In the West, the art of permanently marking your skin with tattoos is more popular than ever. In a 2015 study, it was estimated that 3 in 10 (or 29%) people in the U.S. have at least one tattoo and the numbers are growing.

A lot of people who get and give tattoos understand the dangers of catching a communicable disease from contaminated tattoo guns, needles, and ink. But not many people are aware that you can also become seriously ill from toxic mold (fungus), bacteria and can even develop a lifelong and often fatal disease like cancer.

The U.S. Food and Drug Administration (FDA) is warning the public that people are developing serious infections from contaminated ink, as well as adverse reactions to the inks themselves. The agency says that it has received hundreds of adverse event reports involving tattoos: 363 from 2004-2016.

In an FDA press release, Dr. Linda Katz, M.D., M.P.H., director of FDA’s Office of Cosmetics and Colors said that people 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.”

Dr. Katz says, “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.”

She stated that the symptoms of an infected tattoo may include a rash, redness, bumps, fever, or serious complications. 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 quick search of the internet reveals hundreds of gory images of infected tattoos. For example, the NY Daily had reported on the story of a Harlem woman who developed a serious infection after getting a tattoo from a local shop and then sued them for pain and damages.

Some of these images of tattoos gone bad look like a moldy piece of eaten up fruit.

In 2012, a health scare involving tainted tattoo ink of four different brands of grey or black ink were identified by government authorities possibly to contain a bacteria that was able to enter the ink during the manufacturing process, contaminated ingredients or unsafe practices may be used, or when the tattoo artist diluted the ink with nonsterile water.
Many cases were later identified to be infected with different bacteria, Mycobacterium abscessus, where left untreated can cause lung disease, joint infection, eye problems and other organ infections.(2)

A 2016 study by the European Chemicals Agency (ECHA) found that toxic ink could cause skin problems that last for years, increasing the risk of cancer. The most toxic inks were red, green, black, and blue inks with red being the most toxic cause of allergic reactions. The ECHA said that the most severe concerns are allergies caused by the substances in the inks and possible carcinogenic, mutagenic or reproductive toxic effects.

A 2015 study titled, Complications of Tattoos and Tattoo Removal had detailed how a superficial and deep local infections, systemic infections, allergic reactions, photodermatitis, granulomatous reactions and lichenoid reactions may occur from tattooing. Skin diseases localised on the tattooed area, such as eczema, psoriasis, lichen planus, and morphea can be occasionally seen.

The researchers said viral diseases can result from tattoos such as the transmission of hepatitis B and C virus, human immunodeficiency virus (HIV), human papillomavirus (HPV), molluscum contagiosum virus and herpes simplex virus (HSV) infection has been described.

Bacterial infections related to tattooing comprise infection by Streptococcus pyogenes leading to impetigo, erysipelas and even septicaemia, Staphylococcus aureus causing the rare toxic shock syndrome, skin and soft tissue infections caused by community-acquired methicillin-resistant S. aureus (CA-MRSA), treponema pallidum causing syphilis, infections with atypical mycobacteria and even Mycobacterium leprae which causes leprosy. A study of 31 female patients with leprosy lesions starting over tattoo marks was reported from a leprosy endemic area from India.

Fungal infections can also occur from tattooing. The researchers said that a case of zygomycosis was observed after tattooing. Severe systemic mycoses can be transmitted rarely by tattooing. A case of Candida endophthalmitis in a 40-year-old asplenic man after tattooing has been described.

Last but not least, cancer can develop after tattooing. Malignant lesions complicating tattoos include basal cell carcinoma, keratoacanthoma, squamous cell carcinoma, malignant melanoma and dermatofibrosarcoma protuberans. In one case, a primary non-Hodgkin lymphoma arose in a tattoo. The researchers said numerous factors could be involved, including intradermal injection of potentially carcinogenic substances (benzapyrene in black tattoo ink), exposure to UV radiation and genetic factors.

The study mentioned three potential origins of infections after tattooing.

1. Firstly, use of contaminated tattoo ink.

2. Secondly, inadequate disinfection of the skin area to be tattooed because of which resident skin bacteria can enter the skin during the tattooing process.

3. Thirdly, during the healing process of the injured tissue after tattooing, patients often develop pruritus and burning. This increases the risk of superinfection of the tattooed skin area due to scratching and therefore inoculating microorganisms.(3)

SOURCES:

1. FDA

2. CBS News

3. Complications of Tattoos and Tattoo Removal: Stop and Think Before you ink