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December 1, 2019 5:56 pm
Red is the most risky ink color, and other health issues from tattoos
Now PlayingThe art of ink:...
The art of ink: One-of-a-kind tattoos 03:12
(CNN)If you clicked on this story, you likely either have or are thinking about getting some ink. It might be your first embellishment (in tattoo-speak, you're a tenderfoot), or maybe it's your sixth (on your way to being a showcase).
And you're part of a massive trend. Nearly four in 10 millennials ages 18 to 29 have a tattoo; half of those have two to five tats, the vast majority hidden under clothing, according to a 2010 Pew Research Center report.
Previous generations have about the same amount of ink: 40% of Gen Xers -- who are now between 40 and 54 years old -- sport a tattoo.
Body art has become a form of self-expression. When visible, they tell the world something about you and what you like, about what you believe and value. Tattoos also pay homage to loved ones, permanently enshrining the names of lovers, precious children or dates of special significance.
But are they safe?
While the popularity of tattoos has grown, regulation of the industry has not. Tattoo ink is not regulated by the federal government. And oversight of tattoo parlors and artists on the state and local level is spotty.
Many states and some cities have ordinances restricting tattoos on minors, but not all require cosmetic artists to be certified or tattoos shops to be licensed. Even when they are, inspectors are scarce, and shops may not be monitored to assure they always use clean, fresh needles.
And even in the best of circumstances, there are real dangers in both the inking process and the self-care of the wounds.
"We see people come into our clinic with some bad tattoo reactions," said Dr. Crystal Aguh, an assistant professor of dermatology at Johns Hopkins University School of Medicine.
"You're introducing a foreign body via the skin and there are risks," said Dr. Shawn Kwatra, also an assistant professor of dermatology at Johns Hopkins. "Sometimes your body can react in many ways you may have never thought about."
Allergic reactions
Tattoos can trigger allergic reactions; the most common is to ink. The reaction can be to any color, but the most typical are yellow and red.
According to the American Academy of Dermatology, the allergic response can occur immediately, weeks later, and surprisingly, even years and decades later. The academy says joint-replacement surgery or the beginning of antiviral treatment for HIV can activate a later reaction.
Yellow ink is associated with sun sensitivity, which can be irritating because you have to cover up your tat to protect it. But the photosensitivity typically fades after a few years, Aguh said.
A reaction to red ink, however, is most common. For many, the response is mild: a bit of redness, swelling or an itch that can be treated with a steroid cream.
For some, red ink can spark a potentially serious allergic reaction, turning the tattoo experience into a nightmare.
Pimple-like bumps, blisters, and raised, scaly patches that flake off can appear. There could also be a watery discharge from the site.
If those signs are paired with troubled breathing, or you experience a racing heart, dizziness, stomachache, serious pain, flushing or hives, seek medical care immediately.
In rare cases, people can get neurodermatitis, also known as lichen simplex chronicus.
"It's a persistent, almost chronic-like inflammation, which causes your whole tattoo to bubble up where the pigment is and become like thick, leathery skin," Aguh said.
Treatment is usually effective, she said. But for some it fails and leads to disfigurement.
How do you know if you'll have an allergic reaction or how serious it might be? Unfortunately you won't, which is why dermatologists recommend first getting a tiny test tattoo in a spot that isn't visible.
"You may be completely normal, completely healthy, but there could be something about the red pigment that your body just does not like," Aguh said. "If you've never been exposed to it before there would be no way for you to know before getting the tattoo."
Lymph nodes
A 32-year-old woman with 14 lower body tattoos was being treated for cervical cancer when doctors noticed two swollen lymph glands. Thinking her cancer had spread, they removed the nodes and discovered they were full of tattoo ink particles. In this situation, doctors said they would have operated anyway, but warned that might not always be the case.
In Australia, doctors were treating a woman for a type of cancer called lymphoma. She had lumps under her arms, as well as enlarged lymph nodes near the roots of her lungs, all classic signs of the cancer.
But when they put those nodes under a microscope, they found out it was black tattoo ink placed there 15 years ago. She didn't have cancer; her immune system was reacting to the tattoo on her back.
Another group of researchers studied cadavers with tattoos. In their lymph nodes they found carbon black ink, which breaks down easily into microscopically tiny bits called nanoparticles. They also found larger particles of titanium dioxide, a common ingredient in white ink. White ink is often used to mix tattoo colors.
Their most disturbing discovery, however, was toxic heavy metals in the lymph nodes, including cobalt, nickel and chromium. Heavy metals are sometimes added to tattoo pigment as preservatives.
"There are reports in the published scientific literature of tattoo inks that contain everything from pigments used in printer toner to pigments used in car paint," said Dr. Linda Katz, director of the Food and Drug Administration's Office of Cosmetics and Colors, in a published Q&A.
The FDA considers tattooing to be a cosmetic procedure, so it doesn't regulate the industry. But it does look into adverse reactions.
Katz said the agency is analyzing tattoo inks and pigments for "heavy metals, degradants, potentially toxic chemicals — including pH stabilizers, microbicides and coating agents — and other materials that are not intended to be placed into the body."
Skin diseases
If you carry the gene for psoriasis, dermatologists warn, a tattoo might activate the disease for the first time, or cause a flare if you already have it.
Other skin diseases can appear too: eczema (inflamed, itchy, irritated skin); vitiligo (a loss of skin pigment in blotches); sarcoidosis (an inflammatory disease); lichen planus (flat, itchy, purple bumps); even skin cancer.
If you are prone to scarring or have ever had a keloid, which is a scar that grew bigger than the wound, the American Academy of Dermatology suggests you should "rethink getting a tattoo."
"Keloids are very exaggerated scars in areas of trauma," Aguh said. "Depending on which color of ink the body's most sensitive to, a person could develop a large scar that can be difficult to treat. It also permanently changes the appearance of the tattoo as well."
Self-care
Be sure you know exactly how to care for your new tattoo before you let the artist sling that ink. Few states have any regulations requiring tattoo salons to provide after-care instructions.
You don't want to repeat the tragic mistake of a 31-year-old man in Texas.
Five days after getting a tattoo on his leg of a cross and hands in prayer, with the words "Jesus is my life" written in cursive below, he went swimming in the Gulf of Mexico. Within days he was in the hospital, infected with vibrio vulnificus, a bacterium commonly found in coastal ocean water.
The US Centers for Disease Control and Prevention estimates the bacteria causes 80,000 illnesses and 100 deaths every year in the United States.
The man went into septic shock, kidneys failing, and despite aggressive care died within a month.
Do your own thorough research before you get your tat; and in the meantime, here are a few key tips from dermatologists and tattoo artists:
- A thin layer of petroleum jelly and a bandage or plastic wrap should be applied by the artist before you leave the salon. Keep that on for 6 to 24 hours -- ask your artist for recommendations -- then remove carefully.
- With clean hands, gently wash the tattoo with antimicrobial soap and water and pat dry with a clean, soft cloth. Apply a very thin layer of antibiotic ointment and leave the tattoo open to breathe. Over the next few weeks you'll want to wash the tattoo twice a day and apply moisturizer.
- For the first few days your skin may feel warm, appear reddish and even ooze plasma and ink. That's a normal part of the process. If you see any sort of skin reaction after the first few days, however, visit a dermatologist. Infected skin could be redder, warmer and more painful, and could leak pus.
- Don't go swimming or otherwise immerse yourself in water for at least two weeks. Quick showers are fine.
- Don't pick at the scab or try to rub flakes off. Let them come off naturally to keep the ink in the skin and avoid scarring.
- The tattoo is likely to itch as it heals -- don't scratch, and apply moisturizer to help relieve the sensation.
- Wear protective, loose clothing to keep your tat out of the sun, but don't apply sunblock until after it looks healed, which is around three weeks.
According to dermatologists, your tattoo may appear dull and cloudy as it heals, but should be to its full vibrant colors within four months, about the time that all layers of the tattooed skin have healed.
Topic starter
December 2, 2019 10:58 am
I have heard about the ink not being high quality and people having problems with infections. The same is true for some types of ink that are used in micro blading and cosmetic tattoos. Since the FDA does not regulate this industry I think we will see more cases of adverse effects in the future. Be aware of where you're having these procedures. I suppose even after you think you have picked a safe place you do not know what ink is being used
December 3, 2019 2:22 pm
Wow, I would have never thought about how much is depositted into the body when getting tattooed and it's shocking what they found in that cadaver.
December 5, 2019 6:27 pm
This article reminds me of when I had an allergic reaction to red hair dye on my face, I have to wonder if the red ink on the skin is the same way...
January 27, 2020 10:45 am
I haven't had any reactions from any of my tattoos, but I'm sure it all depends on the ink the artist is buying and the company. I always take care of my tattoos properly when they're healing.
January 27, 2020 10:59 am
I have a bunch of tattoos, I even have a red ink tattoo that's a pretty decent size and I have never had any reaction to the ink and I have very sensitive skin. I feel like the people you do actually hear about having reactions are the people who to the back alley places to get them for dirt cheap. What do you expect? Tattoos are expensive for a reason its because the artists need to be able to afford the good high shelf quality ink and supplies, when they're only charging $20 for a tattoo you're gonna get that crappy god knows what ink in your body. That's why it is always best to do your research on the artists and ask questions don't ever be afraid to ask them things because tattooing is not only permanent but there is ink going into your body you want to make sure it isn't harmful.
November 23, 2020 9:37 pm
Getting a tattoo can quickly become a huge regret. It is super important to go to a professional in a clean establishment, people who care about their work area, care about your health. Although the client could be allergic to the ink, the risk factors drop from getting a bacterial infection when you go to a professional establishment. I have many tattoos and have been so lucky as to never had a bad reaction, only had to get an area with red ink touched up a few times because red is the hardest color to keep.
November 24, 2020 2:31 pm
Over the years I have gotten many tattoos. I was in the middle of tattooing my entire side when I found out I was pregnant with my son, so I had to take a break. My husband has some red ink on his arm and luckily he didn't have a bad reaction. I would agree with Nora that it is very important to go to a professional in a clean establishment. I have also been lucky to not have had any serious or bad reactions when getting my tattoos. I do believe that tattooing is a form of expression and it truly is art. My husband has a tattoo for his father and for our son, and my side piece is dedicated to my family. I do know people who have gotten tattoos from friends and had horrible infections because of the dirty work enviroment.
November 29, 2020 4:31 pm
Nora, You are so right to check out the place to see if it is clean. I went to a place a few years ago and the place was dirty and a mess. They guy who talked to me had a big sore on his hand that looked infected. I left and it was a bad feeling that this was a business that was not new.
November 29, 2020 4:39 pm
Madison, I have 6 tattoos and only 1 became infected. I had to see a DR for antibiotics. Red is not in any of mine. Red color seems to be a problem not only in ink but makeup as well.
December 1, 2020 11:31 pm
Okay, well I'll be the first to admit I had some nightmares about tattoos going wrong...but never to this extent. I guess we all consider that the ink is being forced into your skin, and obviously the irritation and scarring of the skin could be one problem, but i never would've thought that the body would ave such a reaction as to push and pull the ink through the body. It's so scary to think of how many people aren't trained professionally and licensed, and definitely those that may not be truthful. I told my mom when i was 15 that if she didn't take me to a tattoo shop and sign for it that I would go to an infamous "tattoo party".
December 1, 2020 11:33 pm
I don't believe any of mine were ever infected, as they healed pretty normally. but I do notice sometimes depending on maybe the weather or how I am feeling physically that some of my tattoos will actually feel different texture-wise on my skin. I always wondered what would cause that to happen and if something was wrong.
April 15, 2021 6:35 pm
I have a red tattoo on my wrist that for some reason, everyone always thinks is fake or a henna tattoo. I have heard from random people after seeing my tattoo that tattoo shops have told them they wouldn't tattoo an all red tattoo for them. Obviously when I went to get mine that was never said to me. When I've asked them why they were told this some said they told them it fades and others said they had no idea why their tattoo artist told them no. I wonder if maybe that was the reason was the risk of the red? My sister and I both got the same matching tattoo and thankfully neither of us had any bad reaction.
April 15, 2021 6:39 pm
@francescablackiectskin-com Yeah I agree, I never imagined or thought about the possibility of your body pulling that ink into your nodes. The human body is such an amazing and incredible thing, and the things that it will do all on it's own to try and protect you or fight infection is sometimes wild to think about for me.
April 20, 2021 2:51 pm
Kaytlyn
Red ink can cause infections and allergic reactions. Yellow ink is another. The allergic reaction can start even years after getting the tattoo. Most often steroid creams are used on the area. Serious complications are racing heart, hives, and trouble breathing.
April 20, 2021 2:54 pm
Madison, the quality of the ink is another factor. Just like with the permanent cosmetic tattoos the quality of the ink is very important. People can have a reaction to any foreign body put into the skin. Sometimes we just think oh its just a tattoo but that is a foreign body due to the ink
April 20, 2021 7:27 pm
i had no idea tatto ink could go into the lymph nodes and cause them to swell. i dont have many tattoos but i do have a few so this is something you would think people would talk about often. it is kind of scary because you never know if something like this could happen even though the chances are low. and when you go get a tattoo you normally dont ask what kind of ink it is or what it is made of but it is something to think about.
April 20, 2021 7:29 pm
@francescablackiectskin-com yeah when i think of tattoos gone wrong i think of infections or misspelling, but i guess when the ink starts to fade it does have to go somewhere.
May 30, 2021 8:37 pm
Tattoos can be so dangerous if not taken care of properly. It doesn't occur to a lot of people that fresh tattoos are an open wound that penetrates through several layers of skin, making them incredibly susceptible to infection. It's also interesting to consider the red ink tattoo trend, with linework tattoos composed of red ink alone, and how much more risky this color is than any other. I have two tattoos with red ink in them and was never warned that red has a higher chance for adverse reactions. Makes me wonder how comprehensive the aftercare instructions being given by tattoo artists really is.
June 2, 2021 9:58 am
I wonder that too Delaney. I also hope that the permanent tattoo artists for brows and other areas on the face and body are paying attention to where the ink they use comes from. There are inks that are not good quality and one needs to use top quality ink
October 16, 2021 5:51 pm
I have a few tattoos myself and I did more research about the artist than i did anything else. Ive always known its important to make sure your artist is using new needles and the quality of the ink is important. I personally have never had any issues with my tattoos, probably because im paranoid and take extra care of them. All of my tattoos are black and grey , no color, so ive never had an issue with colored ink. Overall its just important to research your artist and their shop, as well as find places that have more than a handful of reviews.
October 16, 2021 5:58 pm
@deborahwatersiectskin-com I had no idea red ink could cause infections and allergic reactions. The only thing ive ever heard is that red is the hardest color to keep looking fresh and pigmented.
October 16, 2021 6:01 pm
@delaneyhiggonsiectskin-com Totally agree, most people dont realize its an open wound that needs to be actively cared for. My good friend who was recently hospitalized , has just gotten a brand new sleeve done from shoulder to wrist only 2 days before his accident. We had to keep the staff updated that he needed his arm washed and clean with ointment daily, they couldnt just allow him to sit and bathe him whenever.
October 17, 2021 4:55 pm
I never knew how tattoos could affect your body so much. I know there are risk to getting them, but never knew how risky it really was. Luckily, I never had a negative experience with my tattoos and I hope I never will.
October 17, 2021 5:04 pm
@deborahwatersiectskin-com I have a red ink tattoo and I never knew it could cause problems, and to make matters worst, I got the tattoo in a girls garage. Not the smartest idea ever.
October 18, 2021 4:43 pm
I never thought about where the ink may go when a tattoo fades. It is crazy that is could cause life threatening effects and even possibly cancer. When I had my tattoo done I was mainly concerned with who was going to do it and their reputation as a tattoo artist. I never thought about the what ifs like whether or not I wouldve had an awful reaction to it.
October 20, 2021 9:18 pm
@gabriellemrasiectskin-com I agree with you, you get what you pay for! Cheap 20$ tattoos from a sketchy artist will probably cause you to get an infection.
October 20, 2021 9:21 pm
@delaneyhiggonsiectskin-com It is crazy to think about how when getting a tattoo done it really is going deep into the layers of your skin! I don't think people think of it that way though so they don't really treat it like an open wound. I know lots of people who have gotten infections from just not taking care of it like they are supposed to.
November 10, 2022 3:07 pm
As someone with two tattoos, and many more to come. I made myself aware of the risks involved when getting a tattoo, and heavily researched my studio and what brand of inks that they use. I fear for those that do not do the same, or have the ignorance allowing them to just walk into any tattoo shop and get a random tattoo just for fun, because it could cost them their life. I knew red ink was the most reactive in people's skin, but I never knew that yellow caused severe sun sensitivity like it does. Shows that there's always more to learn about topics you may have already researched.
November 10, 2022 3:08 pm
@keyonnastarksiectskin-com That is a terrifying combo of risks. I'm very glad that you did not have a negative reaction to your tattoo. Was the girl's garage at least somewhat sanitary?
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