Risks Related to Tattoos. How to Manage Them?

Tattoos are a form of body art that is increasing in popularity, especially among young adults. People use tattoos to express themselves in unique and creative ways and to set themselves apart from others. Before getting a tattoo, it is vital to understand the risks, some of which are serious and life-threatening.

Key takeaways:
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    Tattoos are increasing in popularity among young adults.
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    There are several risks associated with tattoos, such as infections, allergic reactions, keloid scars, masking cancer diagnosis, and fatal bloodborne diseases.
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    You must do your homework and investigate the tattoo shop to ensure they are licensed and clean.
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    Follow all post-op instructions to prevent infection.
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    Ask your doctor if you are healthy enough for a tattoo.

What is a tattoo?

Tattoos have been around since the 1800s and have recently become more popular. The word "tattoo" comes from the Tahitian word "tattau," which means, "to mark." Essentially, tattoos are ways to permanently mark the skin with the artwork.

How is a tattoo done?

A tattoo involves tiny needles injecting dye into the dermis (the middle layer of the skin). The needles are attached to a hand-held electric device, which punctures the skin repeatedly. The punctures are deep enough to cause bleeding and discomfort.

What are the risks of tattoos?

Tattoos carry many serious risks and are not as benign as most people think. It is critical to review the risks before getting a tattoo.

Infection: Infections are the most common risks of tattoos. They come from contaminated needles or inks, improper disinfection of the skin before the procedure, and inadequate care of the tattoo after the procedure. Various microorganisms have been implicated, such as bacteria (Staph or Strep), viruses (Herpes or warts), fungi (Candida), and mycobacteria (leprosy). Treatment consists of doctor-prescribed antimicrobial agents.

Allergic reactions: Many different colored dyes cause allergic reactions, such as red (mercury), yellow (cadmium), blue (cobalt), and green (dichromate). Other culprits include ink contaminants, such as nickel or lead. Allergic reactions may present immediately or years later. Your doctor may prescribe topical, injectable or oral steroids to treat these reactions.

Tumors: Various types of tumors, both benign and malignant, have been caused by tattoos. There are also known carcinogens in some of the tattoo inks.

  • Benign: Seborrheic keratoses, cysts, and milia.
  • Malignant: Basal cell carcinoma, keratoacanthoma, squamous cell carcinoma, melanoma, and dermatofibrosarcoma protuberans. These require surgery and possibly radiation or chemotherapy to cure.

Koebnerization: Several dermatologic conditions, such as psoriasis, lichen planus, and vitiligo, are characterized by the Koebner phenomenon, which causes the condition to appear in areas of trauma, such as a tattoo. Doctors may prescribe steroids to treat these.

Reactivation of infections: The trauma of tattoos has triggered the reactivation of certain chronic viral infections, such as herpes simplex (cold sores and genital herpes) and herpes zoster (shingles). These will require doctor-prescribed antiviral medications.

Exacerbations of medical conditions: Tattoos have caused exacerbation of dermatologic conditions, such as lupus and pyoderma gangrenosum. These require a doctor's care to treat.

Bloodborne diseases: Contaminated needles and inks can transmit chronic viral infections to the patient, such as HIV and hepatitis B and C. These viral infections can be fatal.

Granulomas: Granulomas are inflammatory bumps that form around foreign bodies like tattoo ink. Prescription steroids can help treat these.

Keloids: Keloids are tender bumpy scars that can appear after any trauma to the skin, such as tattoos. These can be difficult to treat. Doctors can treat these with steroids or radiation.

MRI complications: MRI machines have caused redness, swelling, and burns at tattoo sites on the body. The MRI interacts with the metallic compounds in the tattoos, such as iron in red ink.

Alter ability to sweat: Tattoos have been linked to a decreased ability to sweat from the tattooed skin. This is not a problem with small tattoos but can be with large ones. If you cannot adequately sweat, you cannot cool your body down.

Hide skin cancers: Tattoos can obscure the identification of skin cancers, especially if they are black tattoos. The delay in the diagnosis of some skin cancers, like melanoma, can be fatal.

Pain, swelling, redness, and bruising: These are common and transient risks of tattoos. These resolve without treatment.

The dye travels to other body parts: Tattoo ink can get into the bloodstream or lymphatic system and travel to other body parts, such as the brain and lymph nodes. There have been reports of brain and nerve damage caused by ink.

How can I prevent tattoo risks?

You cannot prevent all the risks of tattoos mentioned above, but you can lessen the risk of infection. Be sure to do your homework and check out the tattoo shop before you get one. Make sure they are licensed and have not had any violations from the Department of Health.

Go to the shop and ask questions about their infection control practices, including:

  • Who performs the tattoos, and what is their training?
  • Are they licensed?
  • Do they wear fresh, clean gloves with each person?
  • Do they autoclave their instruments or use fresh disposable ones for each person?
  • Are the inks sterile in single-use containers?
  • What do they use to sterilize the skin?
  • What do they use to sanitize the work area?
  • Do you see a sharps container to dispose of used needles?

You also must follow proper post-op care of your tattoo to prevent infection, including:

  • Be sure to keep the area clean and moisturized as directed.
  • Do not expose your new tattoo to the sun for several weeks.
  • Do not wear tight clothing that rubs the tattoo.
  • Do not pick, rub, or scrub at it.
  • Do not swim in oceans, pools, hot tubs, lakes, and rivers until the tattoo has healed.

Who should not get a tattoo?

Always consult your doctor before getting a tattoo to make sure you are healthy enough for it. Some patients may be advised against getting a tattoo if they have particular health problems, such as:

  • Diabetes
  • Immunosuppression
  • Medications, such as prednisone, blood thinners, or transplant medicines
  • Keloids
  • Severe allergies
  • Pregnant or nursing
  • Bleeding disorders
  • Chronic skin diseases, like severe eczema
  • Numerous moles in the area
  • Heart conditions

Tattoos are permanent pieces of artwork on your skin. Before you get one, you must understand all the possible risks and make sure you really want one because they are difficult to remove. If you have any questions, always consult your doctor.


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