[January 2010 • Volume 3 • Number 1] 39 39 39 39 39 39 39 39 39 39 39 39 39 [CASE REPORT] ABSTRACT Widely considered the gold standard treatment option for tattoo removal, the use of Q-switched lasers may very rarely result in the formation of large bulla. While very disconcerting to patients, these lesions are easily managed and, with proper care, heal quickly with no long-term consequences. The authors present three cases of patients who had bullous reactions shortly after receiving Q-switched laser treatment of tattoo ink. Bullous formation in all three patients was treated successfully. (J Clin Aesthetic Dermatol. 2010;3(1):39–41.) I t is well established that Q-switched lasers are the gold- standard treatment for tattoo ink removal. 1,2 While some unwanted side effects may be associated with the treatment, it is important to distinguish between transient adverse events and true treatment complications. In this article, the authors present three patients who had bullous reactions shortly after receiving Q-switched laser treatment of tattoo ink. All three patients experienced an excellent, nonscarring recovery. CASE REPORT Three clinic patients were treated with a Q-switched neodymium-doped yttrium aluminium garnet (Nd:YAG) laser independently in 2009 for laser tattoo removal (Hoya ConBio MedLite C6 laser; initial treatment setting = 6mm/3.0J). All three patients had been previously treated approximately 6 to 8 weeks earlier with the same laser device and similar settings without complications. None of the patients received treatment for a tattoo that covered up another tattoo. Approximately 18 to 24 hours after a particular laser treatment, all three patients reported painful blisters and were instructed to return to the office (Figures 1–3). Each patient denied the use of topical, over- the-counter antibiotic ointments or photosensitizing medications. Additionally, the patients failed to elevate and intermittently ice the recently treated tattoo areas as instructed. In each case, large, tense blisters were cleansed with alcohol, and serous fluid was aspirated from each bulla with a syringe and a 22-gauge needle until flat. The roof of each bulla was left in place and gentle pressure was applied to keep the blister roof in contact with the underlying structures. The areas were coated with petrolatum ointment and dressed with a bandage offering sufficient compression. As implementation of laser light is a sterile procedure, infections in the treated area occur very rarely and oral antibiotics were withheld. A biopsy was not taken for histopathological evaluation as the cause of the bulla was evident. Over the following two weeks the patients reported spontaneous desquamation around the affected areas without manipulation. In all three cases, the areas healed appropriately without signs of scarring. Pigmentary changes were appreciated, but were not permanent in nature. Tissue texture changes, hypertrophic scars, or keloids were not present (Figures 3a and 3b). DISCLOSURE: The authors report no relevant conflicts of interest. ADDRESS CORRESPONDENCE TO: William Kirby, DO, 8500 Wilshire Blvd., Suite #105, Beverly Hills, CA 90211; E-mail: drwillkirby@hotmail.com Treatment of Large Bulla Formation after Tattoo Removal with a Q-Switched Laser a WILLIAM KIRBY, DO, FAOCD; b FRANCISCA KARTONO, DO; c ALPESH DESAI, DO, FAOCD; d RAVNEET R. KAUR, BSN, MD; c TEJAS DESAI, DO, FAOCD a Kirby Dermatology, Beverly Hills, California; b Department of Dermatology, Botsford Hospital, Farmington Hills, Michigan; c Heights Dermatology, Houston, Texas; d David Geffen School of Medicine at UCLA, Los Angeles, California