A tattoo is a mark made on the body that is indelible and created by the insertion of ink into the dermis, the deeper layer of the skin, with a needle. The result is a permanent change in the pigmentation of the skin at the point of injection. Using multiple injections leads to the formation of a tattooed image of any desired shape and size.
Permanent makeup is the name given for the use of tattooing to create a new outline for the eyes or lips, similar to eyeliner, eyebrow pencil, or lip liner. Here again, ink is used to pigment the dermis permanently at every point on the outline marked.
Though tattooing is a widespread practice in many developed countries, it is not a light thing as the images created cannot be easily removed except by cosmetic surgery. Moreover, there are specific health risks which need to be guarded against to prevent short- and long-term complications.
Tattooist makes a tattoo. Closeup. Image Credit: Mikhail_Kayl / Shutterstock
Health Risks of Tattoos
Tattoos are created using a needle attached to a portable small injector device which plunges the needle into the skin along the marked lines. Each entry results in the injection of ink into the dermis along the needle track. This could result in the following complications.
Skin infections are the most common complications of tattooing. Signs of local infection include inflammation, redness, pain, burning or throbbing at the site, as well as pain on touching and discharge of a smelly greenish-yellow material. Infections may include symptoms of impetigo or deeper skin infections such as cellulitis or furuncle formation. In rare cases, this has the potential to result in systemic life-threatening infections as well, which should be immediately reported to a medical practitioner for appropriate treatment.
Infections are transmitted either directly, from the blood or body secretions of an infected person, or indirectly, through the hands or fomites which have come into contact with an infective material.
Indirect contact is most important in the spread of infection through tattoos. Of the various means of indirect contact, the hands are most commonly involved and one infected person can carry infection to other people, equipment, or other parts of the body. Fomites include the needles, the tattooing equipment, or other instruments used during tattooing which may have been contaminated by infected organisms and carries them into the skin punctures.
Scrupulous handwashing before a procedure, proper sterilization of all equipment, and meticulous disposal of used instruments, are all part of preventing infection during tattooing. It is also wise for tattooists to get immunized against hepatitis B before commencing work as a tattoo artist.
Transmission of bloodborne disease, including the highly fatal hepatitis B or C, HIV, and tetanus or lockjaw, through unsanitized needles. Hepatitis is an inflammation of the liver which can result in acute destruction of the liver cells, or chronic fibrosing inflammation of the liver leading to liver cirrhosis, and in some cases, carcinomas of the liver.
Transmission of bacterial infections such as tuberculosis may occur through unsterilized inks. Mycobacteria may also contaminate the tattooing process when the ink or water used for dilution contains the organism. They are usually non-tuberculous, such as M. chelonae, but may cause lung and joint disease, or ophthalmic tuberculomas, which often require continuous treatment for 6 months or more. Their rarity leads to great difficulty in diagnosis.
Hypersensitivity reactions to the dye present in the tattoo ink. This may be immediate or may occur after years, known as a delayed reaction.
The reaction may appear in the form of a chronic rash at the tattoo site. Skin allergies arise most often in response to metals in the inks, and red ink is known to cause the highest rate of reaction. Other allergenic metals include cobalt (blue), cadmium (yellow) and chromium (green).
Allergic contact dermatitis is the result with wheals and blisters. Photodermatitis may also result from tattooing.
Inflammation and scars
Keloid formation, which is a condition in which some people develop hypertrophied scars in response to a skin puncture or wound, may affect some individuals after having a tattoo.
Burning sensation over the tattoo site, often accompanied by swelling and inflammation, may occur with aseptic inflammation of the site. Delayed healing with chronic infections, which could lead to the formation of raw reddish nodules around the tattoo site, called granulomas.
Tattoos and MRI
The presence of metal particles in certain metallic dyes can make magnetic resonance imaging (MRI) testing impossible in the future. This is because it creates magnetic interference, or may cause skin burns by being heated up by the magnetic radiation.
Other Skin Conditions
Some skin conditions become manifest in areas of tattooing, especially psoriasis, warts, herpes simplex lesions, lichenplanus, and even zoster lesions. The tattoo ink is sometimes carried to nearby lymph nodes and may cause them to enlarge.
Some tattoos may later harbor skin cancers, such as squamous cell or basal cell cancers, malignant melanomas or dermatofibrosarcoma protuberans. Their exact relationship to the tattoo is unknown, although the presence of the pigmented tattoo may delay their detection and diagnosis.
Approval of Dyes
Another potential concern about the safety of tattoos is the absence of any evidence regarding the long-term effects of tattoo inks and dyes. More than 50 types of inks and dyes have been approved for safety for external application but not specifically for injection into the skin. Additionally, the use of non-approved dyes such as charcoal or ink, with ordinary sewing needles or pens, could make infections much more likely.
Reviewed by Yolanda Smith, BPharm