Survey in incidence of health problems related to tattoos

Around the world, millions of people are tattooed, however, the frequency of health problems related to tattoos is unknown.

The results of this survey show that millions of people in the Western world supposedly have transient or persisting health problems after tattooing. Owing to the large number and size of the tattoos, tattooists inject several grams of tattoo colorants into the skin, which partly spread in the human body and stay for a lifetime. The latter might cause additional health problems in the long term.

In recent years, the number of tattooed individuals has increased significantly, especially among young people. In the USA, up to 24% of the population are tattooed. In European countries, we found reports on percentages of 9% (Germany) or 12% (UK).

Tattoo colorants may consist of color pigments (e.g. azo pigments) or black inks. These colorants usually contain titanium dioxide for lightening the shade precursors and byproducts of pigment or ink synthesis, as well as diluents that are used for pigment or ink suspensions. Tattoo colorants are also applied in permanent makeup on eyelids, eyebrows and lips. Despite the high incidence of tattoos worldwide, no common legal requirement for listing ingredients has been imposed so far. In Europe, many pigments employed in tattoos (e.g. several azo pigments) are not allowed for use in cosmetics because they may decompose, yielding carcinogenic amines.

In the process of tattooing, pigment suspension is deposited in the dermis by piercing the skin with tiny solid needles that are moistened with tattoo colorant. This leads to injuries to large skin areas. Depending on the hygienic conditions during tattooing, viral or bacterial infections can occur at the site of tattooing, which even leads to systemic reactions.

In the past years, reports in the medical literature have described various adverse reactions that occurred in combination with tattooing. However, data on the extent and frequency of adverse reactions are not available so far. The first aim of our study was to investigate the facts associated with tattooing, such as the number, color or anatomical location of tattoos. The second aim was to investigate the possible health risks associated with tattoos and to calculate statistical correlations.