How Safe Is Your Tattoo Ink?

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.

But the FDA says it knows little about the tattoo inks in use today. Tattoo inks are considered cosmetics, and their color additives are subject to regulatory authority. But the agency says it hasn’t been using that authority “because of other public health priorities and a previous lack of evidence of safety concerns,” writes spokeswoman Lauren Sucher.

“The FDA cannot identify specific components of concern at this time,” Sucher writes. “The FDA is doing research to improve our knowledge of tattoo inks and the ingredients used in them.”

Sucher declined to say whether the FDA will be testing color additives in the future.

“There are no color additives approved for injection as decorative tattoos,” Sucher says. “When we become aware of a safety problem associated with a cosmetic, including a tattoo ink, we investigate and take action as appropriate.”

For some experts, that’s not good enough. “The bottom line is they’re not doing their job,” says Charles Zwerling, MD, chairman of the American Academy of Micropigmentation. “Tattoo ink has very, very minimal regulation. You don’t know if the bottle’s even sterile. In the European study, they found that 5% to 10% were infected with bacteria. That’s kind of scary.”

Zwerling, a North Carolina ophthalmologist who has studied and written about permanent makeup and tattoos for many years, says, “These newer pigments that are coming out have never been tested and, because they’re organic, have a much higher risk of complications … organic pigments can cause horrific allergic reactions. We know this in medicine. This is nothing new.”

Arisa Ortiz, MD, director of laser and cosmetic dermatology and assistant clinical professor of dermatology at the University of California, San Diego, says that red inks are particularly problematic. They can cause both allergic and inflammatory reactions. “It can happen with any color, but red is the most common culprit for allergic reactions,” she says.

In one case, a patient of hers developed severe swelling and fatigue after getting a lip line tattoo, a cosmetic procedure. Her condition did not improve until the tattoo was removed with lasers.

“Inks can cause systemic reactions when patients are allergic to whatever is in the tattoo, but there’s no way to test if you are allergic to a tattoo dye because the allergic reactions can occur many years later,” she says.

For many people who do react to tattoo inks, the most common symptoms are itching, irritation, and swelling, says Katy Burris, MD, a dermatologist at Northwell Health in Manhasset, NY.

“Usually your immune system eventually learns to accept it, so I wouldn’t say it would be permanent, but it would probably take months to resolve,” Burris says.

No link between tattoo inks and cancer has been established, but concern exists because carcinogens may be among the ingredients. Ortiz says she has seen skin cancers develop shortly after tattooing: “There have been many types of coincidental skin cancers reported, such as melanoma, basal cell carcinoma, and squamous cell carcinoma,” she says. “When it happens so quickly, just a couple weeks after, it makes you wonder.”

The authors of the European report consider it coincidental when skin tumors appear at tattoo sites, but they conclude that it’s a link that should be further studied.

What You Can Do

Should you avoid tattoos? Right now, too little is known to say for certain. Ortiz and Burris suggest that you make sure you really want a tattoo before you commit, and find a reputable place that keeps things clean and sterile.

Says Ortiz: “At this point, it’s hard to say if tattooing is safe. It’s buyer beware.”

They also point out that once you’ve got a tattoo, it’s with you for life, for better or worse.

“Don’t think that if you don’t like it, you can just laser it away,” Burris warns. “It’s quite expensive and quite painful to have a tattoo removed, and there are some colors that are just not that responsive to lasers.”

The FDA also provides these tips:

  • Consumers and tattoo artists should know where their materials come from and should be able to identify and contact the manufacturer in case side effects happen.
  • Be especially wary of products that don’t carry a brand or the name and place of business of the manufacturer or distributor.
  • If you get a tattoo, watch the area closely and talk to your doctor if you have any signs of a rash or think you might have a reaction or infection where you have a tattoo.

Consumers should select a tattoo artist who is licensed and practices sanitary methods.


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