Tattoos: How Cool Are They Really?
When people hear the word danger, what would people think of first? For some, they might think of a feral wolf who hasn’t had anything to eat alongside her starving cubs attacking them, a hurricane ripping up a shoreline, or even the declaration of a serial killer on the loose in a neighborhood. For others, perhaps it’s not so dramatic — the danger of failure in that new promotion, or the danger of asking that charming person who lives across the street on a peaceful dinner date. Regardless of the magnitude of the danger itself, it is obvious that everyone does face at least some kind of danger throughout their lives. When thinking about our loved ones, the fear of danger might multiply, especially when these special individuals could be the cause of our own vulnerability. It makes sense then that we should strive to reduce the dangers that we might be exposed to on a daily basis, and it is important to make distinctions on what is actually safe in our world so that we can enjoy those things wholeheartedly. Thus, it is equally important to identify practices and things that could be harmful to our health — and it is often the things we take for granted that we should take a second look upon.
Particular popular with youth today in the Western world as a form of body art, tattoos are a common sight and are placed in every spot imaginable — some people even have tattoos covering their entire body, or on their tongue!
The creative boundaries of tattoos are endless and are an important part of identity for many people. Typically, people might decide to get tattoos of important occasions, people, or any other kind of personal preference. Although the Western world has seen large increases of tattoos in recent years, tattooing is also very prevalent all across the world, with many cultures incorporating them in their traditions and customs. Tattoos have been around for a long time — history suggests thousands of years dating back to groups such as the Egyptians, Greeks, Romans, Chinese, and others. Religious purposes, protective wards, and symbols of status are some of the ways in which tattoos may have been used the past. Personally, I think it’s remarkable that the practice of tattoos are so widespread then and today.
Alright — sign me up, seems pretty cool, how does it work?
Traditionally, tattoos are usually created by injecting colored pigments and other chemicals into the skin. Of course, many methodologies and variants of tattoos exist and the chemicals used for tattoos differ across cultural contexts making it difficult to go in –depth into analyzing the full effects of tattooing on human health. Its effects on young people are even less poorly understood compared to adults, and its effects on more vulnerable populations such as women with child or senior citizens aren’t well documents either. Considering that it is possible that additional negative effects can be present that affect regions of the body that are particularly potent to areas of the body that have degraded, or haven’t formed fully in the case of fetuses. Some researchers indicate that the possible adverse health effects of tattoos since the occurrence of tattoo-associated conditions have been on the rise, but unfortunately, no single aspect of tattoos have been 100% proven to be a danger to health (Engel et al., 2008). However, there is much evidence to suggest that there are actually a lot of harmful chemicals and procedural risks involved with tattooing that could induce allergic reactions, infections, cancers, or other kinds of diseases. It may be a little disappointing to find out that such a culturally important or sentimental practice might be more dangerous than people normally think, but that just means we must try even harder to make sure they are safe ways for the world to express its creativity through tattoos.
So, what exactly are in tattoos that could make them a risk?
If you live in an urban area, there is bound to be at least one tattoo parlor nearby that can transform your body into a work of art. Although many tattoo parlors are operated by professionals who want nothing more than to create their best work of art in the safest way possible, the bad news is that compared to other kinds of cosmetics, tattoos are not regulated quite as stringently. Thus, it is possible that the artist may not be as informed on all of the chemical properties that goes into tattoo ink, as well as the customer. Studies have shown that azo compounds and polycyclic compounds are commonly used compounds to make tattoos. The color black is one of the most popular. Apparently much of the black coloring is derived from carbon based products to make things like paint, lacquer, and rubber for industrial purposes, and in 1995, the International Agency for Research on Cancer said that carbon-based black is a suspect for cancer. (Vasold et.al, 2008). The actual tattoo coloring itself is under skin about 1–3 mm inside, with the aforementioned azo pigments being insoluble, concentrating in tiny particles. The problem is how these particles can move throughout the body, and evidence indicates that radiation affects the particles’ behavior. We can be exposed to radiation in many ways, from getting an x-ray taken to a nice tanning session by the beach. Although the extent of the exposure can vary considerably among forms, it can be difficult to avoid exposure on a daily basis. Tattoo removal processes also modify the particles’ arrangement and shape inside the body. Lymph nodes have been shown to be a gathering site for tattoo colorants, and this important because colorants may move into areas of the body that have an adverse reaction, or in the case of expecting mothers, possibly deposit in their babies. Some compounds found inside tattoo ink are 2.5-dichloroaniline, 1–4 dichloro-benzene, 2-methyl-5-nitroaniline, and 4-nitrotoluene that have already been associated with cancer. As mentioned earlier, it is difficult to be free of radiation exposure because of how pervasive it is. As a constant form of radiation, sunlight has also been shown to break down tattoo ink particles, and scientists have indicated possible danger in how its breakdown could combine with other chemicals in the body (Vasold et al., 2008). Additional evidence reflects a general lack of knowledge about the finer chemical properties of tattoo chemicals since there is such a large variety of tattoo ink. One study found that as much as 20% of the substances found in the coloring fall under the impure category that is paired up with similar substances in the study, but even so, it is difficult to find any conclusive evidence linking health problems with impurities (Engel et al., 2008). Other kinds of publications have shown that a kind of chemical structure known as aromatic amines linked with cancer can also develop through the decomposition of tattoo ink. In 2016, scientists Sabbioni and Hauri were able to estimate a risk of cancer from looking at the amount of aromatic amines that were released. A tattoo using pigment yellow 14 400cm2 in area is estimated to have about 4 ½ bladder cancer occurrences for every 10,000 people. These statistics are especially troubling if you compare them with other cancer cases — lung cancer that develops from smoking estimates at around 420 cases every 10,000 people, and 6 people out of 10,000 are estimated to get colon cancer from eating red meat (Sabbioni & Hauri, 2016).
Apart from the possible cancer risk, there are also risks for infection and inflammation associated with tattoos — some examples are endocarditis and hepatitis (Juhas & English, 2013). Unfortunately, no one knows for sure what individually causes these issues — it could be from contaminated equipment, unclean practices by tattoo artists, other kind of bacteria or virus going around in the environment, or possibly a combination of all these things. (Behrens, Rauner & Caulkins, 2008). Additionally, malpractices of post tattoo care and lifestyle choices may contribute to problems as well. If a person doesn’t take care of the affected area well, or have other pre-existing conditions due to smoking for example, they can also encourage negative effects that have nothing to do with the artists’ practice and create an environment that more easily allows for bacteria or virus to enter. There have indeed been some studies of Mycobacterium haemophilum diagnosis in tattoo recipients, with the actual cause of these infections being unclear. Water has been scrutinized as being particularly suspicious in many cases because while some tattoo parlors use tap water, others don’t, which means inconsistencies in tattoo ink dilution and high variability in how water is used (Kay et. al, 2011). Another study elaborates on transfusion-related diseases related to tattoos such as Hepatitis B, Hepatitis C, Human Immunodeficiency Virus, Syphilis, Chagas Disease, and others. Nishioka and Gyorkos found that sterilization of the tattoo procedure is important when dealing with conditions such as Hepatitis B and C, but for other conditions, it has been much more difficult to find out for sure how risky it is (Nishioka & Gyorkos, 2001). Allergic symptoms such as itching and other kinds of discomfort are also associated with tattoos. Issues with red coloring and similar colors seem to be more prevalent than others, and some scientists speculate that light exposure could affect the chemicals in the skin to form allergens. One issue however, is that allergic symptoms could be caused by many different factors working together at once so it has been difficult to pinpoint tattoos as the specific agent responsible, particularly when people might not notice any symptoms until sometime has passed (Serup & Hutton, 2014). Another concern about tattoos that is more specific towards childbearing moms is that tattoos can disturb epidural injection. Health professionals can use epidurals for anesthesia under labor or other surgeries, and some scientists have concerns that tattoos can obscure the skin when determining the optimal placement, or that tattoos can have adverse effects when needle coring occurs. Needle coring happens when a select area of tissue is pushed deeper into the body, meaning that it is possible tattoo pigments to be lodged in the body further than normal skin levels (Welliver et.al, 2010).
What’s the verdict and what can be done about it?
From all the different evidence that has been looked at thus far, one thing does seem clear — the colorful decorations that adorn so many bodies include more than meets the eye. Even though many scientists and experts have tried to determine for sure whether tattoos are indeed dangerous and to what degree, it’s been very difficult to do so. One factor that plays into this is the relative lack of knowledge regarding the chemical substances found in tattoos, suggesting a need for a more comprehensive knowledge of the chemical compounds inside tattoos (Vasold et al., 2008). A more in-depth knowledge about the chemical structure of tattoos will reinforce existing theories about tattoos as negative substances to human health. Also, in the cases mentioned earlier dealing with bacterial infection, one mitigation strategy that is also commonly discussed is cleanliness and sanitation held to a particular standard. For example in Washington State, tattoo parlors are not required to use sterile water for ink dilution, which means it introduces a lot of room for tattoo-related incidents to occur. One group of scientists recommended a higher standard of regulation and for health practitioners to refer to scientific writing as only preliminary information until better standards are enforced (Kay et. al, 2011). That being said, individual standards of cleanliness and sanitization are important as well. Keeping the affected area clean through soap and water, using moisturizer, avoiding sun exposure, swimming, and clothing that chafes are all recommendations for better results. Being patient helps too, to allow the skin to heal (Mayo Clinic, 2018). Additionally, scientists cite the importance of safety and training in the tattoo industry because so many different kinds of tattoos and levels of mastery exist all the way from DIY procedures to age-old customs to professional artists (Nishioka & Gyorkos, 2001). This is to help address the large variety of people getting tattoos and any lasting effects that result from it. Unfortunately, the effects of tattoo chemicals in conjunction with other hazardous substances floating around in our homes, cities, and workplaces are very poorly documented, and these combination of adverse effects may actually be the real threat. Factoring in the higher vulnerability that certain people have including pregnant women and children, the dangers of neurodevelopmental, cognitive, and other conditions are definitely real, and any measures to increase sterilization, sanitation, safe practices and research on these subjects should be taken. Diseases such as autism and Parkinson’s disease still haven’t found a definitive cause, and who is to say that tattoo chemicals are not able to contribute to them? In the case of pregnant mothers and fetuses, the transportation of nutrients from the mother to the fetus through the placenta is one of the primary ways that the fetus is exposed to the outside world. Until we know more about the kinds of chemicals that are able to pass through the placental barrier and the kinds of effects they might have, we should continue to carefully monitor tattoo chemicals.
An extensive amount of research will be needed, but even more than that is a concrete reassessment of present and future legislation of tattoo accessibility and practices. Without the backing of a solid wall of legislation that redefines safer handling of tattoo products as soon as possible, it will be difficult to emphasize a more complete risk assessment procedure as well as regulatory practices. Some examples of heightened regulation would be to encourage transparency in the tattoo industry about the kind of chemicals that are in use not only to professionals, but to the public. This could pave the way for transparency in future products such as cosmetics that see similar conflicts with increasing visibility in the materials they use. Another example would be to have the tattoo industry go through much more rigorous testing under the Food and Drug Administration, and other non-governmental organizations to at least provide a better measure of safety. This information would go a long way for medical professionals to implement sounder medical practices and encourage greater awareness to the public as well.
In the same vein, more information should be available to the public for alternatives to tattoos, or at least more opportunities for the general public to get accurate, reliable information for reducing exposure to unwanted health hazards. There are quite a lot of different variants of tattoos that can vary widely from culture to culture, but also because of differences in the kinds of materials that are used. Henna tattoos that are prepared from a dye derived from the plant Lawsonia inermis are only one kind of tattoo for example, and there are an increasing number of organizations offering information about much more transparently-sourced tattoos, or tattoos that are derived from different materials. Many tattoos are sourced from bone char, which is made from animal bones, gelatin, which is commonly made from connective tissues in animals, and glycerin, which can come from animal fats. As a result, individuals who wish to avoid animal — based products or are looking to choose more organically sourced tattoos can investigate vegan tattoo products such as Kuro Sumi inks or Skin Candy tattoo inks. One of the most important takeaways for optimal health and safety though is to be communicative with your tattoo artist, wherever you get it from. Don’t be scared to ask questions about how the materials are sourced, or what the specifics of the tattooing process will be because in the end, each person should have a right to their own health. Tattoos are indeed such a great way of expressing ourselves through art in a way that’s meaningful for many people all across the world, regardless of how long the tattoo is to last. We can often take tattoos for granted, getting caught up in the designs, the cost, or other value, but the truth of the matter is that tattoos can be a lot more than what is above the skin. If we are to be responsible consumers, parents, and citizens, we must take our own health into a higher standard, and just take that little extra effort to ensure that tattoos can remain an awesome part of our identity.
References
Behrens, D., Rauner, M., & Caulkins, J. (2008). Modelling the spread of hepatitis C via commercial tattoo parlours: implications for public health interventions. OR Spectrum, 30(2), 269–288. https://doi.org/10.1007/s00291-007-0090-7
de Groot, A. C. (2013). Side-effects of henna and semi-permanent “black henna” tattoos: a full review. Contact Dermatitis (01051873), 69(1), 1–25. https://doi.org/10.1111/cod.12074
Engel, E., Santarelli, F., Vasold, R., Maisch, T., Ulrich, H., Prantl, L., … Bäumler, W. (2008). Modern tattoos cause high concentrations of hazardous pigments in skin. Contact Dermatitis (01051873), 58(4), 228–233. https://doi.org/10.1111/j.1600-0536.2007.01301.x
Juhas, E., & English, J. C. (2013). Tattoo-Associated Complications. Journal of Pediatric & Adolescent Gynecology, 26(2), 125–129. https://doi.org/10.1016/j.jpag.2012.08.005
Kay, M. K., Perti, T. R., & Duchin, J. S. (2011). Tattoo-associated Mycobacterium haemophilum Skin Infection in Immunocompetent Adult, 2009. Emerging Infectious Diseases, 17(9), 1734–1736.
Nishioka, S. de A., & Gyorkos, T. W. (2001). Tattoos as risk factors for transfusion-transmitted diseases. International Journal of Infectious Diseases, 5(1), 27–34. https://doi.org/10.1016/S1201-9712(01)90045-1
Sabbioni, G., & Hauri, U. (2016). Carcinogenic Tattoos?. Epidemiology, Biostatistics and Public Health, 13(4).
Serup, J., & Hutton Carlsen, K. (2014). Patch test study of 90 patients with tattoo reactions: Negative outcome of allergy patch test to baseline batteries and culprit inks suggests allergen(s) are generated in the skin through haptenization. Contact Dermatitis (01051873), 71(5), 255–263. https://doi.org/10.1111/cod.12271
Vasold, R., Engel, E., König, B., Landthaler, M., & Bäumler, W. (2008). Health risks of tattoo colors. Analytical & Bioanalytical Chemistry, 391(1), 9–13. https://doi.org/10.1007/s00216-008-1978-z
Vasold, R., Naarmann, N., Ulrich, H., Fischer, D., König, B., Landthaler, M., & Bäumler, W. (2004). Tattoo Pigments are Cleaved by Laser Light — The Chemical Analysis In Vitro Provide Evidence for Hazardous Compounds. Photochemistry and Photobiology, 80(2), 185–190. https://doi.org/10.1562/2004-05-17-RA-170.1
Welliver, D., Welliver, M., Carroll, T., & James, P. (2010). Lumbar Epidural Catheter Placement in the Presence of Low Back Tattoos: A Review of the Safety Concerns. AANA Journal, 78(3), 197–201.
