Tattoos: some considerations for your skin’s health

Think before you ink!
As the popularity of tattoos continues to rise, so too do concerns about potential risks. While some of these risks may be known to the general public (e.g. the transmission of serious blood borne infections through unsterilized equipment), others may be less well publicised e.g. tattoo associated skin disorders or indeed, regret.

What is a tattoo?
A permanent tattoo involves having coloured ink injected under the skin using needles. The word is thought to have originated from the Tahitian word ‘tatu’ meaning ‘to mark’. Tattooing as a form of decorative body art, has been practised for many thousands of years and been observed on every continent. However, recent years have witnessed a surge in their popularity, both as a form of self-expression and for aesthetic purposes (including permanent makeup, where a tattoo is used to imitate the results of cosmetic products such as eyeliner).

Potential risks
An anticipated initial side effect of the tattooing process is an acute inflammatory reaction involving temporary redness and swelling of the tattooed area, which resolves quickly. However, other more problematic tattoo associated skin reactions/disorders can include skin infections, hypersensitivity reactions, granulomas (red raised bumps) and scarring.

Skin infections
Unhygienic practices can result in localised skin infections at the site of the tattoo (e.g. impetigo, cellulitis, herpes simplex), underscoring the need to undergo the procedure using sterile equipment in a clean environment. In this regard, in November 2015, the Department of Health published a draft guidance document for tattoo (and body piercing) parlours aimed at minimising the risks of infection, and protecting the health and safety of customers as well as tattoo artists.

Hypersensitivity reactions
Hypersensitivity reactions to tattoo pigments include allergic contact dermatitis and photo (sunlight)-aggravated allergic dermatitis, often presenting as an inflamed (and perhaps scaly) red rash. Establishing the components of tattoo ink pigments often proves challenging, and they may change over time.

Red ink pigments appear to cause hypersensitivity reactions most frequently, while reactions to ink pigments used to make black, blue, purple and green tattoos are less common. Reactions to non-permanent henna tattoos (which are painted onto the skin rather than injected) have also been reported when combined with paraphenylenediamine (PPD), in those who are sensitive to it.

Yellow ink pigments are thought to cause many of the photo-aggravated hypersensitivity reactions when exposed to sunlight.

Granulomatous reactions
Granulomatous reactions can occur due to what’s described as a ‘foreign body reaction’ to ink pigments. The immune system attempts to seal off substances it perceives as foreign, causing red raised bumps to appear at the site of the tattoo.

Removal can be costly and time consuming. Tattoos are often treated with lasers, the choice of which depends on the colour of the pigment. Complete clearance is not always achievable, with white and yellow pigment proving particularly difficult to remove. Scarring, incomplete clearance (ghost tattoos) or darkening of the tattoo are amongst the potential complications.

To conclude, it is of particular importance to consult your doctor if you have any concerns about possible reactions to, or removal of, tattoos. Crucially, as the United States Food and Drug Administration advises, ‘Think before you ink’.

If you need help or guidance about managing a skin condition like eczema, psoriasis, HS, acne or rosacea, contact the ISF Helpline here.