Tattooing

A tattoo is a permanent mark or design made on skin with pigments inserted through pricks into the skin’s top layer. Typically, the tattoo artist uses a hand-held machine that acts much like a sewing machine, with one or more needles piercing the skin repeatedly. With every puncture, the needles insert tiny ink droplets.
The process which is done without anaesthetics causes a small amount of bleeding and slight to potentially significant pain.

A variety of medical issues can result from tattooing. Because it requires breaking the skin barrier, tattooing may carry health risks, including infection and allergic reactions. Modern tattooists reduce such risks by following universal precautions, working with single-use items, and sterilising their equipment after each use. Many jurisdictions require that tattooists have bloodborne pathogen training, such as is provided through the Red Cross and the U.S. Occupational Safety and Health Administration

TATTOOS AND FDA REGULATION
Federal Drug Administration (FDA), the agency has not offered any guidelines or regulations for how tattoo parlours should operate. 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 longterm 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

  1. • Infections such as HIV and hepatitis related to reused needles.
  2. • Allergic reactions to temporary and permanent tattoo inks.
  3. • Scarring as a result of getting a tattoo, or tattoo removal.
  4. • Granulomas in the form of large or small bumps that form to encapsulate foreign substances, such as tattoo ink particles.
  5. • 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):

  1. • Chemical make-up of tattoo inks and how the inks are broken down by the body
  2. • Short- and long-term impact of tattoo ink pigments
  3. • Body response to inks with sunlight and laser

WHAT’S IN TATTOO INKS?
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.

EFFECTS OF TATTOO INK COLORS
Common Ingredients of Inks by Color

  1. Red: mercury, cadmium, iron, ferrocyanide, ferricyanide, naptha derived chemicals
  2. Orange: cadmium, azo chemicals
  3. Yellow: lead, cadmium, zinc, ferrocyanide, ferricyanide, azo chemicals
  4. Green: lead, chromium, aluminum, copper, ferrocyanide, ferricyanide, azo chemicals
  5. Blue: cobalt, copper, ferrocyanide, ferricyanide
  6. Violet: aluminum, azo chemicals
  7. Brown: iron, azo chemicals
  8. Black: nickel, iron, carbon as soot or ash, black henna
  9. 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:

  1. • 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.
  2. • 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.
  3. • 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

  1. • Water
  2. • Ethyl alcohol
  3. • Denatured alcohol
  4. • Methanol
  5. • Rubbing alcohol
  6. • Propylene glycol
  7. • Glycerine
  8. • Formaldehyde
  9. • Other aldehydes

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:

  1. • HIV/AIDS
  2. • hepatitis
  3. • skin infections

Bacterial Infections:

  1. • toxic shock syndrome
  2. • impetigo
  3. • chancroid
  4. • tetanus
  5. • leprosy
  6. • tuberculosis

Fungal Infections:

  1. • zygomycosis
  2. • 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:

  1. • Skin irritation and uticaria
  2. • Lichenoid and granulomateus reactions
  3. • Lymphadenopathy
  4. • Pseudo lymphomas
  5. • 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:

  1. • Malignant melanoma
  2. • Squamous cell carcinoma
  3. • Basal cell carcinoma

By – Assistant Professor – Ms. Annu Panchal
Department of Nursing
Youth Rain Bow
Uttaranchal (P.G.) College Of Bio-Medical Sciences & Hospital

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