Thinking of a Tattoo? Learn About the Rising Concerns First
Over the past 20 years, tattoos have become increasingly popular with an estimated prevalence of 25% among the 18-50 year-old age group. Over 80 million people in the western world are estimated to decorate their bodies with tattoos and 50% of these tattoos belong to women.
During the tattooing process, the needles penetrate the outermost layer of the skin (epidermis) into the skin layer below called the dermis. Pigment is deposited along the entire needle tract. Only the pigment that is deposited in the dermis will permanently remain in the skin. After the tattoo has healed, the pigment is consumed by dermal white cells called macrophages and then carried to regional lymphatics and lymph nodes. The color of the tattoo comes from the pigment that remains in the loose fibrous connective tissue of the dermis.
The Food and Drug Administration (FDA) has not approved any tattoo pigments for human use. In fact, the majority of tattoo ink is industrial-grade dye intended for use as printer ink or automobile paint. Although tattoo ink is not FDA approved for human injection, state and local health authorities regulate the operation and sanitation practices of tattoo parlors.
Tattoo pigments are composed of inorganic and synthetic organic pigments. Mineral sources such as metal oxides, salts, and minerals comprise inorganic tattoo pigments. Synthetic organic pigments are used to create brighter, more diverse colors and contain synthesized chemical compounds such as anthraquinone (yellow), phthalocyanine (blue, green), azo (mostly yellow, orange, red, magenta, purple), and indigoid (violet–blue). In addition to pigment, tattoo inks may contain diluents and preservatives (glycerin or ethanol) to facilitate the dyeing process in the skin. Also of note is the awareness of the wide use of nanoparticles [(NP) particles with diameters < 100 nm] in tattoo ink. Except for the white pigments the vast majority of tattoo inks contain signiﬁcant amounts of NPs. The commonly used black pigments are almost pure NPs. Within black pigments, up to 94 to 99% of the volume of the material is made up of particles with diameters < 100 nm. In general, carbon blacks, and are available in a wide spectrum of particle sizes, ranging from 5 to 500 nm. Carbon black is common in many applications and has been a ﬁeld of interest in nanotoxicology studies. In addition to being one of the most common dyes used for tattoos, carbon black is a component of rubber, plastics, inks and paints. While previous epidemiological studies have not revealed a clear link between occupational exposure to carbon black and cancer frequency in humans, animal studies show an increased risk of damage with long term exposure due to reactive oxygen species (ROS) from this dye.
Another concern is that tattoo dye could have bacterial contamination. A recent European survey, where the tattoo industry is more regulated than in the US, revealed that less than 50% of dye manufacturers claimed their products were sterile. However, 11% of tattoo dyes tested were, in fact, contaminated with bacteria that had the potential for serious infection.
While complications from tattoos are rare, adverse reactions to tattoo inks are becoming much more common. In addition, the number of complaints is likely greatly underreported. The safety of tattoo pigment components for injection into the skin is not well established. The National Center for Toxicological Research is currently investigating the chemical composition of tattoo inks, how the body metabolizes them, short and long-term safety, as well as interactions with light and lasers. It has been found that azo pigments, such as pigment red (PR) 9, PR22, and pigment yellow 74, decompose into known carcinogens with exposure to light and laser irradiation.
Laser light is often used to remove unwanted tattoos and exposure to this light may, in fact, increase the production and release of toxic by-products. These by-products have raised specific concerns regard the occurrence of skin or other organ cancers due to the potential introduction of carcinogenic, pro-carcinogenic, and toxic compounds in the skin. Little is known regarding the impact, if any, of these toxins on pregnancy or breast feeding. A recent survey of the cancer risk associated with tattoos is reassuring. Cancer cases reported, were the same as the background rate, leading to the conclusion, that any association of tattoos with cancer is likely coincidental.
More recent concerns have been raised with the administration of epidural anesthesia to women with tattoos covering their lower back. There appears to be a risk of seeding tattoo dye into the space around the spinal cord and causing inflammation or malignancy. New recommendations include making an incision in the skin prior to placing a needle through these tattoos to avoid complications.
Tattoos appear to be growing in popularity among young, reproductive-aged females, many of whom avoid toxins by eating organic and choosing glass over plastic containers. Perhaps these women will begin avoiding tattoos once more awareness is brought to the possible harmful effects.
Hogsberg, T., Hutton, Carlsen K., and Serup, J. High prevalence of minor symptoms in tattoos among a young population tattooed with carbon black and organic pigments. J Eur.Acad.Dermatol.Venereol. 27(7), 846-852. 2013.
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