Can tattoos have negative effects on your health?

While it is true that most people do not encounter issues with tattoos, it’s not entirely accurate to consider this procedure entirely safe.

Selecting a tattoo parlor with an excellent reputation and correctly tending to a new tattoo can help prevent the most typical complications. However, even with strict adherence to all safety measures, certain risks like ink allergies or scar formation can still occur.

Process of getting a tattoo

The human skin comprises multiple layers that can be divided into three categories, namely, the epidermis, dermis, and hypodermis. The topmost layer, the epidermis, safeguards the skin from microbe and virus invasions.

The lower layer of the epidermis comprises living keratinocytes, while the upper layer is composed of dead cells. Over time, dead keratinocytes shed, and living cells from the lower layer of the skin replace them.

The dermis, or the middle layer, mainly consists of fibrous connective tissue produced by skin fibroblast cells. Blood vessels nourish the dermis, regulate body temperature, and nerve endings in the dermis enable humans to feel pain, hair roots, sweat, and sebaceous glands.

The deepest layer of the skin, the hypodermis, comprises fat cells that protect the body and store energy for future use.

When a person gets a tattoo, the tattoo artist pierces the epidermis and injects ink using a needle into the dermis. As the dermis does not slough off, and the ink particles are usually too large for the lymphatic system to remove them from the body, the tattoo design remains on the skin for life if the ink does not fade over time.

How often do problems with tattoos arise?

In Europe and the United States, 12-33% of people have at least one tattoo on their skin. After getting a tattoo, most people experience a mild inflammation that usually disappears within two to three weeks.

Serious side effects like skin infections or scar formation are rare occurrences. Between 2004 and 2016, the US Food and Drug Administration (FDA) received only 363 reports of severe complications related to tattoos.

However, the actual number of tattoo recipients who have experienced issues after the procedure remains unknown, as not all affected individuals seek medical attention.

What are the risks associated with getting tattoos?

Skin damage during the tattooing process and an individual’s reaction to the ink are the primary causes of severe side effects. In some cases, complications arise in people who have tattoos, but the cause cannot be explained.

Skin infection

Skin infections can occur in the tattoo area when tattoo needles disrupt the structure of the skin, which is the primary barrier protecting the body from external pathogens. This provides an opportunity for microbes to enter the body. Microbes can enter the body in various ways:

• Poorly washed and untreated skin can provide a surface for microbes to enter.
• Non-sterile or improperly sterilized needles can transfer microbes into the body.
• Pathogens can enter the body through ink that has been contaminated with microbes. This can occur when a tattoo artist uses the same ink for multiple people or dilutes the ink with tap water.

Most of these problems arise when safety techniques are not followed, making people who visit uncertified tattoo salons or home-based artists more susceptible to skin infections. However, skin infections can sometimes occur even in people who visit reliable certified salons, and this may not be the fault of the tattoo artist. Commercial ink can sometimes contain microbes, even in sealed bottles labeled as sterile products.

Clients who do not take proper care of a fresh tattoo may experience inflammation. People with chronic diseases are more likely to experience inflammation with fresh tattoos. In healthy people, pathogens typically do not penetrate beyond the tattoo area. However, clients with severe illnesses who visit a tattoo salon may have weakened immune systems, which increases the risk of wound infection. This infection can result in not only local inflammation but also blood infection, also known as sepsis.

A well-known case involves a young man with chronic liver disease who had a fresh tattoo on his leg. He swam in the Gulf of Mexico and later died from blood infection caused by Vibrio vulnificus bacteria that entered the wound. These microbes do not typically cause infectious diseases in people with healthy immune systems.

Pathogenic bacteria and viruses can cause local inflammation in the tattoo area. Bacteria such as Staphylococcus aureus, Streptococcus, and mycobacteria typically cause skin inflammation within the first three weeks after visiting a tattoo salon. If viruses such as human papillomavirus or viruses that cause contagious mollusk, warts, and flat round nodules enter the skin, they usually appear several months after getting the tattoo.

Diseases that are transmitted through blood

People have been infected with hepatitis B or C when tattoo artists use non-sterile or improperly processed instruments. Fortunately, this occurrence is rare, and all known cases have been associated with visits to questionable tattoo salons.

In theory, HIV infection can also be transmitted in the same way. However, there are no confirmed cases of HIV infection in a tattoo salon. People can get infected with the human immunodeficiency virus through tattoos, but only if the tattoos are made in deliberately unsterile conditions using improvised instruments, such as in prison.

Allergy to ink or needles

The body perceives ink as a foreign object, and some individuals’ immune systems regard it as a harmful microorganism and start fighting it. Metal salts, such as chromium, cadmium, cobalt, and nickel, are present in many inks and most often cause allergic reactions. Allergies to metals in tattoo inks usually manifest several weeks or even months after the tattoo is applied.

Usually, the immune system reacts more frequently and strongly to red ink. Scientists once believed that the culprit was cinnabar, a red pigment that contains toxic mercury.

However, modern red tattoo inks no longer contain mercury. The exact component within modern red inks that triggers allergies remains unknown.

Exposure to sunlight can cause swelling and inflammation in some tattoo inks, likely due to the presence of cadmium sulfide, which is light-sensitive and gives the ink a yellow color. In some cases, cadmium sulfide is also added to red ink to lighten the shade.

Black, green, and blue inks are less likely to cause issues, although green tattoos containing potassium dichromate can cause eczema in individuals sensitive to chromium. Similarly, blue tattoos with cobalt aluminate may trigger dermatitis in individuals sensitive to aluminum.

People with black tattoos tend to seek medical attention less frequently than those with other colors, probably because most black inks do not contain metals that can trigger immune reactions. Soot, a substance that rarely causes allergies, is commonly used to produce black inks.

Tattoo needles that contain high levels of chrome and nickel can trigger immune system reactions in individuals with metal sensitivity. Nickel is a potent contact allergen, meaning even tiny needle fragments can cause dermatitis when they enter the skin.

Several allergens found in tattoo inks are also carcinogenic, raising concerns among scientists. During the tattooing process, approximately 2.5 mg of pigment per 1 cm enters the skin, potentially leading to the transformation of nearby skin cells into cancerous cells due to exposure to carcinogens.

While skin cancer may develop in the area of a tattoo, careful investigation has shown that the ink itself is not a causative factor. Rather, the occurrence of both the tattoo and cancer in the same area of the skin is merely a coincidence.

Discomfort and problems with the appearance of tattoos

Hard nodules or bumps can develop in the area of a tattoo for some people several months or even years later. These nodules or bumps can cause pain or itching, although they may also be painless. This condition is known as sarcoidosis, which is associated with tattoos.

Researchers still have not fully understood why sarcoidosis occurs and how it is specifically related to tattoos. Some data suggests that components of purple and violet ink, such as manganese and aluminum, may be the cause. However, it is not excluded that tattoos do not cause the disease, but simply trigger symptoms of this disease in people who have it for completely different reasons. In some cases, these symptoms can occur in people with black tattoos, even though there are no metals in them.

Raised areas that resemble scars can develop in the tattooed area of other individuals after several months or years. This condition is known to occur among tattooed individuals.

In some cases, the raised areas may be related to excessive growth of connective tissue that has caused damage to the skin. However, sometimes the true cause of the problem cannot be identified.

Burn in the tattoo area

During laser hair removal in the tattoo area, it is possible to get a burn. The laser’s light waves heat up the dark pigment melanin present in the hair bulb, which results in the destruction of the hair bulb, and the hair falls out. Similarly, the laser affects the tattoo by heating up the pigment in the skin. If the tattoo is not covered, the laser can cause a serious burn.

How to reduce the risk

Weigh up the pros and cons

Deciding whether or not to get a tattoo is a personal choice. However, it is worth keeping in mind that removing a tattoo can be challenging if you end up disliking it. Laser removal is the most effective way to remove a tattoo.

Laser removal affects the tattoo in a similar way to laser hair removal: the ink absorbs energy and breaks down into smaller particles, making the tattoo less noticeable.

Completely removing a tattoo requires 6-8 painful procedures. However, even after multiple treatments, it is not always possible to completely get rid of the tattoo. Black and blue tattoos are the easiest to remove, while green, red, and yellow are the most challenging to remove.

Choose a reliable tattoo parlor

Tattoo artists in reputable tattoo parlors follow strict hygiene and safety protocols. They sterilize all heat-resistant equipment in autoclaves, use only disposable needles from sealed packages, pour sterile factory-produced ink designed specifically for tattoos into disposable cups, dilute ink only with sterile distilled water, wear disposable gloves, treat the client’s skin with alcohol or iodine solution before the procedure, and use disposable sterile sheets. These measures are typically only found in tattoo salons and offices that have been operating for long periods of time in the same location. To ensure the studio is clean and safe, one can ask the administrator to send photos of the tattooing process or observe how they do tattoos on other people.

Although the risk of an individual reaction to the procedure cannot be completely eliminated by following safety techniques, visiting a reputable studio reduces the likelihood of getting an infection compared to getting a procedure done by a master who works from home or at an event.

Get vaccinated against hepatitis B

Usually, childhood vaccination provides protection against this disease; however, the protection ceases after 18 years of age. Therefore, if you have not been vaccinated as an adult, it is advisable to get vaccinated again before visiting a tattoo salon, just in case.

Take care of your tattoo properly

After finishing the tattoo work, the master must apply a layer of vaseline and a dressing, typically a polyethylene film, to cover the tattoo. The tattoo salon should provide instructions on how to proceed further.

Most instructions recommend that you wash your hands with soap, remove the bandage, rinse the tattooed area with soap and water, and dry it gently with a disposable towel after 24 hours. This process should be repeated at least twice a day for 2-4 weeks until the skin completely heals. To accelerate the healing process, you can apply a healing ointment such as “Bepanthen” or “D-Panthenol” to the tattooed area.

If the tattoo is located on an exposed area of the skin, covering it with a bandage is unnecessary. However, if you plan to go outside or wear clothing that may rub against the tattoo, covering it with a clean bandage is recommended to protect it from UV rays and bacteria.

After getting a tattoo, it’s okay to shower, but avoid taking a bath, going to a sauna, swimming in open water such as the sea or a river, and scrubbing the tattoo with a washcloth and soap. It’s safer to take a cool shower.

While your tattoo is healing, monitor its condition and your overall health carefully. If you experience any of the following symptoms, see a doctor as soon as possible:

• The tattooed area becomes red, swollen, and feels hot
• The tattooed area develops pus or has an unpleasant odor
• You have a fever above 38 °C

Instead of using bandages, some tattoo artists use a surgical film called Suprasorb to cover a new tattoo for healing. This method can help prevent infection and eliminates the need for frequent re-bandaging. The film is applied for 5 days, allowing the skin to heal during this period.

Who should not get tattoos?

Although tattooing is not a medical procedure, there are general guidelines that suggest certain conditions under which interventions are not recommended. For instance, individuals who are feeling unwell or have a cold are advised not to get a tattoo.

In most countries such as the United States, it is illegal to tattoo individuals who are below 18 years of age without parental consent.

Furthermore, it is not recommended for pregnant women to get tattoos, although there are no confirmed risks associated with tattoo ink for this group of women or their unborn children. Old tattoos also pose no harm to the fetus.

During pregnancy, a woman’s immune system temporarily weakens, increasing the risk of infection. Therefore, it is advisable to limit exposure to pathogens, including postponing tattoos and piercings until after childbirth.

Breastfeeding women should also exercise caution when considering getting a tattoo. Although there is no evidence that tattoo ink can harm the baby through breast milk, hepatitis B and C can be transmitted through this medium. Therefore, to avoid any potential harm to the baby, it is better to postpone a visit to the tattoo studio until after breastfeeding is complete.