Tattoo health and safety tips
Don't drink before you ink, and eight other tips
Published: September 2012
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I’m often surprised to hear my patients say that they got their tattoos while they were intoxicated. These confessions usually pour out spontaneously, prompted by anxiety, as I prepare to insert a needle for medical reasons. Getting a tattoo may be exciting, but you shouldn’t get drunk and cloud your judgment before you get one.

Permanent tattoos have been growing in popularity (pop star Justin Bieber’s tattoos even have their own fan website). Twenty-one percent of all U.S. adults admit to having at least one tattoo, according to a Harris Interactive poll taken this year, up from the 14 percent of Americans who said so in 2008. Adults age 30 to 39 are most likely to have a tattoo (38 percent), and women are slightly more likely than men to have tattoos (23 percent vs. 19 percent).

No longer just the stigmata of sailors, prison inmates, and bikers, tattoos have gone mainstream, prompted in part by celebrity body art. Pop star Rihanna, who reportedly has 17, admits she gets "tattoo fever" when the impulse strikes. Singers Miley Cyrus and Selena Gomez, actors Johnny Depp, Colin Farrell, Angelina Jolie, and Brad Pitt, along with quite a few athletes have also flaunted their tattoos.
The health risks

But as tattooing has spread, so have the associated health risks—skin infections, allergic reactions, and blood-borne diseases. Recently in Rochester, N.Y., 19 patrons of a tattoo parlor were infected with the organism Mycobacterium chelonae, which causes a rash and bumps on the skin; left untreated, the bacteria can spread to the lungs. The tattooing was performed using premixed gray ink, manufactured in Arizona, that had been contaminated before distribution, according to a New England Journal of Medicine report. And outbreaks of MRSA (Methicillin-resistant staphylococcus aureus) skin infections from commercially acquired tattoos have also been reported.

State and local authorities oversee tattoo practices, which vary considerably across the country. There is no standard regulation for training or licensing, and virtually no requirements for inspection, record-keeping, or informed consent. Although most states have laws prohibiting minors from getting tattoos, many teens nonetheless find them easy to get. 

And almost anyone can put up a tattoo shingle. For example, in New York City, where tattoo parlors are not licensed, a tattooist can get a practitioner’s license after simply paying some fees and passing a three-hour infection control course.
Safer inking

In New York’s Westchester and Putnam counties, where I practice, tattoo shops are unregulated. leaving multiple opportunities for health dangers. Because the skin itself is teeming with organisms, if rigorous infection control practices are not used, it can become easily infected when pierced. If equipment or surfaces are improperly sterilized, or if needles are reused, it’s possible for viruses such as hepatitis to be transmitted from people who were tattooed earlier.
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In addition, blood splatter can contaminate tattoo inks, which are often sold in more economical bulk containers. Sterile, single-use inks are available, but they are more expensive and rarely offered. Tattoo inks, which may be chemically complex and contain metals and solvents, are not regulated by the Food and Drug Administration. These inks may consist of azo pigments that not only contain multiple impurities, but are also used in car paint. Many of these pigments are illegal to use in cosmetics in Europe because they can break down into cancer-causing compounds, which may be absorbed into the skin.

If your mind is still set on a new tattoo, be sure to take these precautions.

    Find a tattoo artist who has single-use, “throw-away” kits that are individually packaged, dated, and sealed and hold disposable needles and tubes. Watch your tattoo artist remove the new needle and tube from its sealed envelope immediately before your session.
    Make sure that the tattoo parlor is fully licensed (if your state regulates tattoo parlors), and that your tattooist has a great deal of experience, even if that means driving across county lines to find a licensed shop.
    Make sure the artist wears sterile disposable gloves for each client and use sterile disposable towels, much as you’d expect from your dentist.
    Watch a procedure first to make sure that unsterile surfaces and equipment are not touched by the tattoo artist once the procedure has begun.
    Look for telltale signs of sloppy tattoo practices, such as blood splatter, dirty work surfaces, the absence of red “sharps disposal containers,” and a lack of infection-control practices.
    Ask where the ink was manufactured and procured. “It’s best if the ink comes from a large manufacturer that has been in business a long time, and even better if the artists have tried the ink on themselves,” says Byron Kennedy, M.D., deputy director of health for Monroe County, N.Y., and the lead author of the NEJM story. The contaminated ink in the recent outbreak came from a small retailer, he pointed out.
    Ask if the inks used are made of nonmetallic organic pigments.
    Consult a doctor if you see any sign of rash or infection (redness, swelling, or drainage of pus).

It is true that some red inks used for permanent tattoos contain mercury, while other reds may contain different heavy metals like cadmium or iron oxide. These metals—which give the tattoo its “permanence” in skin—have been known to cause allergic reactions, eczema and scarring and can also cause sensitivity to mercury from other sources like dental fillings or consuming some fish. While red causes the most problems, most other colors of standard tattoo ink are also derived from heavy metals (including lead, antimony, beryllium, chromium, cobalt nickel and arsenic) and can cause skin reactions in some people.

Helen Suh MacIntosh, a professor in environmental health at Harvard University and a columnist for the website, Treehugger, reports that as a result of a 2007 lawsuit brought by the American Environmental Safety Institute (AESI), two of the leading tattoo ink manufacturers must now place warning labels on their product containers, catalogs and websites explaining that “inks contain many heavy metals, including lead, arsenic and others” and that the ingredients have been linked to cancer and birth defects.

Of course, exposure to mercury and other heavy metals is hardly the only risk involved with getting a tattoo. The term tattoo itself means to puncture the skin. Tattoo ink is placed via needles into the dermis layer of the skin, where it remains permanently (although some colors will fade over time). Some people have reported sensitivity springing up even years after they first got their tattoo; also, medical MRIs can cause tattoos to burn or sting as the heavy metals in the ink are affected by the test’s magnetism.

Beyond the long term risks of walking around with heavy metals injected into your body’s largest organ (the skin), getting a tattoo in and of itself can be risky business. If the tattoo parlor’s needles and equipment aren’t properly sterilized in an autoclave between customers, you could be exposing yourself to hepatitis B or C, tuberculosis, mycobacterium, syphilis, malaria, HIV or even leprosy.

“The potential risk of infectious spread from tattooing (particularly due to Hepatitis B) is high enough that it is a practice that should be avoided by pregnant women to safeguard the health of the baby [and that of the pregnant woman herself] whose immune system is down regulated and is much more vulnerable to these types of infection,” reports dermatologist Audrey Kunin, who runs the popular Dermadoctor website. Dr. Kunin advises to be careful about choosing a tattoo parlor: “Make sure the place is reputable, perhaps check with the health department to see if there have been past claims against the parlor in question if you still have doubts.” She adds that since tattoos are essentially open wounds, they must be cared for properly, especially in the first few weeks, to stave off infection.

Those who want go ahead with getting a tattoo anyway despite the risks should consider steering clear of colors derived from heavy metals. Dr. Kunin reports that black might be the safest permanent tattoo ink; it is often derived from a substance called carbon black and rarely causes any kind of sensitivity issues. If your heart is set on red in your tattoo, ask around to see if any tattoo parlors in your area are willing to work with non-metallic organic pigments that lend a red color such as carmine, scarlet lake, sandalwood or brazilwood. There are non-metallic alternatives available for many other popular tattoo ink shades, too.
Tattoo ink
From Wikipedia, the free encyclopedia
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Bottles of various tattoo ink colors.

Tattoo inks consist of pigments combined with a carrier, and are used in tattooing.

Tattoo inks are available in a range of colors that can be thinned or mixed together to produce other colors and shades. Most professional tattoo artists purchase inks pre-made (known as pre-dispersed inks), while some tattooers mix their own using a dry pigment and a carrier.[1]

Tattoo ink is generally permanent. Tattoo removal is difficult, painful, and the degree of success depends on the materials used. Recently developed inks claim to be comparatively easy to remove.[citation needed] Unsubstantiated claims have been made that some inks fade over time, yielding a "semi-permanent tattoo."
Contents

    1 Regulations
    2 Pigment bases
    3 Carriers
    4 Health concerns
    5 Other tattoo inks
        5.1 Glow in the dark ink and blacklight ink
        5.2 Removable tattoo ink
        5.3 Black henna
        5.4 Vegan tattoo ink
    6 Ancient Roman recipe
    7 Notes
    8 References

Regulations

In the United States, tattoo inks are subject to regulation by the U.S. Food and Drug Administration as cosmetics and color additives. This regulatory authority is, however, not generally exercised.[2] The FDA and medical practitioners have noted that many ink pigments used in tattoos are "industrial strength colors suitable for printers' ink or automobile paint".[3][4]

In California, Proposition 65 requires that Californians be warned before exposure to certain harmful chemicals;[5] tattoo parlors in California must warn their patrons that tattoo inks contain heavy metals known to cause cancer, birth defects, and other reproductive harm.[5]
Pigment bases

Manufacturers are not required to reveal their ingredients or conduct trials, and recipes may be proprietary. Professional inks may be made from iron oxides (rust), metal salts, or plastics.[6] Homemade or traditional tattoo inks may be made from pen ink, soot, dirt, blood, or other ingredients.[3][7]

Heavy metals used for colors include mercury (red); lead (yellow, green, white); cadmium (red, orange, yellow); nickel (black); zinc (yellow, white); chromium (green); cobalt (blue); aluminium (green, violet); titanium (white); copper (blue, green); iron (brown, red, black); and barium (white). Metal oxides used include ferrocyanide and ferricyanide (yellow, red, green, blue). Organic chemicals used include azo-chemicals (orange, brown, yellow, green, violet) and naptha-derived chemicals (red). Carbon (soot or ash) is also used for black. Other elements used as pigments include antimony, arsenic, beryllium, calcium, lithium, selenium, and sulphur.[5][7]

Tattoo ink manufacturers typically blend the heavy metal pigments and/or use lightening agents (such as lead or titanium) to reduce production costs.[7]
Carriers

A carrier acts as a solvent for the pigment, to “carry” the pigment from the point of needle trauma to the surrounding dermis. Carriers keep the ink evenly mixed and free from pathogens, and aid application. The most typical solvent is ethyl alcohol or distilled water, but denatured alcohols, methanol, rubbing alcohol, propylene glycol, and glycerine are also used. When an alcohol is used as part of the carrier base in tattoo ink or to disinfect the skin before application of the tattoo, it increases the skin's permeability, helping to transport more pigment into the skin.
Health concerns
Main article: Tattoo medical issues

A variety of medical problems, though uncommon, can result from tattooing.

Medical workers have observed rare but severe medical complications from tattoo pigments in the body,[8] and have noted that people acquiring tattoos rarely assess health risks prior to receiving their tattoos.[9][10]

A recent case report also showed that tattoo pigments migrate into lymph nodes. These can show up on some types of medical scans as tumors. One woman was given a complete hysterectomy only to find out later that the lymph nodes contained tattoo pigment.[11][12]
Other tattoo inks
Glow in the dark ink and blacklight ink
Main article: UV tattoo

Both blacklight and glow in the dark inks have been used for tattooing. Glow in the dark tattoo ink absorbs and retains light, and then glows in darkened conditions by process of phosphorescence. Blacklight ink does not glow in the dark, but reacts to non-visible UV light, producing a visible glow by fluorescence. The resulting glow of both these inks is highly variable.

The safety of such inks for use on humans is widely debated in the tattoo community.

The ingredients in some "glow" inks are listed as: (PMMA) Polymethylmethacrylate 97.5% and microspheres of fluorescent dye 2.5% suspended in UV sterilized, distilled water.
Removable tattoo ink
Main article: InfinitInk

While tattoo ink is generally very painful and laborious to remove, tattoo removal being quite involved, a recently introduced ink has been developed to be easier to remove by laser treatments than traditional inks.
Black henna

Health Canada has advised against the use of "black henna" temporary tattoo ink which contains para-phenylenediamine (PPD), an ingredient in hair dyes. Black henna is normally applied externally in temporary Mehandi applications, rather than being inserted beneath the skin in a permanent tattoo.

Another ink may be used instead of black henna. "Jagua", a fruit based ink proven to be a healthier alternative to black henna.

Allergic reactions to PPD include rashes, contact dermatitis, itching, blisters, open sores, scarring and other potentially harmful effects.[13]
Vegan tattoo ink

Various tattoo ink manufacturers also produce vegan-friendly inks that do not contain any animal by-products like bone char, glycerin, gelatin and shellac.[14]
Ancient Roman recipe
The Roman physician Aetius created a recipe for tattoo ink:[15]
One pound of Egyptian pine bark
Two ounces of corroded bronze, ground with vinegar
Two ounces of gall (bile from gallbladder)
One ounce of vitriol (iron sulphate)
Mix well and sift. Soak powder in 2 parts water and 1 part leek juice. Wash the skin to be tattooed with leek juice. Prick design with needles until blood is drawn. Rub in the ink. 
Think Before You Ink: Are Tattoos Safe?

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The FDA issued a Safety Advisory on May 15, 2019 warning consumers, tattoo artists, and retailers about using or selling certain tattoo inks contaminated with microorganisms.
Think Before You Ink: Are Tattoos Safe? (600x365)

Tattoos are more popular than ever. According to a 2015 Harris Poll, about 3 in 10 (or 29%) people surveyed have at least one tattoo. The U.S. Food and Drug Administration (FDA) is also seeing reports of people developing infections from contaminated tattoo inks, as well as adverse reactions to the inks themselves.
Over the years, the FDA has received hundreds of adverse event reports involving tattoos: 363 from 2004-2016.
Before you get a tattoo, consider these key questions, answered by Dr. Linda Katz, M.D., M.P.H., director of FDA’s Office of Cosmetics and Colors.
1. Should I be concerned about unsafe practices, or the tattoo ink itself?
Both. While you can get serious infections from unhygienic practices and equipment that isn’t sterile, infections can also result from ink that was contaminated with bacteria or mold. Using non-sterile water to dilute the pigments (ingredients that add color) is a common culprit, although not the only one.
There’s no sure-fire way to tell if the ink is safe. An ink can be contaminated even if the container is sealed or the label says the product is sterile.
2. What is in tattoo ink?
Published research has reported that some inks contain pigments used in printer toner or in car paint. FDA has not approved any pigments for injection into the skin for cosmetic purposes.
FDA reviews reports of adverse reactions or infections from consumers and healthcare providers. We may learn about outbreaks from the state authorities who oversee tattoo parlors.
3. What kinds of reactions may happen after getting a tattoo?
You might notice a rash—redness or bumps—in the area of your tattoo, and you could develop a fever.
More aggressive infections may cause high fever, shaking, chills, and sweats. Treating such infections might require a variety of antibiotics—possibly for months—or even hospitalization and/or surgery. A rash may also mean you’re having an allergic reaction. And because the inks are permanent, the reaction may persist.
Tattoo rash
This is an example of an allergic reaction to a tattoo.
Contact your health care professional if you have any concerns.
4. Can scar tissue build up after getting a tattoo?
Scar tissue may form when you get a tattoo, or you could develop “granulomas,” small knots or bumps that may form around material that the body perceives as foreign. If you tend to get keloids—scars that grow beyond normal boundaries—you may develop the same kind of reaction to the tattoo.
5. What do I need to know about MRIs if I get a tattoo?
Some people may have swelling or burning in the tattoo when they have magnetic resonance imaging (MRI), although this happens rarely and does not last long. Let your health care professional know that you have a tattoo before an MRI is ordered.
6. What about do-it-yourself tattoo inks and kits?
Inks and kits sold as “do-it-yourself” to consumers have been associated with infections and allergic reactions. FDA is also concerned that consumers may not know how to control and avoid all sources of contamination.
7. Could other problems occur later on?
Although research is ongoing at FDA and elsewhere, there are still a lot of questions about the long-term effects of the pigments, other ingredients, and possible contaminants in tattoo inks. FDA has received reports of bad reactions to tattoo inks right after tattooing and even years later. You also might become allergic to other products, such as hair dyes, if your tattoo contains p-phenylenediamene (PPD).
Then there’s tattoo removal. We don’t know the short- or long-term consequences of how pigments break down after laser treatment. However, we do know some tattoo removal procedures may leave permanent scarring.
8. If I get a tattoo and develop an infection or other reaction, what should I do?
First, contact your health care professional.
Second, notify the tattoo artist so he or she can identify the ink and avoid using it again. Ask for the brand, color, and any lot or batch number of the ink or diluent to help determine the source of the problem and how to treat it.
Third, whether you’re a consumer, tattoo artist, or health care professional, tell FDA. Provide as much detail as possible about the ink and your reaction and outcome. Reports from consumers are one of our most important sources of safety information.
Removing Tattoos May Be Harder Than You Think
So think before you ink. Consider the risks.
Remember, too, that removing a tattoo is a painstaking process, and complete removal without scarring may be impossible.
If you do decide to get a tattoo, make sure the tattoo parlor and artist comply with state and local laws. The National Conference of State Legislatures has a Web page on state requirements for tattooingExternal Link Disclaimerdisclaimer icon. For information on local regulations, contact your county or city health 

How Safe Is Your Tattoo Ink?
By Matt McMillen
From the WebMD Archives

Aug. 26, 2016 -- Before you get that dolphin tattooed on your ankle or "Mom" on your bicep, be warned: The ink used in tattoos may be harmful -- even years later.

A new report has raised questions about the safety of tattoo inks used in Europe, most of which are imported from the United States. The inks have been found to contain hazardous chemicals, including carcinogens.

The report, from the European Commission’s Joint Research Centre, also identified heavy metals such as arsenic, lead, and nickel, preservatives, organic compounds, bacteria, and other potentially harmful substances in the inks.

It calls for a thorough review of tattoo inks in use throughout the European Union, and it highlights the need for strict regulation of the inks, which are also used for permanent makeup.

After the report was released, the organization asked the European Chemicals Agency (ECHA) to look further into tattoo ink safety.

“Tattoo inks and permanent make up (PMU) may contain hazardous substances -- for example, substances that cause cancer, genetic mutations, toxic effects on reproduction, allergies or other adverse effects on health,” an ECHA statement reads.

The concerns accompany a rapid rise in the number of people getting tattoos. Nearly 1 in 3 U.S. adults have a tattoo, according to a Harris Poll. Four years ago, only 1 in 5 adults were inked. Two tattoo industry trade groups, the National Tattoo Association and the Alliance of Professional Tattooists, did not respond to requests for comment.

In this country, the FDA has also raised concerns about tattoo ink.

Last August, the FDA announced a voluntary recall of A Thousand Virgins inks, which were found to be contaminated with bacteria. The year before that, another company, White and Blue Lion, recalled its inks and other tattoo equipment because of contamination that could have caused sepsis, a potentially deadly complication of infections. Other recalls have happened in previous years, both here and in Europe.

Other concerns the FDA raises on its website include:

    Allergic reactions
    Itchiness and inflammation when exposed to summer sunlight
    Granulomas, or small knots or bumps that form around areas where the body senses foreign material, such as the pigments in tattoo ink
    The spread of tattoo ink to the body’s lymphatic system. It’s unknown whether this has health consequences.