The Toxic Effects and Health Risks of Tattoos
Tattooing: A Brief History
Much has been written about the hazards of tattooing if practiced under unsanitary conditions. That said, even less attention has been directed to the potential latent health effects of tattoo inks. The lack of attention to these effects is shocking since tattoos are one of the most popular and prevalent forms of body art. The practice of tattooing is centuries old and is central to some cultures.
Tattooing has been practiced throughout most of the world, though it is rare among darkly pigmented peoples and also in China. Evidence for the practice has even been found in 4,000+ year-old Egyptian mummies and in 5,000 year "Iceman" corpses preserved in ice. It is thought the word “tattoo” entered English and European languages in 1769, having been recorded by James Cook’s Tahiti expedition. In 1891 the first electric tattoo device was patented in the US.
Interest in tattoos has waxed and waned in US and European cultures. Those who object to tattoos would point to its use on prisoners and Nazi concentration camp internees. Religious objection to tattoos can be found in Leviticus 19:28: “You shall not make any cuttings in your flesh on account of the dead or tattoo any marks upon you.”
The practice of tattooing seems to have now become mainstream. Young adults and teens worldwide are having dangerous compounds and chemicals injected under their skin for the sake of body art. The trend started surging in the early 1990s. By 2003 it was projected that 36% of 25- to 29-year olds in the US had at least one tattoo. That makes tattoos a pretty big business and an even bigger health concern.
Tattoos and FDA Regulation
Did you know that there is no federal oversight of tattooing? Although tattoo businesses in the US fall under the purview of the Federal Drug Administration (FDA), the agency has not offered any guidelines or regulations for how tattoo parlors should operate . Their position has been: “Because of other public health priorities and a previous lack of evidence of safety concerns, FDA has not traditionally regulated tattoo inks or the pigments used in them.” Therefore if an establishment claims that their tattoo business or tattoo inks are approved or certified by the FDA, it is simply not true.
The FDA does, however, acknowledge reports of adverse short- and long-term reactions to tattoo ink, including inflammation, itching after exposure to summer sun, and reports of adverse reactions to tattooed make-up.
Risks Acknowledged by FDA
- Infections such as HIV and hepatitis related to reused needles.
- Allergic reactions to temporary and permanent tattoo inks.
- Scarring as a result of getting a tattoo, or tattoo removal.
- Granulomas in the form of large or small bumps that form to encapsulate foreign substances, such as tattoo ink particles.
- Burning and swelling of tattoos in MRI machines due to metal components in tattoo inks.
FDA Research on Tattoos
The FDA and medical providers have determined many tattoo inks contain “industrial strength” pigments suitable for automotive paint and printers’ ink. The following issues will be explored by the FDA’s National Center for Toxicological Research (NCTR):
- Chemical make-up of tattoo inks and how the inks are broken down by the body
- Short- and long-term impact of tattoo ink pigments
- Body response to inks with sunlight and laser
Infection Risks and Tattoos
State Regulation of Tattoo Parlors
Is anyone watching the shop?
The states are. That's where most regulation of tattoo parlors happens. That means, however, that the level of rules and oversight varies. California’s Proposition 65 requires tattoo businesses to warn customers that tattoo pigments contain heavy metals associated with birth defects, other reproductive injury and cancer. On the flip side, some states have very lax rules.
Other Tattoo Concerns
- The US Red Cross imposes a 12 month wait for potential donors who have had a tattoo in a facility that is not state regulated, or in a state that has no oversight of tattoo businesses.
- In the UK there is no regulation for tattooing, and a 6-month wait to give blood is imposed after tattoos, with no exceptions.
- Canada introduced legal tattoo services in the prisons to give prisoners a skill, and to reduce health risks such as hepatitis.
- Plastic polymers are used in glow-in-the dark inks. Polymerization occurs when particles mesh into a solid sheet of plastic under the skin.
- Metal salts in tattoo pigment can cause burning and pain during MRI procedures. Some facilities are refusing to perform MRIs on clients with tattoos.
- Some pigments, especially yellows, react to light and may break down into toxic components due to laser removal treatments. These toxins may, in turn, place a burden on the liver and kidneys.
- The American Academy of Dermatology has voiced concern and identified an extensive list of potentially harmful ingredients and compounds in tattoo inks.
What's in Tattoo Inks?
Central to the issue, is that no one is sure what is in the inks. Manufacturers are not bound to divulge the ingredients of their pigments, and mixtures may be considered trade secrets. Professional tattoo ink pigments may be made from plants, plastics, iron oxides, or metal salts. Homemade inks may be made from dirt, soot, plants, pen ink, blood or an unknown array of other possible ingredients.
Some Known Ingredients of Tattoo Inks:
- Titanium dioxide
- Polymethylmethacrylate (PMMA)
Effects of Tattoo Ink Colors
Common Ingredients of Inks by Color
Red: mercury, cadmium, iron, ferrocyanide, ferricyanide, naptha derived chemicals
Orange: cadmium, azo chemicals
Yellow: lead, cadmium, zinc, ferrocyanide, ferricyanide, azo chemicals
Green: lead, chromium, aluminum, copper, ferrocyanide, ferricyanide, azo chemicals
Blue: cobalt, copper, ferrocyanide, ferricyanide
Violet: aluminum, azo chemicals
Brown: iron, azo chemicals
Black: nickel, iron, carbon as soot or ash, black henna
White: lead, zinc, titanium, barium
Common Reactions to Tattoo Ink
Although data is not collected on allergic reactions, some sources suggest that most of the reactions are to the latex rather than the tattoo inks and recommend that clients ask tattoo artists to use non-latex gloves.
Reports indicate allergic reactions to tattoo inks are most common with red and yellow inks as well as white ink.
Red ink is also associated with complications after laser removal treatments and is known to contain mercy and azo chemicals.
The European Commission report from 2003 recounts:
- A case of allergic skin reaction to cobalt blue, and many cases of reactions of red tattoo ink, of both azo compounds and inks of heavy metal composition.
- Nodular granulomateous reactions, mostly related to azo or heavy metal red inks. One case developed in the red pigmented areas of a 37 year old tattoo.
- Sarcoidosis cases traced to red ink, black ink, and multiple colors of ink.
Pigments are dissolved in a solvent to help “carry” the color from the needle to the skin. Carriers make ink application easier and help keep the ink mixed with the pigment and evenly distributed. Typical carriers are some form of alcohol or aldehyde. Alcohol-based carriers increase the permeability of the skin, increasing absorption into the bloodstream. which results in more chemicals being absorbed into the bloodstream. Alcohol carriers are also known to amplify the carcinogenic effects of these tattoo inks.
- Ethyl alcohol
- Denatured alcohol
- Rubbing alcohol
- Propylene glycol
- Other aldehydes
European Commission Findings
The European Commission published Risks and Health Effects from Tattoos, Body Piercing and Related Practices in May of 2003. The team had identified health risks from tattooing and piercing, as well as lax or non-existent regulation these industries. While, the specific composition of tattoo ink was generally unknown, it was known, however, that organic industrial pigments and heavy metals were used, which had impurities and microbiological components.
One of the problems is that there have been few defined, targeted studies to examine risks for short- or long-term effects of tattoo inks. In examining many studies, including anecdotal reports of adverse effects, they developed a list of health risks that were “potentially associated with tattooing and piercing." Examination of the full report however reveals some findings that are worth paying attention to.
European Commission Findings of Possible Health Effects:
The commission findings can be categorized into 5 areas: infections, allergic reactions, cancer, behavioral changes, and skin diseases. Many of the effects are delayed, sometimes up to 20 years or longer. In my view, this is similar to the problems associated with silicone breast implants, agent orange exposure and Gulf War Syndrome.
Infections are associated with poor hygienic conditions and risky practices such as the reuse of tattoo needles. Infections are understandably also associated with prison tattooing and have also been found with unlicensed tattoo facilities and artists. Known infections include:
Allergic reactions associated with tattoos are almost exclusively associated with inks and pigment carriers. According to numerous Case reports, allergic reactions are "not infrequent." These reactions include:
- Skin irritation and uticaria
- Lichenoid and granulomateus reactions
- Pseudo lymphomas
Skin cancers have formed within a tattoo and gone unnoticed until they began to extend beyond the boundaries into un-inked areas. These cancers include:
- Malignant melanoma
- Squamous cell carcinoma
- Basal cell carcinoma
Young Girl with Painful Red Tattoo
European Commission Recommendations
- Systematic study of adverse health impacts
- Regulation of facilities, materials/inks, workers
- List of prohibited and permitted ingredients
- Education and certification of tattoo artists
Nearly 40% of organic pigments used in tattoos are not approved even for cosmetic topical use. Almost 20% of pigments were cancer-causing aromatic amines.
Tattoo inks travel in the body. Black tattoo pigments have been found in lymph nodes. Further, these pigments look like metastases in the nodes, complicating the evaluation of cancer status.
Laser removal of tattoos has been shown to generate new chemical compounds which travel through the blood and lymph vessels. Cancer-causing compounds have also been generated.
There is no such thing as a safe tattoo. There are a reasonable number of studies and case reports as to the adverse health effects of tattoos. The lack of extensive definitive studies proving adverse effects is just that, a lack of studies. It is not proof that tattoo inks are safe.
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Sources for this Hub
I searched and printed a small mountain of articles to read and assimilate to write this article! Here are my primary resources:
Laws and Regulations of Tattoos and Piercing, overviewing 97 tattoo and piercing laws from 20 countries.
Health Risks of Tattooing and Ear or Body Piercing explores the increasing risk of contracting serious blood-borne diseases from tattooing and body piercing.
Anesthesia Risks of Tattoos and Pierced Tongues More Than Skin Deep reports anesthesia risks when anesthesia is administered by needle to the low back through tattooed skin.
Health Risks of Tattoos provides a listing of Top 10 health resources on the risks of tattoos.
Tattoo Ink provides information on ingredients in tattoo ink and ink carriers.
The Truth About Tattoos: Health Risks, Toxicity and More outlines information on tattoo ink risks. Surprising findings, such as ink ingredients that are carcinogenic or mutagenic. Many ink ingredients are not approved for topical use in cosmetics, yet are present in some tattoo inks.
Risks and Health Effects from Tattoos, Body Piercing and Related Practices provides a wealth of information in a 30 page report by the European Commission.
Tattoo Medical Issues overviews various health problems linked to tattoos.