Almost one in four Americans or Canadians, and about half as many Europeans, sport one or more tattoos according to recent estimates. Reversing former trends, women actually constitute the majority of tattooed people in Denmark, Italy and the United States.
These statistics, from a Joint Research Centre's (JRC) report on the safety of tattoos and permanent make-up, validate prioritization of reducing tattoo hazards which is picking up speed at the regulatory authorities in Europe.
Tattoos have been around for thousands of years, at least as far back as Ötzi, the mummy dated to have last roamed the Alps over 5 millennia ago, who had 61 tattoos possibly related to some sort of medical treatments for joint pain. Modern tats are now being co-opted for environmental and social causes.
In good news, knowledge of hygiene to prevent infections has advanced tremendously and the inks used in most modern tattoos no longer contain the most dangerous pigments based on toxic metals like cadmium or mercury sulfide. None of the pigments studied in the JRC survey are known to be carcinogenic, mutagenic, or reproductive toxins (CMRs is the common acronym for these).
But grounds for concern remain. Tattoos and permanent make-up (PMU) inject pigments into the dermis, the permanent layer of skin just below the epidermis, where they are intended to stay for a lifetime. People who opt to use their body as a canvas for this ancient art may not realize that the pigments being injected might be the same chemicals originated for use in car paints, plastics, or printer cartridges.
Although none of the colorants in the inks studied are known CMRs, over 60% of them have "azo compounds" in which two nitrogen atoms bridge between rings of carbon atoms. Electrons can run freely around the rings in these molecules, which is the physico-chemical reason behind how these organic pigments get their rainbow of colors. But the nitrogen bridge can also break, releasing smaller molecules that are carcinogens. For example the known carcinogen o-Anisole forms when the pigment known as solvent red 1 breaks down:
This sort of breakdown can be triggered by solar, ultraviolet, or laser irradiation - in other words, this happens when tattoos are exposed to sunlight and during the preferred methods for tattoo removal. These risks can be minimized by keeping inked skin under wraps when out in the sun, and thinking twice about the potential for regrets before committing to a tattoo.
Another serious concern with the chemicals in tattoo and PMU inks is sensitization, or allergic reactions. This often occurs shortly after getting new ink, but it can also arise many years later. Anyone with a tendency towards being allergic should consider consulting a doctor about managing tattoo and PMU risks, or at least start small.
Perhaps the biggest concern identified in the recent study, and the one most easily addressed by better regulations, arises due to impurities in the inks. Although no known CMR pigments were intentionally used, carcinogenic impurities were found at levels above the limit considered safe in 43% of 358 inks analyzed for polyaromatic hydrocarbons (PAHs); 24% of samples analyzed for benzo[a]pyrene contained this most toxic carcinogenic PAH at levels above the recommended limit. These PAHs are mostly impurities related to the carbon black pigments, and the fact that 57% of samples had PAHs inside the safe limits proves that it is possible to produce these black inks without such risky levels of impurities. This high levels of dangerous impurities may relate to the fact that the products are not being regulated like cosmetics, so sources of carbon black intended for more industrial purposes are ending up injected into people's bodies.
Metal impurities found include cadmium, mercury and nickel, arsenic, cadmium, chromium, mercury, nickel, lead and selenium - some of which are classified as carcinogens or are known sensitizers, and all of which can build up in the body over time, leading to long-term health issues, especially if they move into lymph nodes and other parts of the body.
Tattoos and PMU has fallen into a sort of no-man's land of regulation. For example, the U.S. Food and Drug Administration considers them to be "cosmetics" and therefore has jurisdiction to regulate them, but has opted not to, justifying the decision:
"because of other competing public health priorities and a previous lack of evidence of safety problems specifically associated with these pigments, FDA traditionally has not exercised regulatory authority for color additives on the pigments used in tattoo inks."
With the growing popularity of permanent body ink, the time has come for a better understanding of the risks and empowerment to minimize those risks, as well as regulations to prevent the clearly avoidable risks.
Until it comes out of regulatory limbo, the best course is caveat emptor (buyer beware). If you choose to get a tattoo (or next time you add to your body art), consider the inks that will be used as seriously as you consider the hygiene practices and artistic skills of your chosen provider. Or try a hand-mixed henna paste tattoo temporarily while you think it over.