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Exploring the Intersection of Permanent Makeup and Dermatology


Walter Liszewski, MD, shares insights into discrepancies between permanent makeup and decorative tattoos and which patients may benefit from permanent makeup.

“I serve on the board of directors of the European Society of Tattoo and Pigment Research. We're an organization of tattoo artists, analytical chemists, bureaucrats from the EU and the FDA, as well as dermatologists, and our focus is how do we learn more about tattoo science? How do we make tattoos safer? And how do we advance technology and pigments that are used in tattoos? Over the past couple of years, permanent makeup has been a very hot topic and I wanted to learn more about how permanent makeup is regulated in the United States and what materials are being used,” said Walter Liszewski, MD, in an interview with Dermatology Times.

Liszewski is a board-certified dermatologist and assistant professor of dermatology at Northwestern Feinberg School of Medicine in Chicago, Illinois. Liszewski and his research team recently had 2 papers published in the Journal of the Academy of Dermatology that explored the use of permanent makeup, regulations, complications, and associations with allergic contact dermatitis.1,2

During a research opportunity in Denmark, Liszewski met a mentor who was passionate about tattoos and who helped him realize how poorly tattoos are regulated and how little is known about the medical complications of tattoos.

In his interview, Liszewski addresses the distinction between permanent makeup and decorative tattoos, differences in training and certifications for each type of tattoo artist, how permanent makeup is regulated, discrepancies in regulations across states, and how dermatologists can become more involved in the conversation of safe permanent makeup for patients with alopecia areata or vitiligo who may seek these tattoos.

Permanent makeup should be considered a conversation in dermatology because patients with certain skin conditions such as vitiligo or alopecia areata can benefit, according to Liszewski. For example, patients with vitiligo who may never achieve repigmentation or not enough may be interested in permanent makeup to fill in patches. Patients with severe alopecia areata who cannot regrow their eyebrows may be interested in permanent makeup.

“It's important to understand that these tattoo artists can be very helpful in helping us get patients to where they want to be cosmetically or have their skin look the way that they would like to,” said Liszewski. For dermatologists to be more involved in these conversations, Liszewski encouraged colleagues to not be afraid to reach out to tattooists and have conversations about the services they offer and how they can help patients.

Another important aspect of Liszewski’s research is tattoo ink and contact dermatitis allergies.

“First, there is no way to really allergy test for tattoo allergies. It's challenging. Tattoo pigments are placed in the dermis, yet traditionally, allergic contact dermatitis occurs in the epidermis. Number 2, fresh pigments are usually not allergenic. Rather, what happens is pigments degrade over months to years, due to UV damage, and those broken-down products are what become very allergenic. Number 3, and I cannot emphasize this enough, if you open up a dermatology textbook, they're factually inaccurate about dermatology allergies, and they're about 50 years behind the times. No one uses Mercury anymore. We're not using cadmium. We haven't used those pigments in decades,” concluded Liszewski.


  1. Rigali S, Cozzi C, Liszewski W. Identification of the pigments used in permanent makeup and their ability to elicit allergic contact dermatitis. J Am Acad Dermatol. Published online May 31, 2024. doi:10.1016/j.jaad.2024.05.067
  2. Ghafari G, Newcomer J, Rigali S, Liszewski W. Permanent makeup: a review of its technique, regulation, and complications. J Am Acad Dermatol. Published online June 14, 2024. doi:10.1016/j.jaad.2024.01.098
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