rare chances of rejection.
3. Inexpensive safe OPD procedure. No hospitalization.
4. Can be done on any anatomical site (hairy, friction site, genitals, nipples etc.)
5. One time permanent procedure for treatment of vitiligo.

Mahapedicon 2005 - Conference Abstracts.Pediatric Oncall [serial online] 2006 [cited 15 July 2006(Supplement 7)];3. Available from:
http://www.pediatriconcall.com/fordoctor/Conference_abstracts/
MAH_PEDICON2006/tattoo_vitiligo_leucoderma.asp