Think Before You Ink: Are Tattoos Safe?

Dec 23, 2007
As the popularity of tattoos continues to grow, so does the
concern about potential risks. Some risks, such as the
spread of infections through the use of unsterilized
needles, have long been known. But what isn't clear is the
safety of tattoo inks.

Permanent tattoos are made by using needles to inject
colored ink below the skin's surface. Permanent make-up is
considered a permanent tattoo that mimics the results of
cosmetic products such as an eyebrow pencil, lip liner,
eyeliner, or blush.

While state and local authorities oversee the practice of
tattooing, ink and ink colorings (pigments) used in tattoos
are subject to FDA regulation as cosmetics and color
additives. However, 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.

FDA has received reports of bad reactions to tattoo inks
right after tattooing or even years later. Some people
report itchy or inflamed skin around their tattoos in the
summer when they've been out in the sun. Recent reports
associated with permanent make-up inks have prompted FDA to
study tattoo ink safety.

"Our hope is to get a better understanding of the body's
response to tattoos and their impact on human health, and
to identify products at greatest risk," says Linda Katz,
M.D., M.P.H., Director of FDA's Office of Cosmetics and
Colors in the Center for Food Safety and Applied Nutrition.

What are the Risks?

•   Infection – Dirty needles can pass infections, like
hepatitis and HIV, from one person to another.
•   Allergies – Allergies to various ink pigments in
temporary tattoos have been reported and can cause
problems.
•   Scarring – Unwanted scar tissue may form when getting or
removing a tattoo.
•   Granulomas – These small knots or bumps may form around
material that the body perceives as foreign, such as
particles of tattoo pigment.
•   MRI complications – People may have swelling or burning
in the tattoo when they have magnetic resonance imaging
(MRI). This happens rarely and does not last long.

Tattoo Ink Research

In a laboratory within FDA's Arkansas-based National Center
for Toxicological Research (NCTR), research chemist Paul
Howard, Ph.D., and his team are investigating tattoo inks
to find out
•   the chemical composition of the inks and how they break
down (metabolize) in the body;
•   the short-term and long-term safety of pigments used in
tattoo inks;
•   how the body responds to the interaction of light with
the inks.
"There have been no systematic studies of the safety of
tattoo inks," says Howard, "so we are trying to ask—and
answer—some fundamental questions." For example, some
tattoos fade over time or fade when they are exposed to
sunlight. And laser light is used to remove tattoos. "We
want to know what happens to the ink," says Howard. "Where
does the pigment go?"

NCTR researchers are exploring several possibilities:

•   The body cells may digest and destroy the ink, just as
they rid the body of bacteria and other foreign matter as a
defense against infection. NCTR studies show that a common
pigment used in yellow tattoo inks, Pigment Yellow 74, may
be broken down by enzymes, or metabolized. "Just like the
body metabolizes and excretes other substances, the body
may metabolize small amounts of the tattoo pigment to make
it more water soluble, and out it goes," says Howard.
•   Sunlight may cause the ink to break down so it is less
visible. NCTR researchers have found that Pigment Yellow 74
decomposes in sunlight, breaking down into components that
are colorless. The pigment components may still be there,
says Howard, and we don't know if these are potentially
toxic.
•   The skin cells containing the ink may be killed by
sunlight or laser light and the body may excrete the dead
cells or may disperse ink breakdown products through the
body.

Research has also shown that some pigment migrates from the
tattoo site to the body's lymph nodes, says Howard. Lymph
nodes are part of the lymphatic system, a collection of
fluid-carrying vessels in the body that filter out
disease-causing organisms. Whether the migration of tattoo
ink has health consequences or not is still unknown. NCTR
is doing further research to answer this and other
questions about the safety of tattoo inks.

Tattoo Tips for Consumers

Ink:
•   FDA has not approved any tattoo inks for injection into
the skin, and many ink pigments used are industrial
strength colors suitable for printers' ink or automobile
paint.
•   The use of henna in temporary tattoos has not been
approved by FDA. Henna is approved only for use as a hair
dye. Similar to other inks, the use of ultraviolet (UV) ink
for glow-in-the-dark tattoos also has not been approved by
FDA.

Permanence:
•   Consider tattoos permanent. Removal is time-consuming,
costly, and doesn't always work. The most common method of
tattoo removal is by laser treatment, which delivers short
flashes of light at very high intensities to the skin to
break down the tattoo ink. FDA allows several types of
lasers to be marketed for tattoo removal. Some color inks
are harder to remove than others. Many repeat visits every
several weeks may be required to remove a tattoo, and it
may never be entirely gone.
•   Do not buy or order online do-it-yourself tattoo removal
products. These acid-based products are not FDA-approved
and can cause bad skin reactions.
•   Consult your health care provider—not a tattoo parlor—if
you want a tattoo removed. The American Society for Laser
Medicine and Surgery can help you find a doctor experienced
in tattoo removal.

Don't Avoid an MRI:
•   If you need to have an MRI done, don't avoid it. Inform
the radiologist or technician that you have a tattoo so
appropriate precautions can be taken.

Source: FDA