Burn Injury Assessment through Tattoos: A Systematic Review

Dr Danika Jurat1, Dr Douglas Copson1

1Fiona Stanley Hospital, Murdoch, Australia


Background: tattoos are a form of body decoration increasing in popularity world-wide¹. By changing the colour of the skin with injection of pigment, assessment of burn injuries are made more challenging for the medical practitioner. A 46 year old male was admitted to the State Burns Unit of Western Australia secondary to an acetone explosion whilst fixing his boat. He received burns to his neck, chest and bilateral upper limbs. This gentleman was heavily, intricately tattooed to bilateral upper limbs with coloured and black pigments. His tattoos made the assessment of the depth of his burns difficult for the initial doctors assessing the patient and for ongoing reviews. This is on a background of 21 similar patients being admitted to the Western Australia State Burns Unit between 2012 and current.

Objectives: to perform a systematic, peer review of the literature on assessment of burn injuries through tattoos.

Data sources: A systematic literature search was performed across electronic databases including PubMed, EMBASE, MEDLINE and Cochrane to identify studies. Key words used were “burn”, “burn injury”, “tattoo”, “assessment” and “depth”.

Study appraisal: Two case reports were identified, one, a reflection on the clinical, diagnostic challenge of burn depth assessment overlying tattoos², the other assessing the depth of burn injury over tattoos utilising laser speckle contrast analysis (LASCA) imaging³.


  1. The case report on the diagnostic challenge of burn depth assessment overlying tattoos discussed issues with identifying colour and capillary refill, examination findings that assist in defining depth of the injury².
  2. The case report on LASCA imaging in burns overlying tattoos assessed the effect of varying shades of pigmentation, from non-tattooed skin to multi-coloured, on the relative perfusion analysis³. Tattoo pigments were shown to alter the results of perfusion patterns. Determination of depth was limited by variety of pigment shades³.

Conclusions: Extremely limited evidence available for assessment of burn injuries overlying tattoos. This review highlights the need for further research into the area.


Danika Jurat is a resident medical officer working in the State Burns Unit of Western Australia with a keen interest in Plastic Surgery, particularly Burns

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