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Glenn D. Braunstein, M.D.

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Tattoos: Inks Raise New Health Concerns About Age-Old Designs

Posted: 10/31/11 07:01 PM ET

While they've adorned skin since time immemorial as exotic emblems of beauty, rebellion or even criminality, if I start talking about tattoos, I can tell that lots of you of a certain age will react simply by sighing deeply or clucking your tongues in disapproval.

Sorry, Mom and Dad: we're long past the time when just sailors, soldiers, performers in burlesque acts or gangsters got inked. An estimated 45 million Americans have tattoos, and that number is quickly rising. Although the practice seemingly is becoming, along with piercings, ubiquitous among certain younger or youthful-minded folk across the country, the ink that tattoo artists inject remains unregulated. And while many potential risks are well known, others -- including long-term aesthetic and health concerns -- are less certain.

The focus of fears by most public health officials about body inking once concerned properly sterilized needles, spreading infections and unsanitary conditions at tattoo parlors. Scientists now are saying attention needs to be diverted to the very ink inside a tattoo needle.

As the market for tattoos has expanded wildly, so, too, have the types of materials employed, including UV inks that glow in the dark and permanent makeup. How toxic are their components, especially over the long run?

Not All Inks Are Equal

One recent study examined black ink, common in nearly every tattoo, as the skin designs often are dark or entirely black. Black tattoo inks are based on soot and iron oxide, they are unregulated and many contain hazardous chemicals that potentially can stay in the skin for a lifetime, absorb UV radiation and may affect skin integrity, researchers say.

Tattooing can require injections of substantial amounts of black ink, meaning large amounts of chemicals shot into and under the skin; many of these chemicals -- such as benzo(a)pyrene, a carcinogen found to cause skin cancer in animal tests -- are toxic, so some advocates have called for further scrutiny and oversight of tattoo inks. The study also suggests that the substances in black tattoo inks -- materials known as polycyclic aromatic hydrocarbons (PAHs) -- migrate into subjects' lymph nodes, which aid an individual's body in filtering out disease-causing organisms.

The FDA's National Center for Toxicological Research is investigating tattoo inks and whether their movement in the body has health consequences. Tattoo pigments are subject to U.S. Food and Drug Administration regulation, but the agency's website says that, "because of other public health priorities and a previous lack of evidence of safety concerns, FDA has not traditionally regulated tattoo inks or the pigments used in them."

While some tattoo inks contain pigments that are FDA-approved, others use materials more typically associated with automotive and industrial paints. A study in the Archives of Dermatology examined samples of 30 tattoo inks and identified aluminum, oxygen, titanium and carbon as the most common elements in them, with researchers concluding components vary vastly.

The FDA has received reports of adverse tattoo reactions, prompting investigators to further study the safety of inks, especially their long-term effects and how they interact with light or metabolize in the body.

The agency's experts say there's an absence of "systematic" studies and little information is available about how the pigments break down, though they note that tattoos tend to fade over time or when exposed to sunlight. They cite the color yellow, particularly when "Pigment Yellow 74" is involved in the tattoo ink, as susceptible to fading and disappearing

In the meantime, those wanting to get inked up should beware: regulators say those multiple reports of bad reactions they have received have come both immediately and even for years after from those getting tattoos. Again, some of the itching and inflammation appears to occur after tattooed folks expose themselves to the summer sun.

The well-known risks associated with tattoos include: infection, as unsterilized needles can carry infections including HIV-AIDS and hepatitis; allergies from various ink pigments; unwanted scar tissue, which can appear after a new tattoo, or after the removal of a tattoo; small knots or bumps known as granulomas, which may form around materials the body finds abnormal (in this case tattoo pigments).

In rare cases, some people experience temporary swelling or burning on their tattooed skin while undergoing magnetic resonance imaging (MRI). An unidentified pro football player suffered such an injury, prompting experts to publish a warning in a sports medicine journal about the prevalence among athletes of both tattoos and the need for MRI tests for injuries; they said caregivers should be wary of tattoos laden with black ink and pigments containing iron oxide, which may be more likely to react electromagnetically with the imagining technology and cause burns.

What Are They Thinking?

I know that those of us of a certain age may need to count to 10 and control our judgmental selves as more people around us display "tats." However, such personal decorations may have been as common in history as they are now, with archeological findings suggesting that as long as 5,000 years ago, Oetzi, a well-preserved "Iceman," had 57 tattoos on his body. In ancient Egypt, tattoos were familiar and in the South Pacific, they are widespread and marks of societal significance, while in Japan, as, frankly, in parts of Southern California, inking is a critical part of life in criminal gangs. There certainly are scholarly publications indicating that those with tattoos can evidence higher levels of mental disturbance or, among teenagers, a greater likelihood of maturity and adjustment issues than those without tattoos.

In Los Angeles in the 21st century, of course, tattoos need not mean anything more than do a pair of stylish shoes or a bright-colored jacket. But just because they're seemingly everywhere in our entertainment-industry driven metropolis doesn't mean that they won't pose quandaries, say for parents of young people who announce their desire for ink. Yes, they adorn people of all levels of education, income, race and color and women get half of the inkings these days. But pragmatism and the cosmetic surgery practitioners who are busy trying to erase skin designs testify that, no matter how fashionable, tattoos may be -- yes, Mom and Dad -- an adornment that must be carefully considered.

Unwanted Ink

If your tattoo's been around for years and your work or personal circumstances shift so that your impulse inking doesn't seem so hot, lasers offer a reliable removable tool. They're an improvement over what was available, including bleaches or wearing long-sleeves or other disguising clothes. The lasers break up the pigment in the tattoo with a high-intensity light beam. But if you're considering this process, research the options with care; choose a qualified dermatologist or health care professional to perform your tattoo removal. Inks respond differently to lasers, so some tattoos may require multiple procedures with different types of lasers to produce the results that will satisfy you. Black often is the easiest color to remove since it absorbs all laser wavelengths.

Most patients do not require anesthesia while undergoing tattoo removal, though a topical anesthesia or pain injections may be used. While laser tattoo removal is relatively safe and effective, infection and scarring still are risks. You also may experience hypo- or hyper-pigmentation, where patches of your skin may appear lighter or darker than surrounding areas.

So, considering the risks, potential costs, time and inconvenience, is it worthwhile to be the coolest person at the club, restaurant or party, with a body covered with all manner of colorful designs, maybe even skin art aglow in black light? That's not a doctor's call. I can say that customs and fashions, especially in a place like L.A., change faster than the blink of a strobe light. So, ask yourself: how are you likely to feel in 10 or 20 years about the mural that you want to cover your back? Asking yourself what your parents and (future) kids might think about it also may help you make a rational decision about body art.

 
 
 
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03:22 PM on 11/11/2011
While not every tattoo is ugly, I've never seen one make anyone look better than they already do.

And unfortunately even the most beautiful ones fade after a while into that dingy greenish gray. To me it's a maintenance issue like dying your hair. If you dye your hair and are just going to let the black roots start to show and slowly take over -- you're going to look worse for doing it only halfway.

One thing not mentioned in this article which I have read elsewhere -- tramp stamps are a bad idea for women who intend to have children, as spinal injections to relieve the pain of childbirth can take some of the inks from that area and put them into the spine with negative results. Friends who are nurses have laughed that many women come into the hospital determined to give birth without anesthetics, but once the real pain sets in, all bets are off and most of them have a "conversion" to painkillers right away. So ... maybe there's one place to think extra carefully about getting a tattoo.
12:07 AM on 11/10/2011
I am a makeup artist and I cover tattoos for weddings at least twice a month. I am finding that more often now brides are not proud to display their ink. Just a thought....... do you really want this design on your body forever????
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twoshoes4u
10:56 AM on 11/06/2011
How comfortable would one be if your surgeon or airline pilot was covered in tatooes with ear lobes hanging to his/her shoulders and maybe some dread locks for total coolness?
02:58 AM on 11/03/2011
It's amazin' the comments a woman gets for having/getting a tattoo... the ones that gets me the most are " At your age? " My comment to that one is "That way,they'll still look good when I die,not all faded and wrinkled! The other comment I get is"What do you want to spend all that money on a tattoo for? " Jeeezzzzz...am I worried about what YOU spend YOUR money on??? I'm a 57 year old woman getting ANOTHER tattoo next week .All my tattoos are meaningful to ME and I found an artist with an art degree, that can now make money doing what he went to school for, on HIS terms. His shop is beyond reproach as far as sanitation. He never forgets he's coming into contact with other people's blood. I must say,I will ask him about the inks composition next week,but I will still get the tattoo....because if the coffee I drink before I go that morning didn't kill me, or the red or yellow dyes from M&M's didn't kill me back in the day or I didn't die from riding in the back of a pick-up truck when I was a kid ...eventually,I WILL die of something..My tattoos will tell my story to the doctors and nurses..of my heritage,my footprints in time...and that I loved my Mom!! And I hope they smile....
12:38 PM on 11/06/2011
You go girl! :o)
02:47 AM on 11/03/2011
As a Tattoo artist this artical is just ignorant. Most reputable shops research all their equipment and inks. Sterilization practices are equal to or better than most hospitals. I take pride in the quality of service we provide at our shop, we walk through all steps with our clients, from designing, placement, colors, possible problems, including after care . maybe the writer here should have put as much research into the article. Get over it, Tattoo's are here to stay!
GOODDOC1
"civil war" is an oxymoron
04:43 AM on 11/03/2011
Please tell me that black ink is NOT made of soot and iron oxide like the article states.
03:27 PM on 11/11/2011
It's hard for layman to understand sometimes, but lay research is in no way equivalent to the research done by medical professionals.

It's great that you take pride in your job as an art professional. That's what I would want from a tattoo artist.

Re scolding the author, he takes pains to point out in more than one place that tattoos are here to stay and that they are nothing new -- as well as to be non-judgmental about it. If anything he comes across as less judgmental than your post was. Your being so defensive makes it hard to believe you could research anything you have any stake or interest in, even at the layman's level, with an even keel and open mind.
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pslcitizen
Intelligence is the ability to adapt to change.
02:28 AM on 11/03/2011
Interesting.. The cost of tattoos is what kept me from getting one.
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Peg Lyons
donor mom & organ donor advocate
01:22 AM on 11/03/2011
I am a 68-year old mother who had a tat drawn on my calf about 6 months ago in memory of my son, who died in a motorcycle accident. I have experienced none of the side effects described in the story, I'm happy to report, and have nothing but the hightest praise for my tattoo artist, who took great pains to be sure that not only were his needles freshly sterilized but also that the area on my calf was clean and had been swabbed with alcohol. I wonder about one step that was taken in the process--some of the ashes from my son's cremation urn were mixed into the black ink. I would hope that the extremely high heat of the crematory oven would destroy anything in the ash that could possibly be dangerous. Can anyone speak to that?
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02:09 AM on 11/03/2011
That is very strange...but YES, the cremation destroys anything that would be contagious. The heat is so intense it does destroy bacteria. I am sorry for the loss of your son.
12:43 PM on 11/06/2011
I think mixing your son's ashes in with the ink for the tattoo was a wonderful way to honor him and keep a small part of him alive in you. I mean that literally, becuase I know figuratively he will always live in your heart and memories. I want to say I am sorry for your loss. As a parent, I cannot imagine how great a pain it must be to lose a child.
When I die, I would like to have some of my ashes made into a diamond. They used to do it in Germany, but now there is a company in the US that makes artificial diamonds that way. I think they use 4 ounces and compressit in a mold under very high heat and pressure (that same way the earth makes diamonds) and 4 days later a beautiful real, albeit manmade, diamond is born. I think that it would be nice if my only child had it made into a necklace or something, or maybe a locket with the diamond in the cover.
12:28 AM on 11/03/2011
LOL, Mine are now55 to58 years old, Maybe having them is the key to my longievity, My only regret is that they havwe faded a bit with the years but at 75 I see no need to spend the money to redo them
12:48 PM on 11/06/2011
I am almost 60 and gravity has done it's magic on me. In a few years I should start to watch out I don't trip on my boobs. I think an appropriate tattoo would be a grandmother clock on my chest centered over my sternum, and then on each of my boobs I will have them tattoo a pendulum, so I can "swing them".. Then in the nursing home I end up in eventually I will make the staff laugh so hard they will all have to wear depends, just like the old folks that live there........lol.
11:22 PM on 11/02/2011
I feel it is very discriminatory what is written when someone choses to have a tatoo. These negative comments are very frustrating. Assuming that a person who has a tatoo is somehow ignorant, criminal, or a drug user is unfortunate. I am an educated adult and have one that is very meaningful to me. It is so common place, I don't believe they will go "out of style", but if they do, I will not regret mine. Of course, one must be careful when they chose what will forever be on their body, what is appropriate, and placement. No one seems to have lost respect for anyone I know in white collar careers who have tatoos (there are many more than most people realize).
12:51 PM on 11/06/2011
I agree 100%.
I have heard though, that if you ever do want a tat removed, that the laser can remove any color except white. The lasor "atomizes" the ink molecules into minute bits so they can be absorbed by your body and flushed out. Except the color white. They said lasers can't remove it. So if you get tattoos, tell them not to use that color as a highlight or anything, just in case.
11:11 PM on 11/02/2011
"The only difference between tattooed people and non tattooed people is that tattooed people don't care if you are not tattooed." Unknown

As others have stated...DO YOU HOMEWORK when it comes to who does them and where you get your tattoos done. Talk to others with tattoos and find out where they've gone. Go to the shops and speak to the artists, check out their work, look at their stations. A reputable place will not have a problem with you doing this. If they do, you don't want them touch you.
03:37 PM on 11/11/2011
No, getting a tattoo doesn't make you more open-minded or less exclusionary. Every trend -- in fashion, politics, religion, culture -- inevitably makes outsiders of those who haven't chosen to embrace it(or have never even heard of it). And that's the way some -- if not many -- who have embraced those trends will inevitably come to look upon those who do not. Many groups are indeed defined more by who and what they leave out than who and what they leave in.

Having a tattoo doesn't change human nature. It's ink, not magic.

In short, there's a reason that author is unknown ...
10:45 PM on 11/02/2011
The reality is that tattoo ink has always been an issue-primarily those tattoos done by unprofessional people who do not understand the ingredients in their products and buy cheap supplies from overseas or Ebay. It is important that someone interested in getting a tattoo really talk to the artist, find out what they use and do your research. A true professional artist will be more than happy to tell where they purchase their materials and should be knowledgable of possible reactions with certain colors etc...if they don't know then I would simply not go, your health is too important to risk.

In the defense of people with ink...They get tattoos because they feel it is important to them to reflect their thoughts, beliefs or share memories...we have a great varied clientele that come from all over and you would be suprised-most are professional business people looking to remember a special person. Do we get people that just pick out something dumb? YES---but we usually say "we are booked, give us a call in a month" and 99% of the time they take it to think before they ink, because later on I will just have to cover it!
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crp767
10:32 PM on 11/02/2011
Never lliked tattoos asked my girls never to get one and they never did, I know I can't tell them what to do, and if they did nothing I could do, but they never did.
10:07 PM on 11/02/2011
I TLDRed this article for the most part.
Just research the place you're getting it done, come in and watch what they do, and make sure they are clean. Not that hard.
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raal246
09:40 PM on 11/02/2011
The only tattoos I've liked and admired have been in Japanese ladiesa. They are works of art, well placed, pleasant and not obscene.
09:35 PM on 11/02/2011
One has to think ahead before getting a tattoo. I have a friend who is a total fashion victim and one starry night he decided the waistband of his undershorts, which said "CALVIN KLEIN" in large letters, would make a dandy tattoo right around his waistline. [I can't help but think that a quantity of alcohol factored into this decision.] Of course in the last five years he has gained about 100 pounds so what once said "CALVIN KLEIN" reads more like "CCCCCAAAAAALLLLLLVVVIIIIINNNNNNNNNN KKKKKLLLLLLLEEEEEEEEIIIIIIIIINNNNNN". The moral of this story: never tattoo any body part that might become larger. The only exception is the male hoo-hoo and if you want to give that go, my prayers are with you.
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a2948
12:22 AM on 11/03/2011
What part of the body do you not tattoo, because it will get old and wrinkled?