Tattoo Inks Pose Health Risks
This photo shows a tattoo infected with a nontuberculous Mycobacteria (NTM) bacteria. It is provided courtesy of Matthew J. Mahlberg, M.D., Dermatology Associates of Colorado, Englewood, Colo., and was obtained by Sarah Jackson, MPH, Colorado Department of Public Health and Environment.
Tempted to get a tattoo? Today, people from all walks of life have tattoos, which might lead you to believe that tattoos are completely safe.
But there are health risks that can result in the need for medical care. These can include a reaction to the ink or ink pigments or an infection. The Food and Drug Administration (FDA) is particularly concerned about infections with a family of bacteria called non-tuberculous Mycobacteria (NTM) that has been found in recent outbreaks of illnesses linked to contaminated tattoo inks.
M. chelonae, one of several disease-causing NTM species, can cause infections of skin, joints, lungs, and other organs, as well as eye problems. These infections can be difficult to diagnose and can require treatment lasting six months or more.
“Contaminated inks have caused serious infections in at least four states in late 2011 and early 2012,” says Pamela LeBlanc, M.P.H., of FDA’s Coordinated Outbreak Response and Evaluation (CORE) Network. FDA is reaching out to tattoo artists, ink and pigment manufacturers, public health officials, health care professionals, and consumers to warn them of the potential for infection.
FDA warns that tattoo inks can become contaminated by NTM and several other types of bacteria, mold and fungi. To raise awareness and ensure that diagnoses are accurate, FDA strongly encourages reporting of tattoo-associated complications to your health care professional and FDA’s MedWatch program, says Linda Katz, M.D., M.P.H., director of FDA’s Office of Cosmetics and Colors.
Getting the word out to tattoo artists is particularly critical. Even when they diligently follow hygienic practices, they may not know that an ink itself may be contaminated. Contamination is not always visible in the inks, Katz says.
FDA’s goal is to encourage tattoo and permanent make-up artists to take certain precautions in their practice and to urge potentially infected clients to seek medical care. “Reporting an infection to FDA and the artist is important. Once the problem is reported, FDA can investigate, and the artist can take steps to prevent others from becoming infected,” says epidemiologist Katherine Hollinger, D.V.M., M.P.H., from the Office of Cosmetics and Colors.
A Challenging Investigation
FDA regulates tattoo inks, investigating and intervening when a serious safety issue arises. And that’s what happened here.
FDA’s CORE Network initiated and coordinated the investigation with state and local health departments and laboratories, the Centers for Disease Control and Prevention (CDC), and FDA investigators working in district offices across the nation.
The investigation began in January 2012 when FDA, through its MedWatch reporting program, learned about seven people in Monroe County, New York, several of whom had confirmed NTM infections. All seven had received tattoos from the same artist, who used the same brand and color of ink on all of them. The infections occurred on the newly acquired tattoos, with red, sometimes itchy bumps appearing soon after the tattoo had healed.
FDA later learned of 12 more people with skin infections who were also clients of the same tattoo artist. Ink of the same brand and color was also used on them. Of these 19 people, 14 were confirmed to have the same type of NTM infection.
Meanwhile, through CDC, FDA learned of outbreaks of NTM infections in other states, including but not limited to Washington, Iowa, and Colorado. The cases in these states involved different NTM species or different ink manufacturers than those in New York. While the infections in Washington, Iowa, and Colorado were not linked to the New York infections, a possible link was identified between one NTM infection in Washington and two in Iowa.
During these outbreak investigations, FDA followed up at five firms in various states. Several ink and pigment samples collected during the investigations contained microbial contaminants.
In response to the outbreak investigations, two ink manufacturers voluntarily recalled inks implicated in the outbreaks.
Strategies for Controlling Risks of Infection
Tattoo artists can minimize the risk of infection by using inks that have been formulated or processed to ensure they are free from disease-causing bacteria, and avoiding the use of non-sterile water to dilute the inks or wash the skin. Non-sterile water includes tap, bottled, filtered or distilled water.
Consumers should know that the ointments often provided by tattoo parlors are not effective against these infections. NTM infections may look similar to allergic reactions, which means they might be easily misdiagnosed and treated ineffectively.
Once an infection is diagnosed, health care providers will prescribe appropriate antibiotic treatment according to Katz. Such treatment might have uncomfortable side effects, such as nausea or gastrointestinal problems. However, without prompt and proper treatment an infection could spread beyond the tattoo or become complicated by a secondary infection.
If you suspect you may have a tattoo-related infection, FDA recommends the following:
- Contact your health care professional if you see a red rash with swelling, possibly accompanied by itching or pain in the tattooed area, usually appearing 2-3 weeks after tattooing.
- Report the problem to the tattoo artist.
- Report the problem to MedWatch, on the Web or at 1-800-332-1088; or contact FDA's consumer complaint coordinator in your area.
You should also know that infections are not the only risk that may be associated with tattoo inks. See Tattoos and Permanent Makeup for more information about other potential hazards associated with tattoo inks.
Why Tattoo Inks Go Bad
Inks and pigments can be contaminated through:
- use of contaminated ingredients to make inks,
- use of manufacturing processes that introduce contaminants or allow contaminants to survive,
- use of unhygienic practices that contaminate ink bottles or mixing with contaminated colors,
- use of non-sterile water to dilute the inks, and
- using tattoo inks past their expiration date.
This article appears on FDA's Consumer Updates page, which features the latest on all FDA-regulated products.
Updated Feb. 10, 2014
For More Information
- New England Journal of Medicine Article (August 23, 2012)
Tattoo-Associated Nontuberculous Mycobacterial Skin Infections — Multiple States, 2011–2012 (CDC's Morbidity and Mortality Weekly Report) The Hidden Dangers of Getting Inked - CDC Fact Sheet on Tatoos & Permanent Makeup Outbreaks: Investigation, Response & Evaluation