Tattooing has been practiced throughout most of the world, though it is rare among darkly pigmented peoples and also in China. Evidence for the practice has even been found in 4,000+ year-old Egyptian mummies and in 5,000 year "Iceman" corpses preserved in ice. It is thought the word “tattoo” entered English and European languages in 1769, having been recorded by James Cook’s Tahiti expedition. In 1891 the first electric tattoo device was patented in the US.
Interest in tattoos has waxed and waned in US and European cultures. Those who object to tattoos would point to its use on prisoners and Nazi concentration camp internees. Religious objection to tattoos can be found in Leviticus 19:28: “You shall not make any cuttings in your flesh on account of the dead or tattoo any marks upon you.”
The practice of tattooing seems to have now become mainstream. Young adults and teens worldwide are having dangerous compounds and chemicals injected under their skin for the sake of body art. The trend started surging in the early 1990s. By 2003 it was projected that 36% of 25- to 29-year olds in the US had at least one tattoo. That makes tattoos a pretty big business and an even bigger health concern.
Tattoos and FDA Regulation
Did you know that there is no federal oversight of tattooing? Although tattoo businesses in the US fall under the purview of the Federal Drug Administration (FDA), the agency has not offered any guidelines or regulations for how tattoo parlors should operate . Their ground has been: “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.” Therefore if an establishment claims that their tattoo business or tattoo inks are approved or certified by the FDA, it is simply not true.
The FDA does, however, acknowledge reports of adverse short- and long-term reactions to tattoo ink, including inflammation, itching after exposure to summer sun, and reports of adverse reactions to tattooed make-up.
Risks Acknowledged by FDA
- Infections such as HIV and hepatitis related to reused needles.
- Allergic reactions to temporary and permanent tattoo inks.
- Scarring as a result of getting a tattoo, or tattoo removal.
- Granulomas in the form of large or small bumps that form to encapsulate foreign substances, such as tattoo ink particles.
- Burning and swelling of tattoos in MRI machines due to metal components in tattoo inks.
FDA Research on Tattoos
The FDA and medical providers have determined many tattoo inks contain “industrial strength” pigments suitable for automotive paint and printers’ ink. The following issues will be explored by the FDA’s National Center for Toxicological Research (NCTR):
- Chemical make-up of tattoo inks and how the inks are broken down by the body
- Short- and long-term impact of tattoo ink pigments
- Body response to inks with sunlight and laser
State Regulation of Tattoo Parlors
Is anyone watching the shop?
The states are. That's where most regulation of tattoo parlors happens. That means, however, that the level of rules and oversight varies. California’s Proposition 65 requires tattoo businesses to warn customers that tattoo pigments contain heavy metals associated with birth defects, other reproductive injury and cancer. On the flip side, some states have very lax rules.
Other Tattoo Concerns
- The US Red Cross imposes a 12 month wait for potential donors who have had a tattoo in a facility that is not state regulated, or in a state that has no oversight of tattoo businesses.
- In the UK there is no regulation for tattooing, and a 6-month wait to give blood is imposed after tattoos, with no exceptions.
- Canada introduced legal tattoo services in the prisons to give prisoners a skill, and to reduce health risks such as hepatitis.
- Plastic polymers are used in glow-in-the dark inks. Polymerization occurs when particles mesh into a solid sheet of plastic under the skin.
- Metal salts in tattoo pigment can cause burning and pain during MRI procedures. Some facilities are refusing to perform MRIs on clients with tattoos.
- Some pigments, especially yellows, react to light and may break down into toxic components due to laser removal treatments. These toxins may, in turn, place a burden on the liver and kidneys.
- The American Academy of Dermatology has voiced concern and identified an extensive list of potentially harmful ingredients and compounds in tattoo inks.
What's in Tattoo Inks?
Central to the issue, is that no one is sure what is in the inks. Manufacturers are not bound to divulge the ingredients of their pigments, and mixtures may be considered trade secrets. Professional tattoo ink pigments may be made from plants, plastics, iron oxides, or metal salts. Homemade inks may be made from dirt, soot, plants, pen ink, blood or an unknown array of other possible ingredients.
Some Known Ingredients of Tattoo Inks:
Heavy Metals
- Aluminum
- Barium
- Cadmium
- Chromium
- Cobalt
- Copper
- Iron
- Lead
- Mercury
- Nickel
- Titanium
- Zinc
Metal Oxides
- Ferrocyanide
- Ferricyanide
Organic Chemicals
- Azo chemicals
- Naptha derivative chemicals
- Carbon
- Polycyclic compounds
Other Compounds
- Antimony
- Arsenic
- Beryllium
- Calcium
- Lithium
- Phosphorus
- Selenium
- Silica
- Sulfur
- Titanium dioxide
- Polymethylmethacrylate (PMMA)
Effects of Tattoo Ink Colors
Common Ingredients of Inks by Color
Red: mercury, cadmium, iron, ferrocyanide, ferricyanide, naptha derived chemicals
Orange: cadmium, azo chemicals
Yellow: lead, cadmium, zinc, ferrocyanide, ferricyanide, azo chemicals
Green: lead, chromium, aluminum, copper, ferrocyanide, ferricyanide, azo chemicals
Blue: cobalt, copper, ferrocyanide, ferricyanide
Violet: aluminum, azo chemicals
Brown: iron, azo chemicals
Black: nickel, iron, carbon as soot or ash, black henna
White: lead, zinc, titanium, barium
Common Reactions to Tattoo Ink
Although data is not collected on allergic reactions, some sources suggest that most of the reactions are to the latex rather than the tattoo inks and recommend that clients ask tattoo artists to use non-latex gloves.
Reports indicate allergic reactions to tattoo inks are most common with red and yellow inks as well as white ink.
Red ink is also associated with complications after laser removal treatments and is known to contain mercy and azo chemicals.
The European Commission report from 2003 recounts:
- A case of allergic skin reaction to cobalt blue, and many cases of reactions of red tattoo ink, of both azo compounds and inks of heavy metal composition.
- Nodular granulomateous reactions, mostly related to azo or heavy metal red inks. One case developed in the red pigmented areas of a 37 year old tattoo.
- Sarcoidosis cases traced to red ink, black ink, and multiple colors of ink.
Pigment Carriers
Pigments are dissolved in a solvent to help “carry” the color from the needle to the skin. Carriers make ink application easier and help keep the ink mixed with the pigment and evenly distributed. Typical carriers are some form of alcohol or aldehyde. Alcohol-based carriers increase the permeability of the skin, increasing absorption into the bloodstream. which results in more chemicals being absorbed into the bloodstream. Alcohol carriers are also known to amplify the carcinogenic effects of these tattoo inks.
Common Carriers
Water
Ethyl alcohol
Denatured alcohol
Methanol
Rubbing alcohol
Propylene glycol
Glycerine
Formaldehyde
Other aldehydes.
European Commission Findings
The European Commission published Risks and Health Effects from Tattoos, Body Piercing and Related Practices in May of 2003. The team had identified health risks from tattooing and piercing, as well as lax or non-existent regulation these industries. While, the specific composition of tattoo ink was generally unknown, it was known, however, that organic industrial pigments and heavy metals were used, which had impurities and microbiological components.
One of the problems is that there have been few defined, targeted studies to examine risks for short- or long-term effects of tattoo inks. In examining many studies, including anecdotal reports of adverse effects, they developed a list of health risks that were “potentially associated with tattooing and piercing." Examination of the full report however reveals some findings that are worth paying attention to.
European Commission Findings of Possible Health Effects:
The commission findings can be categorized into 5 areas: infections, allergic reactions, cancer, behavioral changes, and skin diseases. Many of the effects are delayed, sometimes up to 20 years or longer. In my view, this is similar to the problems associated with silicone breast implants, agent orange exposure and Gulf War Syndrome.
Infections
Infections are associated with poor hygienic conditions and risky practices such as the reuse of tattoo needles. Infections are understandably also associated with prison tattooing and have also been found with unlicensed tattoo facilities and artists. Known infections include:
Viral Infections:
- HIV/AIDS
- hepatitis
- skin infections
Bacterial Infections:
Fungal Infections:
- zygomycosis
- sporotrichosis
Allergic Reactions
Allergic reactions associated with tattoos are almost exclusively associated with inks and pigment carriers. According to numerous Case reports, allergic reactions are "not infrequent." These reactions include:
- Skin irritation and uticaria
- Lichenoid and granulomateus reactions
- Lymphadenopathy
- Pseudo lymphomas
- Sarcoidosis
Cancer
Skin cancers have formed within a tattoo and gone unnoticed until they began to extend beyond the boundaries into un-inked areas. These cancers include:
Squamous cell
carcinoma
Basal cell carcinoma
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