Think before you ink your body!

Dr Sentila Longkumer

Planning on getting a tattoo on your body? Well, think twice and think hard about the consequences of it. Not only can it have health risks, you may have to live with a life time of regret.

Tattooing or Body Art has been increasingly popular for decades especially among teenagers and young adults, who are influenced by peers and celebrities,although there is no age limit. It is considered as an art or a form of self - expression and portrayal.Tattooing is a process of implantation of permanent pigment granules in the skin. While getting a tattoo sounds fun and exciting, the removal can prove to be less so, more expensive, painful and cumbersome. Many times, tattooing can come with health risks and unwanted adverse effects due to unsafe inking practices and use of toxic inks. Through this article, we aim to educate the young population on the implicationsof having a tattoo and create an awareness on the negative effects before getting the procedure done on an impulse. The article is not intendedat targeting tattoo artists or people having tattoos, but merely to sensitize the young populace.

What is in tattoo ink?

Tattoo inks can contain natural or artificial pigments. There are reports of many inks containing pigments used in car paints and printer toners so one can imagine how toxic they can be. Red ink contains mercury which can cause severe tissue damage. Black ink has iron oxide or carbon. There is no FDA approved ink for tattoos. FDA is currently researching on health effects of tattoo inks due to several reports of harmful reactions after tattoo procedures.

What are the types of tattoos?

Tattoos can be classified as: 

Cosmetic (decorative and permanent make up)

Medical (as camouflage in vitiligo, areolar reconstruction post-surgery, permanent hair loss and scars post-surgery)
Traumatic (accidental implantation post injury)

Why are tattoos harmful?

Apart from the toxicity of inks, unsafe and unhygienic practice during the procedure can lead to adverse events. Improperly sterilized or unsterilized equipments and tools, contaminated ink, or using unsterile water to dilute the ink can cause infections and reactions. Here are some immediate and late medical issues associated with tattoo procedures:

- Bacterial skin infections manifesting as redness, swelling, pain, itching, discharge of pus, rise in local temperature, and fever or chills.

- Viral infections like Hepatitis B/ C/ HIV/ Herpes simplex/ Molluscumcontagiosum

-    Fungal infections affecting deeper layer of skin

-    Atypical mycobacterial infections

-    Bleeding and haematoma

-    Tattoo site ulceration

-    Allergic and foreign body reactions caused by pigments in the ink. Common culprits are dichromate (green), mercury (red), cadmium (yellow), cobalt (blue). Contamination with nickel sulfate can cause marked allergic reactions. In addition, the body can recognize these pigments are foreign or alien and stimulate the immune system to develop reactions later in the form of granulomas or incite a hypersensitivity reaction.

-    Photosensitivity reaction due to red or yellow pigment

-    Tumours : Both benign and malignant tumors have been rarely documented or published in literature. Scientists and researchers are studying the carcinogenic effects of Benzo(a)pyrene in black ink.

-    Keloid formation which can form even months or years after the procedure.

-    Masking of skin cancer by tattoo – leading to a delay or failure in diagnosis of the condition thus disabling intervention that could prove beneficial for the patient. Tattoos are to be avoided over moles, birthmarks and other discolored areas in the skin. 

-    Koebnerisation of pre-existing skin diseases whereby new lesions appear at or near the sites of tattoo like Psoriasis, Lichen planus, Vitiligo.

-    Reactivation of skin diseases like herpes simplex, herpes zoster, lupus erythematosus.

Psychosocial implications of tattoos

Different tattoos bear different meanings to the wearer and to the observer. While tattoos can hold deep significance to the wearer, many have negative perceptions and prejudices of the individual thereby labelling him or her as rebellious andimmoral. Even between sexes gender bias and stereotype exists with women having tattoos perceived in a more negative light in both professional and non - professional settings. A study showed that nurses with visible tattoos were considered less caring, skilled and knowledgeable than their tattooed male counterparts. A survey of Canadian undergraduates reported that both male and female respondents had negative attitudes towards description of women with visible tattoos. Such perceptions act as a deterrent in the recruitment process at job interviews where the female applicants may be rejected and stigmatized. Apart from the gender bias, people with tattoos in general are less likely to be recruited or hired whether at the hospitality sector like airlines, hotel management or army recruitments. Admission into schools and colleges are declined to students with visible tattoos. People with tattoos face rejection even when it comes to marriage proposals. In India, those with recent tattoos have to wait for at least 6 months before they can donate blood. Tattoos bearing names of love interest may cause significant distress later on in life. Tattoos inked on an impulse and under peer pressure may cause regrets which ultimately lead them to seek removal. Feelings of low self esteem and anxiety are common in patients seeking tattoo removal. Youngsters need to be aware of these many negative implications before deciding on getting a tattoo.

Can tattoos be removed?

The answer is yes. Currently the Q Switched laser is the standard for tattoo removal although not all pigments respond to it. It does not come without side effects and is more expensive and painful than getting a tattoo. It is time consuming and multiple sessions need to be performed at 1-2 months intervals, especially with professional tattoos which may well extend to over a year or more of treatment.

What are the complications of tattoo removal?

Complications with laser removal can be immediate or delayed. 

Immediate effects include pain, blisters, weals, pin point haemorrhages, bruising and crusting.

Delayed effects include localized allergic reactions to the pigments especially red and yellow, which can lead to formation of papules and nodules. Most common effect is pigmentary changes in the form of hypopigmentation or hyperpigmentation. Paradoxical darkening of preexisting tattoo has been reported. The marks left behind post tattoo removal can lead to a Ghost tattoo. There may be textural changes in the skin and more often than not, scarring of the tattoo site.

What should you know before deciding to get a tattoo?

First and foremost, be aware of the consequences especially if you are planning to seek a job. 

Secondly, do a good research on your tattoo artist and the parlour regarding expertise and sterilization techniques. Do not ink names of lovers or friends!

And finally, stop and think again before you ink your body!

The writer is Senior Consultant, Department of Dermatology & Cosmetology, CIHSR