Studies Question Safety of Tattoo Ink

Dozens of Cases Traced to Unsterile Pre-Mixed Inks

By Brenda Goodman, MA
WebMD Health News

Reviewed by Louise Chang, MD

Aug. 22, 2012 -- When it comes to tattoos, here's the rub: The tattoo parlor may be spotless; the tattoo artist may be using sterile techniques; but you can still wind up with a nasty infection from ink that was contaminated before it arrived at the shop, new studies show.

The first study is published in the New England Journal of Medicine. It describes an outbreak of 19 skin infections in New York State that were traced to the same pre-mixed tattoo ink.

When health officials took their investigation nationwide, they found 32 other suspicious skin rashes linked to four brands of ink. Those findings are described in a study in the CDC's Morbidity and Mortality Weekly Report. In addition to the cluster in New York, cases were confirmed in Colorado, Washington, and Iowa.

"You can do everything right at the tattoo parlor, there are still potential risks that folks need to be aware of," says researcher Byron S. Kennedy, MD, PhD, MPH. Kennedy is deputy director of the Monroe County Department of Public Health in Rochester, N.Y.

Public health officials became aware of the problem after a healthy 20-year-old man developed a tenacious rash around a recent tattoo. A dermatologist cultured bacteria from red bumps on his arm and alerted the state health department.

Germs in Tattoo Ink

The infection was caused by Mycobacterium chelonae, which is related to the same germs that cause leprosy and tuberculosis. Mycobacterium chelonae like to hang out in water. They usually don't cause a problem for people with strong immune systems.

But injecting the ink under the skin to make a tattoo bypasses many of body's natural defenses and can allow these germs to set up shop.

Once established, mycobacterial infections are stubborn. They often require months of treatment with antibiotics to clear.

After an extensive investigation, researchers traced the source of the outbreak to an unopened bottle of gray ink. Gray ink is used to create a smudgy, shaded effect around tattoos. It's made by diluting black ink with water.

"It appears that probably in this case it was diluted with tap water or non-sterile water, but we're not sure," says Linda Katz, MD, MPH, director of the Office of Cosmetics and Colors at the FDA.

Few Safeguards Against Unsafe Ink

Katz says people should be aware that the FDA has never approved a color or pigment for injection into the skin. Many colors are approved for other uses, such as automobile paint or printer's ink.

"In this case, there have been no inks, as of now, that have been approved for use in tattoos," Katz says.

Inks don't have to be tested for safety or purity before they're sold to consumers.

Katz says it's difficult to know how often ink-related infections occur because reporting of problems is voluntary. It seems to be an uncommon phenomenon.

But here's why health officials are worried: Tattoos are more popular now than they ever have been. According to a Harris Interactive poll, 1 in 5 adults now has a tattoo, up from 1 in 7 just four years ago.

It's also not the first time the safety of tattoo ink has come under scrutiny. Public health authorities in Seattle and Rochester, Minn., have also recently reported cases of stubborn mycobacterial skin infections caused by contaminated inks.

Last year, researchers in Denmark tested 58 bottles of tattoo ink purchased over the Internet from suppliers in the U.S. and U.K. They found 10% of the unopened inks were contaminated with bacteria.

Advice for Inking Safely

Katz says people should look at a variety of things when they get a tattoo:

  • Is the tattoo parlor meeting state requirements for cleanliness and needle care?
  • Does the tattoo artist know about the nature of their inks? Do they know how they are prepared? If the ink was diluted, was it done with sterile water?

In addition, Katz advises the newly inked to carefully follow any instructions for aftercare. Some redness and irritation is normal for the first few days. Any rash that pops up a week or two after you get a tattoo should be checked by a doctor.

She advises people who get rashes to report the problem to the tattoo artist so they can take the ink out of circulation. The person should also notify the local department of public health and the FDA.

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SOURCES: Kennedy, B. The New England Journal of Medicine, Aug. 22, 2012. LeBlanc, P. The New England Journal of Medicine. Aug. 22, 2012. Bedard, B. Morbidity and Mortality Weekly Report. Aug. 22, 2012. Byron S. Kennedy, MD, PhD, MPH, deputy director, Monroe County Department of Public Health, Rochester, N.Y. Linda Katz, MD, MPH, director, Office of Cosmetics and Colors, FDA, Silver Spring, Md.

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