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Health effects of tattoos

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A variety of health effects can result from tattooing. Because it requires breaking the skin barrier, tattooing carries inherent health risks, including infection and allergic reactions. Modern tattooists reduce such risks by following universal precautions, working with single-use disposable needles, and sterilising equipment after each use. Many jurisdictions require tattooists to undergo periodic bloodborne pathogen training, such as is provided through the Red Cross and the U.S. Occupational Safety and Health Administration.

Dermatologists have observed rare but severe medical complications from tattoo pigments in the body, and have noted that people acquiring tattoos rarely assess health risks prior to receiving their tattoos. Some medical practitioners have recommended greater regulation of pigments used in tattoo ink. The wide range of pigments currently used in tattoo inks may create unforeseen health problems.

Infection

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Since tattoo instruments come in contact with blood and bodily fluids, diseases may be transmitted if the instruments are used on more than one person without being sterilised. However, infection from tattooing in clean and modern tattoo studios employing single-use needles is rare.[1] With amateur tattoos, such as those applied in prisons, however, there is an elevated risk of infection. To address this problem, a programme was introduced in Canada as of the summer of 2005 that provides legal tattooing in prisons, both to reduce health risks and to provide inmates with a marketable skill. Inmates were to be trained to staff and operate the tattoo parlours once six of them opened successfully.[2]

In the United States, the Red Cross prohibits a person who has received a tattoo from donating blood for 3 months, unless the procedure was done in a state-regulated and licensed studio, using sterile technique.[3] The District of Columbia, Georgia (until January 2025), Idaho, Maryland, Massachusetts, New Hampshire, New York, Pennsylvania, Utah and Wyoming do not have a rigorous licensing and regulation (e.g. bloodborne pathogen training) program, meaning that people who receive tattoos there are subject to the 3-month deferral regardless of the hygienic standards of the studio. Similarly, the UK does not provide certification for tattooists, and blood donations are prohibited without exception for four months following a tattoo.[4]

Infections that can theoretically be transmitted by the use of unsterilised tattoo equipment or contaminated ink include surface infections of the skin, hepatitis B, hepatitis C, tuberculosis, and HIV.[1] However, no person in the United States is reported to have contracted HIV via a commercially applied tattooing process.[5] Washington state's OSHA studies have suggested that since the needles used in tattooing are not hollow, in the case of a needle stick injury the amount of fluids transmitted may be small enough that HIV would be difficult to transmit. Tetanus risk is reduced by having an up-to-date tetanus booster prior to being tattooed. According to the Centers for Disease Control and Prevention, of 13,387 hepatitis cases in the USA in 1995, 12 cases (0.09%) were associated with tattoo parlours; by comparison, 43 cases (0.32%) were associated with dentists' offices.[6]

In 2006, the CDC reported 3 clusters with 44 cases of methicillin-resistant staph infection traced to unlicensed tattooists.[7]

Reactions to inks

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Perhaps due to the mechanism whereby the skin's immune system encapsulates pigment particles in fibrous tissue, tattoo inks have been described as "remarkably nonreactive histologically".[8] However, some allergic reactions have been medically documented.[9][10] No estimate of the overall incidence of allergic reactions to tattoo pigments exists.[11] Allergies to latex are apparently more common than to inks; many artists will use non-latex gloves when requested. Tattoos may even trigger a positive immune response by strengthening it.[clarification needed][12]

Allergy to metals

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People who are sensitive or allergic to certain metals may react to pigments in the skin with swelling and/or itching, and/or oozing of clear fluid called serum. Such reactions are quite rare, however, and some artists will recommend performing a test patch. Because the mercury and Azo-chemicals in red dyes are more commonly allergenic than other pigments, allergic reactions are most often seen in red tattoos. Less frequent allergic reactions to black, purple, and green pigments have also been noted.[unreliable medical source?] Tattoo inks contaminated with metal allergens have been known to cause severe reactions, sometimes years later, when the original ink is not available for testing; see metal allergy.[13]

Traditional metallic salts are prevalent in tattoo inks. A 3-by-5-inch (76 by 127 mm) tattoo may contain from 1 to 23 micrograms (1.5×10−5 to 0.000355 gr) of lead, but there is insufficient evidence to assess whether the metallic salts are harmful at this dosage and via this method. However, in 2005, there were no reports of metal toxicity from tattoo ink.[14]

Photosensitisation

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Allergic reactions to tattoo pigments, while uncommon, are most often seen with red, yellow, and occasionally white. Tattoos that are exposed to the sun may result in an allergic reaction, particularly those that contain yellow tattoo ink. Yellow and some red pigments contain cadmium sulfide, which can cause an allergic reaction when exposed to the sun.[15]

Allergy to organic pigments

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Organic pigments (i.e., non-heavy metal pigments) may also pose health concerns. A European Commission noted that close to 40% of organic tattoo colorants used in Europe had not been approved for cosmetic use, and that under 20% of colorants contained a carcinogenic aromatic amine.[16]

MRI complications

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A few cases of burns on tattoos caused by MRI scans have been documented. Problems tend to occur with designs containing large areas of black ink, since black commonly contains iron oxide; the MRI scanner causes the iron to heat up either by inducing an electric current or hysteresis.[17] Burning can occur on smaller tattoos such as "permanent makeup",[18] but this is rare.[19]

Dermal conditions

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Keloid formation at the site of a tattoo

The most common dermal reactions to tattoo pigments are granulomas and various lichenoid diseases. Other conditions noted have been cement dermatitis, collagen deposits, discoid lupus erythematosus, eczematous eruptions, hyperkeratosis and parakeratosis, and keloids.[citation needed]

Delayed reactions

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Hypersensitive reactions to tattoos are known to lay latent for significant periods of time before exhibiting symptoms. Delayed abrupt chronic reactions, such as eczematous dermatitis, are known to manifest themselves from months to as many as twenty years after the patient received their most recent tattoo.[citation needed]

Other adverse effects

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Other documented conditions caused by tattoo pigments have been carcinoma, hyperplasia, tumours, and vasculitis. Keratoacanthoma may also occur, which makes excision of the affected area mandatory. Eyeball tattoos carry their own unique risks.[20]

Hematoma

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Occasionally, when a blood vessel is punctured during the tattooing procedure a hematoma (bruise) may appear. Bruises generally heal within one week.[21] Bruises can appear as halos around a tattoo, or, if blood pools, as one larger bruise. This bluish or dark blurry halo that surrounds a tattoo can also be attributed to ink diffusion or 'blow-out'. Commonly mistaken for a hematoma, this discolouration occurs when tattoo pigments spread out into the subcutaneous tissue beneath the dermal skin layer, and may be caused by ink being deposited too deep in the skin.[22]

Burden on lymphatic system

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Some pigment migrates from a tattoo site to lymph nodes, where large particles may accumulate.[23]

Particles created by laser tattoo removal treatments may be small enough that they are carried away by the lymphatic system and excreted, but this is not always the case;[24] the laser technology used for removal and the composition of the pigment(s) being removed are variable.

Interference with cancer diagnosis and treatment

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In medical imaging, such as mammography,[25] pigments in lymph nodes may be accidentally interpreted as abnormal results, giving false positive results for cancer.[26][27] Treatment of cancer may include using blue dye in the body to detect a sentinel lymph node, so existing tattoo pigments in lymph nodes may cause difficulty in identifying and treating sentinel nodes.[28][29]

Lymph nodes may become discolored and inflamed with the presence of tattoo pigments, but discoloration and inflammation are also visual indicators of melanoma; consequently, diagnosing melanoma in a patient with tattoos is made difficult, and special precautions must be taken to avoid misdiagnoses.[30]

Effects of blood thinners

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A regimen of blood thinners may affect the tattooing process, causing excess bleeding. This increased bleeding can slow the process of getting enough ink into the skin. The aftercare healing may also take longer.[31]

References

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  1. ^ a b Tattoos: Risks and precautions to know first - MayoClinic.com
  2. ^ Canada to open prison tattoo parlors May 4, 2004, CNN.com
  3. ^ "Eligibility Criteria Alphabetical Listing". www.redcrossblood.org. Retrieved 2023-12-23.
  4. ^ Who Cannot Give Blood
  5. ^ HIV and Its Transmission Archived 2010-03-04 at the Wayback Machine July 1999, CDC
  6. ^ CDC. Hepatitis Surveillance Report No. 56, 1995
  7. ^ Centers for Disease Control and Prevention, MMWR 55(24)
  8. ^ Tattoo lasers / Histology, Suzanne Kilmer, eMedicine
  9. ^ Weiß, Katharina T.; Schreiver, Ines; Siewert, Katherina; Luch, Andreas; Haslböck, Birgit; Berneburg, Mark; Bäumler, Wolfgang (2021-05-06). "Tattoos - more than just colored skin? Searching for tattoo allergens". Journal of the German Society of Dermatology. 19 (5): 657–669. doi:10.1111/ddg.14436. ISSN 1610-0387. PMID 33955682.
  10. ^ Hutton Carlsen, K.; Køcks, M.; Sepehri, M.; Serup, J. (2016-03-14). "Allergic reactions in red tattoos: Raman spectroscopy for 'fingerprint' detection of chemical risk spectra in tattooed skin and culprit tattoo inks". Skin Research and Technology. 22 (4): 460–469. doi:10.1111/srt.12287. ISSN 1600-0846. PMID 26991512.
  11. ^ Sewak S, Graham P, Nankervis J (1999). "Tattoo allergy in patients receiving adjuvant radiotherapy for breast cancer". Australas Radiol. 43 (4): 558–61. doi:10.1046/j.1440-1673.1999.00733.x. PMID 10901983.
  12. ^ Lynn, Christoper D. (2 October 2019). "Untangling tattoos' influence on immune response". The Conversation. Retrieved 10 October 2019.
  13. ^ Riedel, F; Aparicio-Soto, M; Curato, C; Thierse, HJ; Siewert, K; Luch, A (15 October 2021). "Immunological Mechanisms of Metal Allergies and the Nickel-Specific TCR-pMHC Interface". International Journal of Environmental Research and Public Health. 18 (20): 10867. doi:10.3390/ijerph182010867. PMC 8535423. PMID 34682608.
  14. ^ Metal Toxicity: Tattoos: Safe Symbols?, Environmental Health Perspectives, retrieved 7 September 2014
  15. ^ "Tattoo Ink: Allergic Reaction Warnings".
  16. ^ Workshop on "Technical/scientific and regulatory issues on the safety of tattoos, body piercing and of regulated practices", European Commission, 2003
  17. ^ Wagle, WA; Smith M. (June 2000). "Tattoo-induced skin burn during MR imaging". American Journal of Roentgenology. 174 (7): 1795. doi:10.2214/ajr.174.6.1741795. PMID 10845532. Retrieved 1 July 2010.
  18. ^ Offret, H; Offret M; Labetoulle M; Offret O. (February 2009). "Permanent cosmetics and magnetic resonance imaging". Journal Français d'Ophtalmologie. 32 (2): 131.e1–3. doi:10.1016/j.jfo.2008.07.002. PMID 20579475.
  19. ^ Tope, WD; Shellock FG (February 2002). "Magnetic resonance imaging and permanent cosmetics (tattoos): survey of complications and adverse events". Journal of Magnetic Resonance Imaging. 15 (2): 180–4. doi:10.1002/jmri.10049. PMID 11836774.
  20. ^ Murphy, Cheryl G. (30 October 2017). "The Terrifying Trend of Eyeball Tattoos". Scientific American Blogs. Scientific American. Retrieved 30 October 2017.
  21. ^ All Experts, New Tattoo - Bruising or Leaking, archived from the original on 2012-05-19, retrieved 2009-10-08
  22. ^ "The Definitive Tattoo Aftercare Guide". Dr. Jason K. Rivers, MD, FRCPC, DABD, FAAD (Dermatologist). Archived from the original on 2019-03-04. Retrieved 2014-03-19.
  23. ^ "Think Before You Ink: Are Tattoos Safe?". FDA. 20 May 2019.[failed verification]
  24. ^ "Tattoo Removal: Options and Results". FDA. 22 June 2017.[failed verification]
  25. ^ Paul Litton, Tyler; Vijay Ghate, Sujata (2020-06-09). "Tattoo pigment mimicking axillary lymph node calcifications on mammography". Radiology Case Reports. 15 (8): 1194–1196. doi:10.1016/j.radcr.2020.05.014. ISSN 1930-0433. PMC 7292895. PMID 32550957.
  26. ^ Grove, Narine; Zheng, Ma; Bristow, Robert E.; Eskander, Ramez N. (July 2015). "Extensive Tattoos Mimicking Lymphatic Metastasis on Positron Emission Tomography Scan in a Patient With Cervical Cancer". Obstetrics & Gynecology. 126 (1): 182–185. doi:10.1097/AOG.0000000000000701. ISSN 0029-7844. PMID 25923020. S2CID 30397036.
  27. ^ Mulcahy, Nick (15 June 2015). "Tattoos Mistaken as Cancer Metastases, Surgery Performed". Medscape. Retrieved 2017-10-24.
  28. ^ Ben Naftali, Yeela; Brodsky, Asia; Bar-Meir, Eran D. (December 2018). "What Is the Color of Your Lymph Node?". Plastic and Reconstructive Surgery – Global Open. 6 (12): e1990. doi:10.1097/GOX.0000000000001990. PMC 6326623. PMID 30656101. S2CID 58016647.
  29. ^ Chikkamuniyappa, Shylashree; Sjuve-Scott, Rolf; Lancaster-Weiss, Kris; Miller, Alexander; Yeh, I.-Tien (2005). "Tattoo pigment in sentinel lymph nodes: A mimicker of metastatic malignant melanoma". Dermatology Online Journal. 11 (1): 14. doi:10.5070/D31b43m26h. PMID 15748555.
  30. ^ Chikkamuniyappa, Shylashree; Sjuve-Scott, Rolf; Lancaster-Weiss, Kris; Miller, Alexander; Yeh, I.-Tien (2005). "Tattoo pigment in sentinel lymph nodes: A mimicker of metastatic malignant melanoma". Dermatology Online Journal. 11 (1): 14. doi:10.5070/D31b43m26h. PMID 15748555.
  31. ^ "Community Answers".

Case studies

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Reactions to inks

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Toxins in inks

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  • Civatte J, Bazex J (2007). "Piercing and tattooing: regulation is needed to reduce complications". Bull Acad Natl Med. 191 (9): 1819–38. PMID 18663977.
  • Hannuksela M (2005). "Tattoo pigments contains toxic compounds, but legislators do not pay attention". Duodecim. 121 (17): 1802–2. PMID 16262117.
  • Möhrenschlager M, Worret WI, Köhn FM (2006). "Tattoos and permanent make-up: background and complications". MMW Fortschr Med. 148 (41): 34–6. doi:10.1007/bf03364782. PMID 17190258. S2CID 79090296.
  • Poon, Kelvin Weng Chun (2008), In situ chemical analysis of tattooing inks and pigments: modern organic and traditional pigments in ancient mummified remains, University of Western Australia
  • Wollina U, Gruner M, Schönlebe J (2008). "Granulomatous tattoo reaction and erythema nodosum in a young woman: common cause or coincidence?". J Cosmet Dermatol. 7 (2): 84–8. doi:10.1111/j.1473-2165.2008.00368.x. PMID 18482009. S2CID 24012924.

Other dermatological reactions

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MRI

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Lymph nodes and melanoma

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