Medical Complications of Tattoos: A Comprehensive Review

Abstract

Tattoos are defined as the introduction of exogenous pigments into the dermis in order to produce a permanent design. This process may occur unintentional or may be deliberately administered for cosmetic or medical reasons. Tattoos have been around for over 5000 years and over time have evolved to represent a common cosmetic practice worldwide. Currently, adverse reactions are relatively rare and generally unpredictable and predominantly include immune-mediated reactions and skin infections. Along with better healthcare standards and more stringent public health mandates such as the provision of disposable needles, major infectious complications related to hepatitis and human retroviral infections have decreased significantly. When they do occur, skin infections are most frequently associated with Staphylococcus aureus or Streptococcus pyogenes. The aim of this study is to review the types and rates of medical complications of permanent tattoos. PubMed search and search dates were open ended. Acute local inflammation is the most common complication, but infections, allergic contact dermatitis, and other inflammatory or immune responses that are not well-characterized may occur. As many patients with immune reactions to tattoos do not react on skin or patch testing, it is postulated that the antigens contained in dyes or pigments are such small molecules that they need to be haptenized in order to become immunogenic. Red ink is associated more frequently with long-term reactions, including granulomatous and pseudolymphomatous phenomena or morphea-like lesions and vasculitis. Exacerbation of preexisting psoriasis, atopic dermatitis, and pyoderma gangrenosum may occur after tattooing. There is no well-defined association between cancer and tattoos. The treatment of tattoo-related complications may include local destructive measures (cryotherapy, electro-surgery, dermabrasion, chemical destruction, ablative laser destruction), surgical excision, and thermolysis of the pigment using Q-switched laser therapy.

Women and Tattoos: Fashion, Meaning, and Implications for Health

“…Tattooing, a type of body art that marks human skin with indelible designs, is growing in popularity . Derived from the Tahitian ta‐tau , meaning results of tapping , tattoos occur when exogenous pigment is introduced into the dermis by piercing the skin with a needle or other sharp object laden with pigment, until an image is created (Figure ) . Most often, this process is deliberate, although accidental tattoos may result from blast or road surface trauma .…”

“…Sources: Bandodkar et al, Ho and Goh, Islam et al, Juhas and English, Kluger and De Cupyer, Naga and Alster, US Food and Drug Administration, Ortiz and Alster, Para Phenylenediamine Manufacturer, Sisti et al …”

“…Although infectious complications are declining with regulation and professionalization of tattoo practice, concerns about allergic reactions and long‐term potential for harm from unregulated tattoo ink ingredients are growing . When complications of tattooing occur, individuals most frequently return to their tattoo artist for minor problems or visit emergency rooms for more compelling issues .…”

Oral bullous lichenoid tattoo reaction against red dyes on the lips

“…Meanwhile, tattoo reaction is nothing new in dermatology departments and worthy of our vigilance. Tattooing can be responsible for delayed tattoo reaction, for example lichenoid reaction mediated by foreign bodies, mainly red dyes implanted in the dermis.…”

Using India Ink as a Sensor for Oximetry: Evidence of its Safety as a Medical Device

“…Although there are rare serious complications [42], the overwhelming majority of problems, if any, were not serious, i.e., would not be reportable adverse events in a clinical study. (Of note, the most common ‘problems’ associated with cosmetic tattoos, infection due to poor hygienic practices during or following the tattooing, ‘regret’ and desire to remove the tattoo, are not associated with a pigment type per se.…”