Possible complications of tattooing and piercing

Infections. They can occur when the integrity of the skin barrier is disturbed. Micro-organisms can be introduced into the skin and cause inflammation. The majority of infections are superficial and caused by common bacteria; they can be avoided by using sterile materials and good hygiene. Superficial skin infections usually present as redness, swelling, pain and oozing, they can usually be dealt with by local measures like disinfection. Severe infections however can occur. Severe infections can cause fever, more important redness and swelling and painfull lymphnodes; they can lead to life-threatening complications and need competent approach.

Transmission of blood-borne diseases such as hepatitis and HIV must be considered when hygienic measures are not respected.

Allergy. Some people develop an allergic reaction to the materials in contact with the skin. These allergies present with itching, swelling, redness and often small vesicles or blisters. A well known reaction is nickel allergy to poor quality metal piercings. Nickel allergy can be proven by a skin test.

Jewels can be tested with a simple nickel spot test, by putting one drop of dimethylglyoxime on the ornament or jewel and rubbing with a cotton tip. If the cotton tip shows a pink color this means that the jewel is releasing nickel.

The European Nickel Directive (here) limits the nickel content in materials in contact with the skin. Allergies to tattoo inks are rare and unpredictable. Unfortunately there is no skin test to check and predict these allergies. We know that reactions in red tattoos are most frequent. Sun sensitivity with an itchy or burning sensation in tattoos is quite common.

Toxicity and Cancer. Tattoo and PMU inks contain a lot of chemicals. Many harmful substances, some of them with  carcinogenic properties can be found in tattoo inks. It is a fact that there is some uptake in the body of the colorants and drainage of tattoo pigments and decomposition products. Researchers have demonstrated the presence of tattoo pigments in the lymph nodes.

The effects on human health are unclear and under investigation. Although there is no evidence that tattooing causes cancer, caution is necessary. To limit the risk for human health the European authorities established restrictions on the composition of tattoo inks published in a Resolution (here). However these restrictions are still insufficient to guarantee absolute safety of all materials, moreover there is a lack of control.

New initiatives have been undertaken to develop guidelines and better regulation on the composition of tattoo and PMU inks with harmonisation on European level as an ultimate goal.

Scarring. Scars and bumps can appear when the skin is harmed.  Tattoo pigment particles can be considered by the human body as foreign material and evoke a “foreign body reaction”. This presents as small bumps or even as global thickening of the skin in a tattoo or around a piercing.

MRI complications . People may have swelling and experience tingling or burning in a tattoo when they undergo magnetic resonance imaging (MRI). This happens rarely, it is not dangerous and it does not last long. The metal containing pigments can also disturb the MRI images. The radiologist should be informed before the examination. Read a recent article on the topic by clicking here.

Medical interventions. Piercings can interfere during medical and dental procedures. This has to be discussed with the doctor or dentist.

Regret. At long term people can be unhappy with the result.  Up to 30% regret their tattoo and 10-20% ask medical advice for tattoo removal.

Tattoo removal. Laser treatment of unwanted tattoos is the best solution. However tattoo removal with laser is painful, tedious, expensive and not always successful. Some colours are difficult to remove (blue, green, purple, orange, yellow). Moreover laser treatment can result in temporary but also permanent pigmentary changes and some scarring. Some colorants containing iron and titanium can darken during laser treatment.  Doctors with specific laser training and experience can give competent advice.