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Think Before You Ink: Health Risks Associated With Tattoos

Medically reviewed by Carmen Fookes, BPharm. Last updated on April 29, 2022.

Compromising Our Barrier To The Outside World

Tattooing involves the use of tiny needles piercing the skin, which place ink droplets into a previously stenciled pattern. But our skin is our barrier to the outside world, and any breach puts us at risk of infection or allergy.

Which is why you should only use a reputable tattooing studio with properly trained employees. Statutory laws in almost every state require that persons receiving a tattoo must be 18 years of age or older; however, some states will allow tattooing in younger people with parental consent. Other regulatory requirements and licensing standards vary from state to state. Check out the minimum requirements applicable to your state or county before you select your tattooist.

Multiple Avenues For Infection

Infection is a real threat, and microbes can be easily transferred beneath your skin during the inking process from the tattoist, the environment, dirty equipment, and potentially your own skin.

Always ask the tattoo studio about the tattoo inks they use and try to keep up to date with ones that have been recalled. Also ensure that before each procedure, or before even touching your skin, your tattooist washes his or her hands properly, and puts on a clean pair of disposable gloves.

All needles and tubes should be new and taken from sealed packages. All inks and containers should be unused as well. Nondisposable equipment should be autoclaved (heat sterilized) before each use. Bleach or a commercial disinfectant should be used to wipe down all drawer handles, tables and sinks after each customer.

Bacterial Infections:Skin to Core

Staphylococcal and Streptococcal bacteria are the most likely organisms to invade your skin during tattooing.

Symptoms of localized infection include redness, pus, swelling, or pain at the tattoo site which potentially could spread to surrounding skin areas (cellulitis), and occasionally into the blood stream (sepsis). People with heart disease, diabetes, poor circulation or peripheral arterial disease, or with a compromised immune system are more at risk.

In addition to the usual avenues for infection (such as dirty equipment and needles, unwashed hands) inferior inking products may also pose a risk. Although the FDA has not approved any inks for injection into your skin, they do monitor problems from tattoos and permanent make up. In 2019 they recalled six tattoo inks because they were contaminated with bacteria.

Consumers should always ask to examine their tattooist's inks and check bottles are sealed and are from a reputable company with good labeling details.

Inform your tattooist and seek medical care straight away if you develop any symptoms suggestive of an infection. Even once healed, localized infections can still leave nasty, permanent scars.

Viral Infections: Inking The Perfect Entry For HCV And Other Viruses

While significant infections arising from tattooing procedures are rare thanks to required current standards for hygiene and infection control, they still occasionally happen. The risk is very real for people using unlicensed, "back-yard" tattoo artists with limited knowledge of exposure risk and blood product disposal practices.

While any sort of virus may potentially be transmitted via a break in the skin caused by tattooing, there is a very strong association between tattooing and hepatitis C. Research indicates the hepatitis C virus (HCV) can remain infectious in blood droplets outside the body for up to six weeks, possibly longer. Bleaching, boiling water, or flame exposure does not effectively kill HCV from equipment; autoclaving or a germicide with documented effectiveness against HCV and other viruses is the only way to ensure equipment is HCV free.

Transmission of hepatitis B, HIV, leprosy, syphilis, tuberculosis and warts from tattooing has also been reported.

Allergic Reactions: Sensitivity To Ink Relatively Common

The art of tattooing involves the insertion of permanent ink into the lower layer of skin (the dermis) with a needle. One embedded, skin cells take up the pigments which measure 2-400nm in diameter. The fact that the pigments are located both inside (intracellularly) and outside (extracellularly) the cell can cause a whole range of allergic and toxic reactions.

Many people are allergic to tattoo pigments. Sensitivity reactions can range from a mild dermatitis or photosensitivity (more likely to burn or develop into a rash in the sun), to a severe, blistering-type skin rash. While any type of ink may cause an allergic reaction, henna and mercury-containing red tattoo pigments are a common cause.

While 100% pure henna rarely causes problems when used as a hair dye or on unbroken skin, "black henna" is never pure henna and is generally not safe. Black henna usually contains paraphenylenediamine, also known as PPD, a synthetic coal tar dye, that can cause severe reactions even when just applied as a temporary tattoo (such as to the surface of the skin and not with needles). Avoid all "black henna" tattoos; but if you still decide to get one and it starts to blister and itch go to a doctor straight away!

Pain Worth What You Gain?

Many people underestimate how painful the tattooing procedure is going to be, or how much it is going to bleed.

All tattoos hurt during the application and healing process. Areas of the body that contain more nerve endings - such as the hands, feet, face/neck, arm pits, back of the knees, and genital regions - will hurt much more than other body areas such as the shoulder or the hips.

Many of those areas also have a much higher blood supply than others, meaning there will be a lot more blood during the procedure. Another reason to choose a professional who is knowledgeable about protecting you (and themself) from disease.

If you are unsure of your pain tolerance, start small and go slow. Speak to your tattooist about tattoo placement long before you set a date for the procedure.

Tattoos And MRIs: Not Such A Good Combination

Some tattoo pigments contain small amounts of metal. Even thought these amounts are tiny, they still have the potential to interfere with MRI scanning.

In one documented case, a professional football player undergoing an MRI for a groin injury suffered a relatively serious burn in the area of his tattoo. The black ink used in his tattoo contained iron oxide which created an electrical current between his skin and the MRI machine, raising the local temperature of his skin enough to burn it.

Ink pigments that contain metals, particularly when used in looping or large circular designs, are more likely to react with an MRI. A cold compress may be used on the area before the procedure as a prophylactic treatment, or afterwards, to cool the skin. Alternatively, a towel or cloth may be used to protect against potential electrical arcs between separate tattoos.

Tattoo Regret: The Fate Of The Unloved Tattoo

Sometimes, your circumstances change, and it pays to consider the possibility of falling out of love with your tattoo well before the first needle touches your skin.

Unfortunately, tattoo removal is not guaranteed. Permanent raised scarring or ghost images of the original tattoo are commonplace. Certain colors - such as green - are easier to remove than yellow or orange. Removal requires multiple treatments with gaps of about 4-8 weeks in between. Fading is generally slower for tattoos on the extremities, such as the hands or the feet, since blood supply is less due to their distance from the heart.

In addition, hyperpigmentation (darkening of the skin) is common in fair skinned people, and hypopigmentation (lightening of the skin) is common in darker skinned individuals. Infection, burns, and textural changes of the skin may also occur during the removal process.

Finished: Think Before You Ink: Health Risks Associated With Tattoos

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.