Dermatologist Warns Consumers About Complications Linked to Newer Tattoo Inks

Tattooing as a form of body art is increasing in popularity, especially among young adults. In fact, the Pew Research Center found that 36 percent of Americans ages 18-25 report getting a tattoo. As a result, dermatologists are seeing increased complications such as allergic reactions, serious infections and reactions to tattoo ink that can mimic skin cancer.

Michi Shinohara, MD, FAAD, a board-certified dermatologist and clinical assistant professor of dermatology at the University of Washington in Seattle, provides the following information about risks related to newer tattoo inks.

The composition of tattoo ink has changed dramatically over the years. In the past, metal salts, lead, cobalt, and carbon were used in inks. Today, many modern tattoo inks (especially intense reds and yellows) contain organic azo dyes with plastic-based pigments that also have industrial uses in printing, textiles and car paint. As a result, Shinohara explains that there are many unknowns about how these inks interact with the skin and within the body and if they are responsible for an increasing number of complications.

One of the most common problems associated with tattooing is allergic reactions to the tattoo pigments. Itching, bumps, or rashes can occur days, months, or even years after the initial tattoo. These reactions need to be treated with a topical steroid ointment. In cases where an allergic reaction occurs months or years later, the affected person might not suspect that the tattoo is the culprit.

In people with psoriasis and eczema, tattoos may cause the chronic skin conditions to flare.

Sarcoidosis is an autoimmune disorder characterized by swelling and itching that can occur in a tattoo decades after the procedure can involve other organs, such as the lungs or eyes. This type of reaction is not directly caused by the original tattoo, but pops up within the tattoo. Treatments include topical creams and, in severe cases, immunosuppressant medications.

Some tattoo-related infections can pose profound health implications. Common infections linked to tattooing include localized bacterial infections. In addition, there have been reports of syphilis and hepatitis B and C being transmitted due to non-sterile tattooing practices. However, Shinohara notes that outbreaks can also stem from the tattoo ink rather than the tools used in the procedure. A recent outbreak of atypical mycobacterial infections has been traced to contaminated tattoo ink, which causes itchy, painful pustules and red bumps within a tattoo during the first month of the procedure. With this type of infection, a biopsy of the tattoo is taken, and the bacteria is cultured. This type of bacteria is more complex to treat than regular staph bacteria and can require several months of oral antibiotics to clear the infection.

Skin cancer can occur within a tattoo, so Shinohara explains that tattoo artists need to be careful not to place a tattoo over an existing mole. However, one reaction that can result is a bump that mimics skin cancer, which can ruin the tattoo. This type of bump or lesion that can occur within a tattoo looks like a type of skin cancer known as squamous cell carcinoma. Since the bump is so hard to distinguish from this skin cancer, it requires a biopsy and, in some cases, may need to be treated as a skin cancer with additional surgery. Shinohara notes that this unusual reaction is thought to stem from tattoo ink and can result in potentially unnecessary and expensive skin cancer treatment.

Other articles on tattoos are here and here.

Shinohara offers the following tips for those who insist on getting tattoos:

Be sure to go to a professional tattoo parlor and to a tattoo artist who is licensed based on a state's requirements.

• Insist on seeing the equipment in sterile packaging.
  
• Let the tattoo artist know if you have a reaction. See a board-certified dermatologist if a problem lasts more than one to two weeks.
  
• Those with a chronic skin condition such as psoriasis, eczema, or a tendency toward keloid scarring should check with a board-certified dermatologist before getting a tattoo.
  
• Avoid tattooing over a mole, as it will make it more challenging to diagnose a problem if the mole changes in the future.

Since tattoos are not regulated in any way, many unknowns could pose potential problems for consumers regarding the inks and tools used, says Shinohara. Consumers need to be aware of the potential risks, report any situation that develops to the tattoo artist and see a board-certified dermatologist for proper diagnosis and treatment.

Information about FDA's recent (June 2023) draft guidelines to tattoo ink creators and distributors to ensure that the inks are not contaminated with microorganisms, which could lead to severe infections.