Common Skin Concerns: Dark Spots and Traumatic Tattoos

Inquiry for clarification?

Dear Dr.
Wu,
I have two questions regarding skin issues that I would like to consult with you:
1.
Regarding the flat dark spots on the sides of my feet: I have a flat dark spot (or dark macule) approximately 0.1 to 0.2 cm in size located about 2.5 cm below the base of my left and right little toes, and these spots are almost symmetrical on both feet.
Since I rarely wear socks, the sides of my feet often come into direct contact with my shoes.
Here are my questions:
Q1: In your opinion, could the flat dark spots (or dark macules) located about 2.5 cm below the base of my left and right little toes be a result of frequent friction from my shoes? I am curious because their size and position are almost identical (symmetrical).
Q2: Following up on the previous question, if the flat dark spots (or dark macules) on the sides of my feet are indeed a result of prolonged friction, do you think this is "pigmentation" caused by friction with the shoes, or could it be another skin issue (such as a mole)?
2.
Regarding the linear "traumatic tattoo" on my right elbow: I have a linear "traumatic tattoo" on my right elbow, measuring approximately 2.3 x 0.2 cm, which appears light blue to black (somewhat similar to a bruise).
This scar was left from an injury I sustained about 17 years ago.
I initially thought this scar was a result of pigmentation from the injury, but later learned that it is likely a "traumatic tattoo." This scar resulted from my right elbow hitting the ground, possibly due to incomplete cleaning of the wound, which allowed dirt or debris from the ground to mix in, leading to the formation of this "traumatic tattoo" after the wound healed.
Here are my questions:
Q1: If I do not treat my "traumatic tattoo" at all, will it have any adverse effects on my body? I am concerned that since this "traumatic tattoo" formed from dirt or debris mixing with the wound 17 years ago, not addressing it might lead to negative health consequences, and whether I should take proactive measures to treat it.
Q2: Following up on the previous question, if I decide to actively treat the "traumatic tattoo," I understand that "laser" removal is an option.
Could you please clarify whether laser removal of a "traumatic tattoo" is covered by health insurance or considered an out-of-pocket cosmetic procedure?
Thank you for your guidance on these four questions.

Axiang, 40~49 year old female. Ask Date: 2023/01/30

Dr. Wu Yuxin reply Dermatology

1.
Is it a pigment deposition caused by simple friction, or is it the formation of an actual mole? A physical examination is necessary to determine this.
2.
Tattoos resulting from trauma are primarily a matter of aesthetic consideration; if not removed, they will not pose any adverse effects on health.

Reply Date: 2023/01/30

More Info

When it comes to skin concerns such as dark spots and traumatic tattoos, it’s essential to understand the underlying causes and potential treatment options. Let's address your questions systematically.

Dark Spots on the Side of the Feet
1. Cause of Dark Spots: The flat dark spots you described, located about 2.5 cm below the base of your little toes, could indeed be a result of friction from your shoes. This friction can lead to a condition known as frictional hyperpigmentation, where the skin darkens due to repeated irritation or trauma. The symmetrical nature of these spots suggests that they are likely caused by consistent pressure or rubbing against your footwear, especially since you mentioned not wearing socks.

2. Nature of the Spots: If these spots are indeed a result of friction, they are likely to be areas of increased melanin production due to the irritation. This is different from moles (nevi), which are typically raised and can vary in color and texture. However, without a physical examination, it’s challenging to definitively diagnose the nature of these spots. If they change in size, shape, or color, or if you notice any new spots, it would be prudent to consult a dermatologist for a thorough evaluation.

Traumatic Tattoo on the Elbow
1. Health Implications of Traumatic Tattoos: The traumatic tattoo you described on your elbow, which formed after an injury 17 years ago, is essentially a scar that has incorporated foreign material (dirt or debris) into the skin. Generally, such tattoos do not pose any health risks if they remain stable and do not show signs of infection or other complications. However, if you experience any changes such as increased redness, swelling, or pain, it would be wise to seek medical attention.

2. Treatment Options: If you are considering treatment to remove the traumatic tattoo, laser therapy is indeed a common and effective option. The type of laser used will depend on the color and depth of the tattoo. As for insurance coverage, this can vary widely. In many cases, laser tattoo removal is considered a cosmetic procedure and may not be covered by health insurance. It’s best to check with your insurance provider and the clinic where you plan to receive treatment to understand the costs involved.

Additional Considerations
- Skin Care Post-Injury: For both the dark spots and the traumatic tattoo, proper skin care is crucial. Keeping the area clean and moisturized can help promote healing and minimize the risk of further irritation. If you decide to pursue laser treatment, follow your dermatologist's aftercare instructions closely to ensure optimal healing.

- Preventing Future Issues: To prevent further friction-related pigmentation, consider wearing well-fitted shoes and using protective barriers like blister pads if you are prone to friction in certain areas. For the traumatic tattoo, if you are concerned about its appearance, you might want to discuss options like camouflage makeup or further cosmetic procedures with a dermatologist.

In conclusion, while the dark spots on your feet may be benign and related to friction, the traumatic tattoo on your elbow is a more complex issue that may require professional evaluation if you wish to pursue removal. Always consult with a qualified dermatologist for personalized advice and treatment options tailored to your specific skin concerns.

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