Six percent of adult New Yorkers who have a tattoo say they have suffered from a related rash, severe itching, or swelling that lasts longer than four months and in some case for many years.
While some adverse skin reactions are treatable with anti-inflammatory steroid drugs, others may require laser surgery. For stronger reactions, surgery is sometimes necessary to remove tattooed areas of the skin or built-up scar tissue and granular skin lesions, which can rise several millimeters on the skin and cause considerable itching and emotional distress.
“We were rather alarmed at the high rate of reported chronic complications tied to getting a tattoo,” says senior study investigator Marie Leger, assistant professor of dermatology at New York University Langone Medical Center. “Given the growing popularity of tattoos, physicians, public health officials, and consumers need to be aware of the risks involved.”
An estimated one in five adult Americans has at least one tattoo.
Published in the journal Contact Dermatitis, the findings, derived from survey interviews with some 300 adults in New York’s Central Park in June 2013, mirror those in other European countries, which have only recently begun to monitor medical complications associated with tattoos.
A lack of regulatory oversight is an underlying weakness in measuring the true scope of complications tied to tattooing, Leger says, noting that the chemical composition of colored inks used in the process is poorly understood and not standardized among dye manufacturers.
“It is not yet known if the reactions being observed are due to chemicals in the ink itself or to other chemicals, such as preservatives or brighteners, added to them, or to the chemicals’ breakdown over time. The lack of a national database or reporting requirements also hinders reliable monitoring.”
“The skin is a highly immune-sensitive organ, and the long-term consequences of repeatedly testing the body’s immune system with injected dyes and colored inks are poorly understood. Some of the reactions appear to be an immune response, yet we do not know who is most likely to have an immune reaction to a tattoo.”
Red and black
Among the study’s other key findings was that similar types of short-term complications, including delayed healing, pain, swelling, and infection within weeks of getting tattooed, occur in as many as 10 percent of people. Only a third of people who experience a reaction seek medical advice or help. Instead, many go back to the tattoo parlor for advice.
Most long-lasting complications occur in skin regions injected with the two most common tattoo ink colors, red and black. Almost half (44 percent) of chronic reactions were to red ink, even though only slightly more than a third (36 percent) had tattoos with red ink. One-third of chronic cases involved black ink, while over 90 percent of tattoos encompass black coloring.
Survey respondents ranged in age from 18 to 69, with a majority having no more than five tattoos. One had 53. The arm is the most popular tattoo site, at 67 percent.
Leger plans a larger survey to determine what colored inks and possible dye components are most closely tied to adverse reactions.
Other researchers from NYU and from University of Nevada in Reno, contributed to the work.