Key points Cosmetic tattoos represent the standard treatment for achieving permanent coverage of vitiligo areas. This is particularly effective for mucosal vitiligo. Adverse reactions need to be considered. Solution In the past and present, the general population has tattoos painted for religious reasons or for their symbolic meaning. Tattoos are injected in the dermis with micro-pigments, inert iron oxides that cannot migrate. The micro-pigments implanted in the skin will not wash off, but the color will fade naturally within 24-36 months. The cosmetic results depend on the skill of the doctor or technician in matching the tattoo color to the normal skin color surrounding it. Dark-skinned people usually have better results than fair-skinned people. Adverse effects that have been reported include recurrent herpes simplex virus infections, chronic granulomatous reactions to implanted pigments, allergic reactions, isomorphic reactions, improper color matching, and in our experience, pseudolymphoma of the skin.