Before They Ink: The Role of the Clinician in Preventing Infected Tattoos

Body ink has transformed from counterculture to mainstream. A 2015 Harris poll found that 29% of US adults have at least 1 tattoo – an 8% increase in 4 years – and 69% of inked Americans have multiple tattoos.¹

Unfortunately, tattoos come with risks such as infection. In fact, the US Food and Drug Administration (FDA) recently recalled 6 tattoo inks from 3 manufacturers. In a press release, the agency warned artists, retailers, and consumers that “inks contaminated with microorganisms can cause infections and lead to serious health injuries when injected into the skin during a tattooing procedure, since there is an increased risk of infection any time the skin barrier is broken.”²

With body art surging in popularity, chances are a fair percentage of your patients have or intend to get tattoos. What should your role be in protecting them against infection?

Explain the Risks of Getting a Tattoo

When performed by a licensed, reputable artist in a safe and sanitary studio, the chances of sustaining an infection from tattooing are fairly low. However, because tattooing involves piercing the skin, there remains a possibility of infection.³

• Viral infections such as hepatitis B, hepatitis C, HIV, HPV, and herpes simplex virus (HSV)
• Bacterial infections such as impetigo, erysipelas, and sepsis

In addition, patients can develop fungal infections, allergic reactions, and benign lesions, among other complications.

Broadly speaking, there are 2 main reasons why tattoos get infected⁴:

• Tattoo artists fail to use sterile techniques, which can lead to the spread of bacteria and other infectious organisms. A systematic review of 67 cases between 1984 and 2015 found that poor hygiene in tattoo studios was a major risk factor for infections.⁵
• Contaminated tattoo ink is used. Traditionally, the FDA “has not exercised regulatory authority for color additives on the pigments used in tattoo inks.” As such, the agency generally only responds once a problem occurs, as in the case of the recent recall.⁴

Describe the Signs of an Infected Tattoo

Inform your patients – especially the ones who are getting a tattoo for the first time – that it’s normal to experience a bit of redness, swelling, and tenderness after getting a tattoo. By carefully following instructions and keeping the tattoo clean afterward, it should heal nicely.

However, as the FDA noted in its press release, rashes and lesions consisting of red papules in the area the ink has been applied can signify an infection. These infections can be mistaken for allergic reactions and, in some cases, result in permanent scarring.²

Other major signs of an infected tattoo include⁶:

• A buildup of pus;
• Skin near the tattoo that turns cool or pale;
• Numbness or a tingly feeling in the area of the tattoo; and/or
• Blood soaking through the bandage (a small amount of blood is normal).

Ask your patients to be alert for these symptoms and to contact you if they are getting worse.

Encourage Safety Precautions

If a patient intends to get a tattoo, encourage him or her to find a reputable artist and sanitary studio. Signs of a safe tattoo studio include the following⁷:

• The studio is clean and has separate areas for tattooing and piercing.
• Needles are only used once and are opened from individual packages in front of the customer prior to the procedure.
• The studio uses an autoclave.
• The staff wears new latex gloves during every procedure.
• Inks are placed in a single-use cup and then disposed; they are never taken directly from the main bottle.
• The artist provides clear after-care instructions and is receptive to all questions.

Final Note

The best thing you can do for your patients is provide information. Getting a tattoo is a personal decision, so be sure to tell your patients that your advice is not meant to sway their opinion but rather to inform them and reduce the likelihood they sustain an infection.

References

1. Shannon-Missal L. Tattoo takeover: three in ten Americans have tattoos, and most don’t stop at just one. The Harris Poll. February 10, 2016. Accessed May 21, 2019.
2. FDA advises consumers, tattoo artists, and retailers to avoid using or selling certain tattoo inks contaminated with microorganisms. US Food and Drug Administration. May 15, 2019. Accessed May 21, 2019.
3. Khunger N, Molpariya A, Khunger A. Complications of tattoos and tattoo removal: stop and think before you ink. J Cutan Aesthet Surg. 2015;8(1):30-36.
4. Skerrett PJ. Tattoos and infection: think before you ink. Harvard Health. October 12, 2012. Accessed May 21, 2019.
5. Dieckmann R, Boone I, Brockmann SO, et al. The risk of bacterial infection after tattooing. Dtsch Arztebl Int. 2016;113(40):665-671.
6. Infection from tattoos: care instructions. MyHealth Alberta. Updated September 23, 2018. Accessed May 21, 2019.
7. Body art: what you need to know before getting a tattoo or piercing. University of Michigan. Accessed May 21, 2019.