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A variety of health effects can result from tattooing. Because it requires breaking the skin barrier, tattooing carries inherent health risks, including infection and allergic reactions. Modern tattooists reduce such risks by following universal precautions, working with single-use disposable needles, and sterilising equipment after each use. Many jurisdictions require tattooists to undergo periodic bloodborne pathogen training, such as is provided through the Red Cross and the U.S. Occupational Safety and Health Administration.
Dermatologists have observed rare but severe medical complications from tattoo pigments in the body, and have noted that people acquiring tattoos rarely assess health risks prior to receiving their tattoos. Some medical practitioners have recommended greater regulation of pigments used in tattoo ink. The wide range of pigments currently used in tattoo inks may create unforeseen health problems.
Since tattoo instruments come in contact with blood and bodily fluids, diseases may be transmitted if the instruments are used on more than one person without being sterilised. However, infection from tattooing in clean and modern tattoo studios employing single-use needles is rare. [1] With amateur tattoos, such as those applied in prisons, however, there is an elevated risk of infection. To address this problem, a programme was introduced in Canada as of the summer of 2005 that provides legal tattooing in prisons, both to reduce health risks and to provide inmates with a marketable skill. Inmates were to be trained to staff and operate the tattoo parlours once six of them opened successfully. [2]
In the United States, the Red Cross prohibits a person who has received a tattoo from donating blood for 3 months, unless the procedure was done in a state-regulated and licensed studio, using sterile technique. [3] The District of Columbia, Georgia (until January 2025), Idaho, Maryland, Massachusetts, New Hampshire, New York, Pennsylvania, Utah and Wyoming do not have a rigorous licensing and regulation (e.g. bloodborne pathogen training) program, meaning that people who receive tattoos there are subject to the 3-month deferral regardless of the hygienic standards of the studio. Similarly, the UK does not provide certification for tattooists, and blood donations are prohibited without exception for four months following a tattoo. [4]
Infections that can theoretically be transmitted by the use of unsterilised tattoo equipment or contaminated ink include surface infections of the skin, hepatitis B, hepatitis C, tuberculosis, and HIV. [1] However, no person in the United States is reported to have contracted HIV via a commercially applied tattooing process. [5] Washington state's OSHA studies have suggested that since the needles used in tattooing are not hollow, in the case of a needle stick injury the amount of fluids transmitted may be small enough that HIV would be difficult to transmit. Tetanus risk is reduced by having an up-to-date tetanus booster prior to being tattooed. According to the Centers for Disease Control and Prevention, of 13,387 hepatitis cases in the USA in 1995, 12 cases (0.09%) were associated with tattoo parlours; by comparison, 43 cases (0.32%) were associated with dentists' offices. [6]
In 2006, the CDC reported 3 clusters with 44 cases of methicillin-resistant staph infection traced to unlicensed tattooists. [7]
Perhaps due to the mechanism whereby the skin's immune system encapsulates pigment particles in fibrous tissue, tattoo inks have been described as "remarkably nonreactive histologically". [8] However, some allergic reactions have been medically documented. [9] [10] No estimate of the overall incidence of allergic reactions to tattoo pigments exists. [11] Allergies to latex are apparently more common than to inks; many artists will use non-latex gloves when requested. Tattoos may even trigger a positive immune response by strengthening it.[ clarification needed ] [12]
People who are sensitive or allergic to certain metals may react to pigments in the skin with swelling and/or itching, and/or oozing of clear fluid called serum. Such reactions are quite rare, however, and some artists will recommend performing a test patch. Because the mercury and Azo-chemicals in red dyes are more commonly allergenic than other pigments, allergic reactions are most often seen in red tattoos. Less frequent allergic reactions to black, purple, and green pigments have also been noted.[ unreliable medical source? ] Tattoo inks contaminated with metal allergens have been known to cause severe reactions, sometimes years later, when the original ink is not available for testing; see metal allergy. [13]
Traditional metallic salts are prevalent in tattoo inks. A 3-by-5-inch (76 by 127 mm) tattoo may contain from 1 to 23 micrograms (1.5×10−5 to 0.000355 gr) of lead, but there is insufficient evidence to assess whether the metallic salts are harmful at this dosage and via this method. However, in 2005, there were no reports of metal toxicity from tattoo ink. [14]
Allergic reactions to tattoo pigments, while uncommon, are most often seen with red, yellow, and occasionally white. Tattoos that are exposed to the sun may result in an allergic reaction, particularly those that contain yellow tattoo ink. Yellow and some red pigments contain cadmium sulfide, which can cause an allergic reaction when exposed to the sun. [15]
Organic pigments (i.e., non-heavy metal pigments) may also pose health concerns. A European Commission noted that close to 40% of organic tattoo colorants used in Europe had not been approved for cosmetic use, and that under 20% of colorants contained a carcinogenic aromatic amine. [16]
A few cases of burns on tattoos caused by MRI scans have been documented. Problems tend to occur with designs containing large areas of black ink, since black commonly contains iron oxide; the MRI scanner causes the iron to heat up either by inducing an electric current or hysteresis. [17] Burning can occur on smaller tattoos such as "permanent makeup", [18] but this is rare. [19]
The most common dermal reactions to tattoo pigments are granulomas and various lichenoid diseases. Other conditions noted have been cement dermatitis, collagen deposits, discoid lupus erythematosus, eczematous eruptions, hyperkeratosis and parakeratosis, and keloids.[ citation needed ]
Hypersensitive reactions to tattoos are known to lay latent for significant periods of time before exhibiting symptoms. Delayed abrupt chronic reactions, such as eczematous dermatitis, are known to manifest themselves from months to as many as twenty years after the patient received their most recent tattoo.[ citation needed ]
Other documented conditions caused by tattoo pigments have been carcinoma, hyperplasia, tumours, and vasculitis. Keratoacanthoma may also occur, which makes excision of the affected area mandatory. Eyeball tattoos carry their own unique risks. [20]
Occasionally, when a blood vessel is punctured during the tattooing procedure a hematoma (bruise) may appear. Bruises generally heal within one week. [21] Bruises can appear as halos around a tattoo, or, if blood pools, as one larger bruise. This bluish or dark blurry halo that surrounds a tattoo can also be attributed to ink diffusion or 'blow-out'. Commonly mistaken for a hematoma, this discolouration occurs when tattoo pigments spread out into the subcutaneous tissue beneath the dermal skin layer, and may be caused by ink being deposited too deep in the skin. [22]
Some pigment migrates from a tattoo site to lymph nodes, where large particles may accumulate. [23]
Particles created by laser tattoo removal treatments may be small enough that they are carried away by the lymphatic system and excreted, but this is not always the case; [24] the laser technology used for removal and the composition of the pigment(s) being removed are variable.
In medical imaging, such as mammography, [25] pigments in lymph nodes may be accidentally interpreted as abnormal results, giving false positive results for cancer. [26] [27] Treatment of cancer may include using blue dye in the body to detect a sentinel lymph node, so existing tattoo pigments in lymph nodes may cause difficulty in identifying and treating sentinel nodes. [28] [29]
Lymph nodes may become discolored and inflamed with the presence of tattoo pigments, but discoloration and inflammation are also visual indicators of melanoma; consequently, diagnosing melanoma in a patient with tattoos is made difficult, and special precautions must be taken to avoid misdiagnoses. [30]
A regimen of blood thinners may affect the tattooing process, causing excess bleeding. This increased bleeding can slow the process of getting enough ink into the skin. The aftercare healing may also take longer. [31]
Dermatitis is a term used for different types of skin inflammation, typically characterized by itchiness, redness and a rash. In cases of short duration, there may be small blisters, while in long-term cases the skin may become thickened. The area of skin involved can vary from small to covering the entire body. Dermatitis is also called eczema but the same term is often used for the most common type of skin inflammation, atopic dermatitis.
Contact dermatitis is a type of acute or chronic inflammation of the skin caused by exposure to chemical or physical agents. Symptoms of contact dermatitis can include itchy or dry skin, a red rash, bumps, blisters, or swelling. These rashes are not contagious or life-threatening, but can be very uncomfortable.
Melanoma is the most dangerous type of skin cancer; it develops from the melanin-producing cells known as melanocytes. It typically occurs in the skin, but may rarely occur in the mouth, intestines, or eye.
Acral lentiginous melanoma (ALM) is a type of skin cancer. It typically begins as a uniform brownish mark before becoming darker and wider with a blurred, irregular border. ALM is most frequently seen on the foot of a person with darker skin but can also be found in non-sun exposed areas such as the palms, soles, and under finger and toenails. It may become bumpy and ulcerate. When under the nail it typically appears as dark longitudinal streaks. As it grows, ALM may also spread to other areas of the body.
Permanent makeup, also known as permanent cosmetics, derma-pigmentation, micro-pigmentation, semi-permanent makeup and cosmetic tattooing, is a cosmetic technique which employs tattooing techniques to replicate the appearance of traditional makeup. By implanting pigments into the dermis, long-lasting designs are created such as eye liner, eyebrows, and lip color. This procedure appeals to a diverse range of people; from those who want to make their daily routines more simple to individuals with medical conditions. By eliminating the need to apply traditional makeup regularly, permanent makeup has become a very convenient and effective solution. More than an aesthetic technique, permanent makeup plays a crucial role in procedures of reconstructive type.
Allergic contact dermatitis (ACD) is a form of contact dermatitis that is the manifestation of an allergic response caused by contact with a substance; the other type being irritant contact dermatitis (ICD).
Tattoo removal is the process of removing an unwanted tattoo. The process of tattooing generally creates permanent markings in the skin, but people have attempted many methods to try to hide or destroy tattoos.
Tetrazepam is a benzodiazepine derivative with anticonvulsant, anxiolytic, muscle relaxant and slightly hypnotic properties. It was formerly used mainly in Austria, France, Belgium, Germany and Spain to treat muscle spasm, anxiety disorders such as panic attacks, or more rarely to treat depression, premenstrual syndrome or agoraphobia. Tetrazepam has relatively little sedative effect at low doses while still producing useful muscle relaxation and anxiety relief. The Co-ordination Group for Mutual Recognition and Decentralised Procedures-Human endorsed the Pharmacovigilance Risk Assessment Committee (PRAC) recommendation to suspend the marketing authorisations of tetrazepam-containing medicines across the European Union (EU) in April 2013. The European Commission has confirmed the suspension of the marketing authorisations for Tetrazepam in Europe because of cutaneous toxicity, effective from the 1 August 2013.
Tattoo inks consist of pigments combined with a carrier, used in the process of tattooing to create a tattoo in the skin. These inks are also used for permanent makeup, a form of tattoo.
Rosai–Dorfman disease, also known as sinus histiocytosis with massive lymphadenopathy or sometimes as Destombes–Rosai–Dorfman disease, is a rare disorder of unknown cause that is characterized by abundant histiocytes in lymph nodes or other locations including the skin, sinuses, brain and heart. Individuals with the disorder often present with enlarged lymph nodes and a nodular red skin rash. The main causes of morbidity with the illness are systemic infection from impaired immune response and organ dysfunction from histiocyte deposition throughout the body.
Amelanotic melanoma is a type of skin cancer in which the cells do not make any melanin. They can be pink, red, purple or of normal skin color, and are therefore difficult to diagnose correctly. They can occur anywhere on the body, just as a typical melanoma can.
Melanocyte protein PMEL also known as premelanosome protein (PMEL), silver locus protein homolog (SILV) or Glycoprotein 100 (gp100), is a protein that in humans is encoded by the PMEL gene. Its gene product may be referred to as PMEL, silver, ME20, gp100 or Pmel17.
Phytophotodermatitis, also known as berloque dermatitis, margarita photodermatitis, lime disease or lime phytodermatitis is a cutaneous phototoxic inflammatory reaction resulting from contact with a light-sensitizing botanical agent followed by exposure to ultraviolet A (UV-A) light. Symptoms include erythema, edema, blisters, and delayed hyperpigmentation. Heat and moisture tend to exacerbate the reaction.
Cutaneous amoebiasis, refers to a form of amoebiasis that presents primarily in the skin. It can be caused by Acanthamoeba or Entamoeba histolytica. When associated with Acanthamoeba, it is also known as "cutaneous acanthamoebiasis". Balamuthia mandrillaris can also cause cutaneous amoebiasis, but can prove fatal if the amoeba enters the bloodstream It is characterized by ulcers. Diagnosis of amebiasis cutis calls for high degree of clinical suspicion. This needs to be backed with demonstration of trophozoites from lesions. Unless an early diagnosis can be made such patients can develop significant morbidity.
Granuloma gluteale infantum is a cutaneous condition that appears in the anogenital region of infants as a complication of diaper dermatitis. According to some, no granulomas are found.
Skin cancer, or neoplasia, is the most common type of cancer diagnosed in horses, accounting for 45 to 80% of all cancers diagnosed. Sarcoids are the most common type of skin neoplasm and are the most common type of cancer overall in horses. Squamous-cell carcinoma is the second-most prevalent skin cancer, followed by melanoma. Squamous-cell carcinoma and melanoma usually occur in horses greater than 9-years-old, while sarcoids commonly affect horses 3 to 6 years old. Surgical biopsy is the method of choice for diagnosis of most equine skin cancers, but is contraindicated for cases of sarcoids. Prognosis and treatment effectiveness varies based on type of cancer, degree of local tissue destruction, evidence of spread to other organs (metastasis) and location of the tumor. Not all cancers metastasize and some can be cured or mitigated by surgical removal of the cancerous tissue or through use of chemotherapeutic drugs.
Iodopropynyl Butyl Carbamate (IPBC) is a water-soluble preservative used globally in the paints & coatings, wood preservatives, personal care, and cosmetics industries. IPBC is a member of the carbamate family of biocides. IPBC was invented in the 1970s and has a long history of effective use as an antifungal technology.
The process or technique of tattooing, creating a tattoo, involves the insertion of pigment into the skin's dermis. Traditionally, tattooing often involved rubbing pigment into cuts. Modern tattooing almost always requires the use of a tattoo machine and often procedures and accessories to reduce the risk to human health.
CP-GEP is a non-invasive prediction model for cutaneous melanoma patients that combines clinicopathologic (CP) variables with gene expression profiling (GEP). CP-GEP is able to identify cutaneous melanoma patients at low-risk for nodal metastasis who may forgo the sentinel lymph node biopsy (SLNB) procedure. The CP-GEP model was developed by the Mayo Clinic and SkylineDx BV, and it has been clinically validated in multiple studies.