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TATTOO
TOXICITY |
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When I started to do the research for this article, I was
jaw-dropped at the amount of available information that has been
published about tattoos, including history, equipment, ingredients,
contaminants, regulations, cosmetic vs medical applications. There
are specific applications for various body parts including eyelids,
lips, nipples and for medical conditions such as vitiligo, burns,
and stretch marks. There is an entire industry built around tattoo
removal using YAG lasers, alexandrite lasers, and high-frequency
focused ultrasound machines. I even found an entire textbook,
called Cosmetic
and Medical Tattoos: Technique and Application. Published in
2023, it has 30 chapters and costs $233!
A Little History The art of tattooing goes back to ancient
Egypt, at
least 3000 BC. Other ancient cultures wore body figures as a
symbol dedicating one to a certain god. It apparently was used as a
‘brand’ or symbol of servitude. Some tattoos represented a
profession (such as a prostitute) or were used to encourage
fertility or protection. Mummies of Egyptian royalty were tattooed,
indicating a cosmetic practice. Based on mummy tattoos, the artists
used dark pigments, usually black, blue, or green, with little
variation. Egyptians tinted their eyelids black with kohl (powdered
antimony) or green with copper salts. The lips and cheeks were
tinted red. Henna gave a golden red hue to the nails and the soles
of the feet. The same
apothecaries who prepared medicines for physicians prepared
substances and treatments to be used in perfumes and cosmetics.
According to WorldHistory.com,
No written work on the subject of tattoos survives from ancient
Egypt, so interpretation is always speculative. But it seems likely
these tattoos were not simply adornments to make a woman more
attractive to a man but served a higher purpose.
Why tattoos? Again, a lot has been written about why people
choose to get – or not get – tattoos. Although they have been around
for more than 5,000 years, body art has exploded in both popularity
and acceptance over the last 25 years. Tattoos are becoming more
popular, with more than 50%
of Americans under the age of 40 sporting tattoos. A 2019 study
done in South Africa and then reported in Psychology
Today has a lot of interesting perspectives. Here’s an excerpt:
Among those who harbored negative views, they stated that tattoos
were (in their own words), ugly, trashy, messy, cheap, and filthy.
Similarly, they saw tattooed individuals as evil, satanic,
dangerous, rebellious, ungodly, stupid, reckless, unprofessional,
weird, not-Christian, associated with criminality, cruel, showoffs,
outcasts, anti-social, bereft of morals, and defiant of society. A
respondent expressed, “They want to feel a sense of
belonging, attention, and want to be feared.” Among those
with positive views about tattoos, they saw them as attractive, and
those who sport them as cool, trendy, fashionable, interesting,
spontaneous, creative, artistic, free-spirited, more open/accepting,
liberal, adventurous, brave, strong, courageous, and unafraid of
commitment and pain. As one participant put it, “People with tattoos
are the realest people [you] ever will meet.” In my opinion, the
older you are, the less chance you'll be forgiving and/or accepting
of tattoos, especially large, overly-consuming, or grotesque
designs.
Health Risks Infections Tattooing involves puncturing the skin
about 100 times per second with needles and depositing ink 1.5 to 2
millimeters below the surface of the skin. It generally causes
bleeding because the needles pierce the blood vessels. Contaminated
tattoo ink can cause infections and serious injuries. Reported
problems with tattoo ink have ranged from superficial conditions
(allergic reactions, inflammation, impetigo, or erysipelas – usually
caused by strep or staph bacteria), to deeper, widespread
complications (limb edema, swollen lymph nodes, cellulitis) and even
life-threatening systemic complications (endocarditis, septic shock,
and multi-organ failure). According to a national German
survey of 3,411 tattooed individuals, 67.5% complained of health
problems after tattooing; 10% were described as “moderate” and 1.8%
described their side effects as “intense” to “very intense.”
Injection-site rashes, blisters, nodules, and granulomas have been
reported that have resulted in permanent scarring. It has been
reported that up to 20% of all piercings and tattoos have at least
local infections.
As recently as June
2023, the FDA issued new guidance for manufacturers and users of
tattoo inks. Also, according
to the FDA: Between 2003 and 2019, tattoo ink firms conducted 15
voluntary ink recalls, 14 of which resulted from findings of
microbial contamination. Eight of these recalls occurred after the
FDA conducted multiple surveys of tattoo inks available in the U.S.
market and tested them for microbial contamination. Many of these
inks were heavily contaminated with a variety of microorganisms,
some of which (such as Pseudomonas aeruginosa and Bacillus cereus)
can cause serious infections. In 2018, an
article in the Journal of Applied Microbiology reported that 49%
of the surveyed tattoo inks on the U.S. market were contaminated
with microorganisms. In 2019, consumers, tattoo artists, and
retailers were alerted to the potential for serious injury from the
use of certain tattoo inks contaminated with bacteria. Many of these
products were removed from use.
MRI Burns: Tattooed patients undergoing magnetic resonance
imaging (MRI) can develop mild-to-moderate complications during the
procedure. Symptoms of severe burning can come on abruptly during
MRI, sometimes requiring termination of the procedure. No skin burns
have been seen. The symptoms were thought to be caused by metal
pigments in the ink. Recovery was fast and complete after the
procedure ended. MRI-induced tattoo complications are uncommon.
However, in a review
paper published in 2020, 17 cases had been reported, with five
occurring in cosmetic tattoos.
Donating Blood: Historically, people have been advised to wait a
year before giving blood after receiving a tattoo to reduce their
risk of transmitting blood infections, particularly hepatitis A,
hepatitis B, hepatitis C, or HIV. However, in April 2020, the FDA
updated its recommendations (pg.
11) and proposed the deferral period be reduced to three months.
The FDA’s new rules make the presumption if one of these infections
was contracted during the 3-months from the time of a tattoo
procedure, the person would have detectable antibodies when
screened. That said, you may want to obtain your tattoo at a
state-regulated tattoo shop. These are routinely monitored for safe
and clean tattooing practices, lowering the risk of infection.
Esthetic Changes: In addition to the long-term health effects of
tattoos listed above, there are also some unconsidered aesthetic
changes. The quality of the body “art” will change over time. As
your skin ages and stretches, this will have an impact on the color,
shape, and definition of the tattoos which are prone to fade,
stretch, and wrinkle. The meaning of the tattoo could change as you
age and life circumstances change. Your favorite girl/guy whose name
is on your arm may be long gone and you might not feel the same
about that quote from 15 years ago.
Tattoo vaccines: Fortunately, from my perspective, this
experimental way to manipulate the human immune system hasn’t gotten
out of the experimental phase (at least not yet!) There have been mouse
studies with DNA vaccines to be delivered by tattooing because
the inflammation caused by the tattoo procedure has been shown to
induce higher specific humoral and cellular immune responses than
intramuscularly injected DNA. This is thought to be a more “robust”
response. Thankfully, this experimentation has yet to get traction
or leave the lab.
Tattooing and Crime Victims: While ancient times often used
tattoos as a form of ownership, skin signs and ‘branding’ are still
used today in both human labor and sex trafficking industries. A study
from 2021 sought to identify and possibly catalog skin signs
reported in victims to create a framework for dermatologists and the
broader medical community to appropriately screen patients at risk,
and to assist with more timely identification of and intervention
with affected persons. After screening 577 pertinent records in the
PubMed and Google Scholar databases for information about the
physical signs of human trafficking in health care, 10 final studies
were selected. Significant findings of rashes and tattoos were more
likely in sex-trafficked patients, whereas burns and deep cuts were
more likely to be found in labor-trafficked patients. The paper
advocates for very physician to perform a thorough physical
examination and document all signs of injury, abuse, lesions,
surgical incisions, tattoos, and piercings. A poor quality tattoo
can be attributed to its “homemade nature” and should be highly
suspected. Given the prevalence of mental health and behavioral
manifestations of trafficking, the physician should also document
any signs of anxiety, depression, posttraumatic stress disorder,
drug abuse, and suicidal ideation. Unfortunately, these researchers
were not able to identify any standardized signatures for medical
and police authorities to add in identifying this horrible and
pervasive problem. Tattoos, especially in the criminal justice
system, are somewhat different and can be good identifiers for
police officers who are given descriptions of a suspect. In
Florida, for example, the police have set up a specific tattoo
and markings database to help in identifying potential suspects of
crimes, or when determining if certain tattoos may affiliate the
person with a gang, creed, or organization. However, as more and
more young persons are becoming inked, the use of tattoos as
evidence is still in the early stages across the country.
Ink Toxicity Tattoo inks are not
classified as pharmaceutical or cosmetic. The body is directly
exposed to the contained substances through puncturing the skin.
Pigments may accumulate throughout the body via the lymphatic
system. Tattoo application is widely performed all over the world;
the injection of colored substances into the skin may pose a risk
for allergies, inflammation, and systemic disease as previously
stated. In
one study, 56 inks purchased from 4 different supply companies
were analyzed for metal concentrations. Some of the elements found
in high doses were aluminum, barium, cadmium, chromium, mercury,
nickel, cobalt, copper, iron, and zinc. Of the 56 inks tested,
chromium, nickel, and cobalt exceeded the safe allergy limit. One
simple solution to removing the heavy metals from the ink is
Touchstone Essential’s Pure Body Extra zeolite spray. Zeolite is a
one-way basket that scoops up the heavy metals found in the inks to
gently remove them from the body. If you really want to rid your
body of your art choice, consider removal. Many laser techniques are
now available.
By DR. SHERRI TENPENNY
2023
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