Tattoos Last, and So Does the Pain for 1 in 10

By Dr. Mercola

About one in five US adults, or 21 percent, has at least one tattoo. This is up from 14 percent in 2008, according to a Harris poll.1 Tattoos have been around for more than 5,000 years. They were used in ancient Egypt as a way to identify peasants and slaves.2

They were discovered on a 5,000-year-old frozen mummy identified as the “Iceman,” and it’s thought his tattoos may have been placed as a therapeutic tool on areas prone to joint pain and degeneration.3

In Samoa, extensive tattoos were given as a show of courage, endurance, and dedication to cultural traditions,4 while around the world different cultures valued the designs as status symbols, signs of religious beliefs, declarations of love, beautifications, or as a form of punishment.5

In the US, tattoos, once thought of as more of a fringe or alternative practice, are becoming practically mainstream and are often used as a form of self-expression. There are still some stereotypes remaining, however.

While 73 percent of voters said they would hire someone with a visible tattoo,6 27 percent of respondents to a Harris poll believed people with tattoos are less intelligent and 50 percent believed they were more rebellious.7

Most people getting a tattoo are not doing so to appease the views of others, of course, but there is one consideration you might not have considered: your health. If you’ve ever gotten a tattoo, or thought about it, chances are high that you weighed the artistic and social aspects of it far more than the health aspects.

But, unbeknownst to many, a significant number of people with tattoos have experienced lasting health issues as a result.

10 Percent of People with Tattoos Experienced Abnormal Reactions

Researchers from the NYU Langone Medical Center surveyed 300 people in New York’s Central Park. Of those who had a tattoo, more than 10 percent said they developed abnormal reactions as a result, including pain, itching, and infection that sometimes required antibiotics.8,9

In 4 percent of the cases, the symptoms went away within four months, but for 6 percent symptoms such as itching, scaly skin, and swelling lasted much longer. Chronic reactions occurred more often in people with more colors in their tattoo, particularly shades of red.

Past research has also found “red pigments are the commonest cause of delayed tattoo reactions.”10 One study conducted actual skin biopsies from red tattoo reactions and determined interface dermatitis was the primary problem, in many cases due to an allergic response.

In many cases, however, “overlapping reactive patterns were identified,” which suggests the red pigment was irritating the skin and body via multiple mechanisms.11 In addition to red, pink and purple colors were also commonly involved in reactions.

The featured study’s lead author was actually motivated to conduct the study after seeing a patient who seemed to develop an intolerance to red tattoo dye after receiving her multiple tattoos. She told CNN:12

“[Dr. Marie C. Leger, assistant professor of dermatology at NYU Langone Medical Center]… got motivated to study tattoo complications after treating a patient who developed itching and raised, scaly skin around only the red parts of a tattoo on her arm.

She had the first tattoo for years but the symptoms started after getting a more recent tattoo on her foot. In addition to the problems at the tattoo site, she developed a rash over her whole body.

‘It was like her body decided after being exposed to red dye more than once, that it just didn’t like it,’ Leger said. There are many questions over what is causing these undesirable side effects. Leger said she suspects that allergic reactions to the dyes, especially red dye, are responsible for some of the chronic reactions lasting more than four months.”

Tattoo Ink Is Unregulated

While tattoo parlors are often inspected to ensure safe practices (such as the use of single-use needles), however tattoo inks typically fly under the radar. Inks and ink colorings (pigments) used for tattoos are technically subject to regulation by the US Food and Drug Administration (FDA) as cosmetics and color additives.

However, the Agency states that because of other public health priorities and a “previous lack of evidence of safety concerns,” they have not traditionally regulated such products.13

It has been said that “tattoo ink is remarkably nonreactive histologically, despite the frequent use of different pigments of unknown purity and identity by tattoo artists.”14

However, University of Bradford researchers using an atomic force microscope (AFM) that allows them to examine skin with tattoos at the nano-level have found evidence that suggests otherwise. In a preliminary study (the first to use an AFM to examine tattoos), the researchers found that the tattoo process remodels collagen (your body’s main connective tissue).15

Carcinogenic Nanoparticles Found in Tattoo Ink

In 2011, a study in The British Journal of Dermatology revealed that nanoparticles are indeed found in tattoo inks,16 with black pigments containing the smallest particles (white pigments had the largest particles and colored pigments were in between).

Nanoparticles are ultramicroscopic in size, making them able to readily penetrate your skin and travel to underlying blood vessels and your bloodstream. Evidence suggests that some nanoparticles may induce toxic effects in your brain and cause nerve damage, and some may also be carcinogenic.

Further, nanoparticles from tattoo ink were found to exist in both the collagenous network of the skin as well as around blood vessels, according to the University of Bradford researchers.

This suggests the ink particles are leaving the surface of your skin and traveling elsewhere in your body, where they could potentially enter organs and other tissues. This is particularly worrisome because tattoo inks are known to contain cancer-causing compounds…

Black Tattoo Ink May Also Carry Unique Risks

While red ink appears to be associated with chronic skin reactions and those that are allergic in nature, black ink is also implicated in health problems. This might be, in part, because of its high concentration of nanoparticles.

“The black pigments were almost pure NPs [nanoparticles], i.e. particles with at least one dimension <100 nm,”researchers said in The British Journal of Dermatology.17 Writing in Experimental Dermatology, researchers highlighted the dangerous potential of tattoo inks (particularly black) even beyond nanoparticles:18

“Black tattoo inks are usually based on soot, are not regulated and may contain hazardous polycyclic aromatic hydrocarbons (PAHs). Part of PAHs possibly stay lifelong in skin, absorb UV radiation and generate singlet oxygen, which may affect skin integrity.

Tattooing with black inks entails an injection of substantial amounts of phenol and PAHs into skin. Most of these PAHs are carcinogenic and may additionally generate deleterious singlet oxygen inside the dermis when skin is exposed to UVA (e.g. solar radiation).”

That being said, all tattoo inks have toxic potential. Some tattoo pigment may migrate from your skin into your body’s lymph nodes, for instance.19 Other potential health effects include:

  • Potentially carcinogenic20
  • May cause inflammation and DNA damage21
  • May contain carcinogenic Polycyclic Aromatic Hydrocarbons (PAHs) like benzo(a)pyrene (a Class 1 carcinogen according to the International Agency for Research on Cancer)

‘Think Before You Ink’

While I certainly value artistic and self-expression, I do urge you to “think before you ink” for the sake of your health. No systematic studies have been performed on the safety of tattoo inks, and many of those used are industrial-grade colors suitable for printers’ ink or automobile paint.22

There is much yet to be learned about how these pigments interact with your body. For instance, National Center for Toxicological Research (NCTR) studies show that Yellow 74, a common yellow tattoo ink, is broken down by enzymes and metabolized by your body.

This pigment also breaks down in sunlight, often turning colorless, but the pigments remain and it’s unknown if they are toxic. Ink breakdown products may also disperse throughout your body, again with unknown effects.23 As the number of teenagers and young adults getting tattoos increases, it’s expected that complications will too. As reported in the Journal of Cutaneous and Aesthetic Surgery:24

Unfortunately there are no legislations to promote safe tattooing, hence complications are quite common. Superficial and deep local infections, systemic infections, allergic reactions, photodermatitis, granulomatous reactions and lichenoid reactions may occur. Skin diseases localized on the tattooed area, such as eczema, psoriasis, lichen planus, and morphea can be occasionally seen.”

Additional risks that can occur with any tattoo include:25

  • Scarring
  • Granulomas, which are small knots or bumps that may form around a material your body perceives as foreign
  • MRI complications, such as swelling or burning at the tattoo site during an MRI

Tattoo Removal Carries Its Own Set of Risks

If you do decide to get a tattoo, consider it a permanent decision. Although tattoo removal is possible using laser treatment and other methods, it is time-consuming, expensive, and may not rid you of the tattoo completely. As explained in the Journal of Cutaneous and Aesthetic Surgery:26

“…regrets after a tattoo are also seen and requests for tattoo removal are rising. Laser tattoo removal using Q-switched lasers are the safest; however, complications can occur. Acute complications include pain, blistering, crusting and pinpoint hemorrhage. Among the delayed complications pigmentary changes, hypopigmentation and hyperpigmentation, paradoxical darkening of cosmetic tattoos and allergic reactions can be seen.

Another common complication is the presence of residual pigmentation or ghost images. Scarring and textural changes are potential irreversible complications. In addition, tattoo removal can be a prolonged tedious procedure, particularly with professional tattoos, which are difficult to erase as compared to amateur tattoos. Hence the adage, stop and think before you ink holds very much true in the present scenario.”

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