Tattoos - Think before you Ink!

The Tattoo and now, Permanent Makeup has advanced since the days when such were only sported by sailors with a chain and anchor tattoo. Now, many people of all ages seek permanent makeup or body tattoos. It is really time, though, with Tattoos - think before you ink. This is a professional article covering many aspects to consider, before going under the needle.

The tattooing process is associated with significant health risks. The growing popularity of tattoos and permanent makeup is captivating the minds of an increasing number of individuals globally, and many fail to consider the potential health risks that could arise from introducing ink under the skin. Questions such as “What is the hygiene standard of the studio?”, “What inks are being used?”, “How is the equipment sterilised?”, “What are the potential health risks?”, and “What are the potential benefits (physical, emotional, and social) of such body modification practices?” often remain unanswered or unclear.

This highlights the importance of addressing this issue in terms of public health protection. It is crucial that individuals undergoing such procedures are well informed. At present, there is a lack of scientifically based information at the world level about the possible risks associated with body modifications (tattoos and permanent makeup). Given that these practices are most popular among adolescents and young adults, it is essential to provide all opportunities for informed decision-making through appropriate channels. Making an informed decision about where to go for tattoo is important to reduce the risks of tattoo ink allergy; going to a reputable artist who is knowledgeable about tattoo ink ingredients and has good knowledge of health and safety guidelines can help avoid the development of tattoo ink health risks.

Clinical observations and existing scientific literature clearly demonstrate that tattoo inks can have harmful effects on skin health, body functions, and cause complications over time. However, the impact of tattoo inks on the skin microbiome has not yet been investigated for toxicity levels. This underscores the need for future research exploring how physical and chemical interventions (tattooing and the inks used) may potentially disrupt the skin microbiome and track their long-term effects.

1. The penetration of needles disrupts the subcutaneous tissue layers and significantly impacts the skin microbiome, which plays a critical role in maintaining overall skin health. Often referred to as the “fourth layer of the skin,” the human skin microbiome encompasses diverse bacterial, fungal, and viral populations that interact closely with the epidermal and dermal layers. This microbiome is fundamental to skin physiology and immune defence.

   
   

2. The tattooing process inherently involves intentional skin injury, which may result in a range of complications such as superficial and deep infections, systemic inflammatory reactions, eczema, psoriasis, lichen planus, photodermatitis, and other conditions. The breach of the epidermal barrier during tattooing creates an entry point for microbial pathogens. These pathogens can lead to localized wound infections and, in some cases, systemic complications.

   
   

3. Allergic reactions are the most common complications associated with tattooing. Tattoo ink allergies may occur immediately or may be delayed, possibly occurring years after the individual has been tattooed. One frequently observed allergic manifestation is the formation of granulomas, localized inflammatory responses at the tattooed site. These granulomas are often confined to the tattooed area and can appear either as a single lesion covering the entire pigmented region or as multiple small nodules within the affected area. Red tattoo ink is most commonly implicated in granuloma formation. In some cases, contaminated tattoo ink can lead to atypical mycobacterial infections, resulting in painful, itchy, and inflamed pustules at the tattoo site.

   
   

4. One of the most common non-infectious complications of tattooing includes allergic reactions to the pigments or heavy metals (primarily chromium and nickel) present in tattoo inks. Additionally, some researchers have highlighted the presence of immuno-toxic, mutagenic, carcinogenic compounds and azo dyes in tattoo pigments as potential contributors to disease development. Consequently, the composition of tattoo inks is considered a primary source of health risks.

   
   

5. Historically, tattoo inks were derived from natural pigments, such as the Lawsonia Inermis plant extract, which was commonly used for tattooing decades ago. However, in modern tattooing, synthetic pigments dominate due to their cost-effectiveness and the ability to produce a broader range of colours.

   
   

   Presently, tattoo inks with unclear origins and content are widely used due to the lack of unified international standards for their production. These inks are complex mixtures containing over 100 compounds, including pigments, solvents, thickeners, preservatives, and impurities. Although manufacturers are required to provide detailed ingredient information, compliance is inconsistent, posing significant health risks

   
   

6. Tattoo artists and cosmeticians often purchase inks online or from local suppliers, which increases the likelihood of obtaining unregulated products. Compounding the issue is the widespread use of reusable containers for ink storage and transportation, raising concerns about contamination. Scientific studies have identified the presence of both aerobic and anaerobic bacteria in tattoo and permanent makeup inks stored under various conditions. Notably, even factory-sealed inks have been found to harbour anaerobic bacteria, which thrive in low-oxygen environments like the dermis, alongside aerobic bacteria. Contaminated inks are therefore a potential source of dual bacterial infections.

   
   

7. The lack of standardized test methods for analysing tattoo inks and assessing their safety remains a significant issue. To address these concerns, several Resolutions on Requirements and Criteria for the Safety of Tattoos and Permanent Makeup (ResAP2003 and ResAP2008) were introduced in Europe to regulate tattoo and permanent makeup safety. As of January 2022, the European Union (EU) has restricted over 4000 potentially hazardous substances from use in tattoo inks. These banned substances include specific pigments (notably all currently used green and blue colours) and solvents. Tighter EU restrictions also include lower thresholds for metallic impurities introduced through pigment manufacturing. These changes in the usability of specific chemicals and impurity thresholds pose tremendous challenges for the tattoo ink industry.

   
   

8. Another significant source of danger can be the lack of sufficient hygiene in the tattoo studio or salon and inadequate aftercare for injuries caused by non-medical professionals. Infections may develop during the wound healing process or as a result of improper treatment after the tattoo is applied. Aftercare for tattoos is essential for proper wound healing and to prevent infection and irritation. Pathogens can be introduced through contaminated instruments, ink, or the tattoo artist’s saliva. In some cases, tattoos may be placed on already infected skin. If proper disinfection is not performed, there is a high risk of transmitting bloodborne pathogens such as hepatitis and HIV.

Symptoms associated with skin infections include but are not limited to redness, itching, local swelling, and general discomfort. If the infection spreads, additional symptoms may appear. Proper hygiene and aftercare are crucial to prevent these infections and ensure the safe healing of the tattoo. The increasing concern is fuelled by the fact that most individuals do not seek prior information regarding the contents of tattoo inks, the associated health risks, aftercare procedures, and other critical factors. Tattoo aftercare instructions describe how to care for a tattoo. Unfortunately, tattoo artists often base their advice on personal experience rather than best practices in medical wound management. The diversity of recommendations in these instructions is currently unknown.

Furthermore, additional challenges arise due to the lack of a systematic training framework for tattoo artists that could enhance their knowledge of health-related issues.

NOT MY OWN WORK. Please see the full article, which has relevant supporting references and research on this subject:

Bakova, D.; Yaneva, A.; Harizanova, S.; Shopova, D.; Mihaylova, A.; Kasnakova, P.; Parahuleva, N.; Semerdzhieva, M.; Bakov, K.; Iliev, I. Monitoring Health Risks Associated with Body Modifications (Tattoos and Permanent Makeup): A Systematic Review. Cosmetics 2025, 12, 8. https://doi.org/10.3390/cosmetics12010008