Think Before You Ink!

Getting “inked” is a decision that one should not take lightly. Tattoos can have potential – and very real – health consequences.

Know the Risks

We have long acknowledged and mitigated some problems (like infectious blood borne diseases like hepatitis and HIV through the use of unsterilized needles). Other risks include:

• Allergies – ink pigments or dyes in permanent and temporary tattoos can cause allergic contact dermatitis, a condition with itching, swelling, and redness. Reactions can occur years after tattoo placement and may be temporary or chronic. Traditionally, delayed hypersensitivity reactions stemmed from mercury and sulfides (especially in red inks). Most reactions are now occurring due to new organic pigments like Pigment Red 170 & 181.
• Skin infection – from poor care at the tattoo site.
• Scarring – can result when receiving or removing a tattoo.
• Keloids – tough, firm, heaped-up scars abruptly above the skin – smooth top and a pink or purple color, irregularly shaped, and often enlarge progressively. They do not fade over time but can be treated with intralesional corticosteroid injections.
• Granulomas – small knots or bumps that form around tattoo pigment. 
• MRI complications – can result in swelling or burning sensation in the tattoo.

Granulomas

Keloid scars

Two Prominent Issues

1. Tattoo infections may not have obvious causes

Even with sterilization and hygiene best practices, the needles and ink can still cause cutaneous (skin) infections. Infections may also result from contact with the tattoo before it is healed.

2. Tattoos may hide a skin problem

Tattoos can camouflage skin conditions like atypical or cancerous moles. The ink (especially if dark) can impair identification of skin cancer. Dermatologists recommend avoiding tattoos on skin areas with prominent growths or moles. But remember that new moles can form anytime after the tattoo placement.

The Ink Issue

State and local authorities oversee tattoo parlors, and the Food and Drug Administration (FDA) has authority over tattoo inks and pigments. But the FDA has not actually done much regulating for a variety of reasons. This may change in the near future, as ink accounts for approximately 10 percent of adverse events, many of which are only recently being documented and reported. FDA is studying ink safety due to recent reports of dangers. “Our hope is to get a better understanding of the body’s response to tattoos and their impact on human health, and to identify products at greatest risk,” says Linda Katz, M.D., M.P.H., Director of FDA’s Office of Cosmetics and Colors in the Center for Food Safety and Applied Nutrition.

Safety First: Be Your Own Health Advocate

To make sure your tattoo will be applied safely, research tattoo parlors, and insist on enforcement of safety protocol. Consider the following:

Who does the tattooing? Go to a reputable tattooing studio that employs only properly trained employees. Keep in mind that regulation requirements and licensing standards vary from state to state. Check with your city, county, or state health department for information on local licensing and regulations.

Be sure the tattoo artist wears gloves.

Does the tattoo artist use proper equipment? Make sure the tattoo artist removes the needle and tubes from sealed packages before your procedure begins. Any pigments, trays or containers should be sealed, as well.

Does the tattoo artist sterilize nondisposable equipment? Make sure the tattoo artist uses a heat sterilization machine (autoclave) to sterilize all nondisposable equipment between customers. Instruments and supplies that can’t be sterilized with an autoclave, like drawer handles, tables and sinks, should be disinfected with a commercial disinfectant or bleach solution after each use.

After-Care

Be sure to take good care of your new tattoo. Basic instructions include:

• Remove the bandage after 24 hours. Apply an antibiotic or greasy ointment, such as Vaseline or Aquaphor, two to three times daily (under occlusion when able) to the tattooed skin while it heals.
• Keep the tattooed skin clean. Use unfragranced soap and water and a gentle touch. While showering, avoid direct streams of water on the newly tattooed skin. Pat the area dry, and avoid rubbing.
• Avoid sun exposure. Keep the tattooed area out of the sun for at least a few weeks. Sun exposure may induce an allergic reaction in some.
• Avoid swimming. Stay out of pools, hot tubs, rivers, lakes, and other bodies of water while healing, as these can be sources of pathogens (causes of infection).
• Choose clothing that won’t stick to the tattoo.
• Don’t pick scabs. This increases the risk of infection, can damage the design, and may cause scarring.
• Allow two full weeks for the site to heal fully.

If you suspect infection or experience improper or delayed healing, contact a dermatologist immediately. If you’re interested in tattoo removal, ask your dermatologist about laser surgery, and research reputable laser operators.