Tattoo Designs & More…

Question: I am thinking about getting a tattoo but the unsanitary reputation of tattoo parlors worries me. Is getting a tattoo hazardous to my health?

Answer: According to the limited statistics available, there appears to be resurgence in the popularity of tattoos. Tattooing has been performed as a decorative practice since ancient times. It is now also being used for some cosmetic medical procedures and for permanent make-up applications. Tattooing involves multiple intradermal injections of the skin by a small machine having one or more needles connected to tubes containing the dyes. The tattooist guides the machine over the skin and controls its speed. The procedure involves a variable amount of pain and a small amount of bleeding. It can take several hours depending on the size of the tattoo. The site of application usually takes 7 to 10 days to heal. Those considering an intradermal tattoo should also remember that it is ‘permanent’ and removal can involve painful surgery or dermabrasion and possible scarring.

Tattooing received a bad reputation in the past and has been banned in some states and localities due to operation of parlors with neglect of health and safety, resulting in outbreaks of infectious diseases. In most of the parlors operating now, there is a greater focus on cleanliness and sterilization of equipment. However, individuals who provide tattooing in unsanitary conditions from their home or the back of a van still exist.

Even in modern facilities, tattooing is not without risks. The two most significant ones are allergic responses to the pigments and exposure to bloodborne pathogens. The compounds used as pigments range from metal oxides to synthetic organic dyes. Cases of hypersensitivity to a pigment resulting in allergic responses have been reported but the incidence of such reactions is low. Since tattooing involves injections under the skin, poor infection control practices before, during and after the procedure by the tattooist and the consumer can lead to risk of bacterial and/or viral infection. There have been cases of hepatitis B transmission through tattooing. Transmission of hepatitis C and HIV are also possible with lack of proper sanitation but have never been reported.

If appropriate disinfection and sterilization techniques are used, the health risk associated with tattooing is small. Currently, many state and local health departments regulate tattooing facilities. In considering whether to get a tattoo, they are a source of information concerning the guidelines and regulations for tattoo parlors in the local area. Another way to ensure safety is to check whether the tattooist at a particular parlor has been certified by the Alliance for Professional Tattooists (APT). This nonprofit professional organization has developed a set of infection control guidelines, in association with the FDA, for its members to follow.

The following are the primary complications that can result from tattooing:

• Infection. Unsterile tattooing equipment and needles can transmit infectious diseases, such as hepatitis and skin infections caused by Staphylococcus aureus (“staph”) bacteria^*. Tattoos received at facilities not regulated by your state or at facilities that use unsterile equipment (or re-use ink) may prevent you from being accepted as a blood or plasma donor for twelve months.

• Removal problems. Despite advances in laser technology, removing a tattoo is a painstaking process, usually involving several treatments and considerable expense. Complete removal without scarring may be impossible.

• Allergic reactions. Although FDA has received reports of numerous adverse ractions associated with certain shades of ink in permanent makeup, marketed by a particular manufacturer, reports of allergic reactions to tattoo pigments have been rare. However, when they happen they may be particularly troublesome because the pigments can be hard to remove. Occasionally, people may develop an allergic reaction to tattoos they have had for years.

• Granulomas.These are nodules that may form around material that the body perceives as foreign, such as particles of tattoo pigment.

• Keloid formation. If you are prone to developing keloids — scars that grow beyond normal boundaries — you are at risk of keloid formation from a tattoo. Keloids may form any time you injure or traumatize your skin. Micropigmentation: State of the Art, a book written by Charles Zwerling, M.D., Annette Walker, R.N., and Norman Goldstein, M.D., states that keloids occur more frequently as a consequence of tattoo removal.

• MRI complications. There have been reports of people with tattoos or permanent makeup who experienced swelling or burning in the affected areas when they underwent magnetic resonance imaging (MRI). This seems to occur only rarely and apparently without lasting effects.

There also have been reports of tattoo pigments interfering with the quality of the image. This seems to occur mainly when a person with permanent eyeliner undergoes MRI of the eyes. Mascara may produce a similar effect. The difference is that mascara is easily removable.

The cause of these complications is uncertain. Some have theorized that they result from an interaction with the metallic components of some pigments.

However, the risks of avoiding an MRI when your doctor has recommended one are likely to be much greater than the risks of complications from an interaction between the MRI and tattoo or permanent makeup. Instead of avoiding an MRI, individuals who have tattoos or permanent makeup should inform the radiologist or technician of this fact in order to take appropriate precautions and avoid complications.