It seems that everywhere you look today you see people with tattoos. Tattoos, of course, are nothing new, they have been around for thousands of years. In recent times we have predominately seen them displayed on the muscular forearms and shoulders of our sailors or members of motorcycle clubs. Today, the tattooing craze extends not just to those who are most visible in our society, such as athletes, musicians, singers, and movie and TV stars, but to every walk of life, especially to adolescents and young adults. In fact, according to an August 22, 2012 report by the Centers for Disease Control and Prevention (CDC), 21 percent of adults in the United States have at least one permanent tattoo. So what are the health risks behind this tattoo epidemic?
Who Regulates Tattoos?
Under the Federal Food, Drug, and Cosmetic Act, tattoo inks are categorized as cosmetics, and while the pigments in the tattoo inks are considered color additives, and thereby subject to premarket approval by the Food and Drug Administration (FDA), no specific FDA regulation requires that tattoo inks be sterile. Tattooing may be regulated locally by cities or counties. These regulations usually require blood-borne pathogen training and hygienic practices in tattooing. Some local jurisdictions also have required that sterile water be used in the dilution of tattoo ink.
Analyzing the Health Risks
Most people seeking tattoos think they know what to look for when choosing a tattoo parlor. Does the parlor sterilize its equipment? Does the tattoo artist wear protective gloves? Does the artist open a package containing a new sterile needle right in front of you? Is this checklist enough? Probably not.
What about the tattoo ink? What does the ink consist of? Was the ink produced in a sterile fashion specifically for tattooing or was it made from products (i.e., calligraphy ink, drawing ink, or printing ink) never intended for tattooing?
And what about the water used to create the tattoo ink or the water used to dilute the ink product in the tattoo parlor? Is it merely tap-water, distilled water, or is it actually sterile?
The FDA has expressed concern about a family of bacteria called nontuberculous Mycobacteria (NTM) that was found in an outbreak of serious skin infections linked to contaminated tattoo inks in late 2011 and early 2012. These outbreaks occurred in four states. According to CDC, these NTM skin infections can be difficult to diagnose, may require 4-6 months of treatment with drugs that can cause serious side effects, and may require multiple surgeries to remove infected tissue leading to substantial scarring.
CDC Recommendations to Artists and Consumers
The CDC recommends that ink manufacturers produce only sterile inks. In addition, tattoo artists should not: (1) use inks not intended for tattooing; (2) dilute ink, but if dilution is needed, only use sterile water; (3) use non-sterile water to rinse equipment; and (4) use tattoo inks beyond their expiration date.
According to the CDC, consumers should: (1) use approved and register tattoo parlors; (2) request sterile inks manufactured specifically for tattooing; (3) insist upon correct hygienic practices by the artist (hand hygiene, the wearing of disposable gloves, and the use of sterile water); and (4) promptly seek medical care if skin problems occur.
Additional Tattooing Risks
In addition to infection, additional complications can result from tattooing. According to CDC, these include: (1) removal problems; (2) allergic reactions; (3) granulomas (nodules that may form around material that the body perceives as foreign, such as particles of tattoo pigment); (4) keloid formation (scars that form beyond normal boundaries); and (5) MRI complications (swelling or burning in tattooed areas when they undergo magnetic resonance imaging (MRI).
The bottom line: Think twice before tattooing. And if you have a bad reaction to tattooing, seek medical care, contact the tattoo artist and parlor, and notify the FDA’s MedWatch program.