Design made on skin by puncturing the skin and adding pigment; typically, cannot be removed, washed away or erased without special techniques, sometimes including plastic surgery. Unless sterile surgical technique is used, transmission of diseases such as hepatitis or AIDS may occur. Traumatic tattooing refers to embedding of fine dirt particles in the skin following an abrasion or close-range exposure to gunfire (powder bums). If promptly removed, little or no permanent scarring occurs. Otherwise, the particles are absorbed by scavenger cells (macrophages) in the skin, and may be permanent.