Beneath the needle and ink lies a world few consider. While tattoos have long been symbols of identity, rebellion, or memorial, recent findings might cast a shadow over this age-old practice. According to new research by the US Food and Drug Administration (FDA), many bottles of tattoo and permanent makeup ink, including those marked sterile, may harbor dangerous bacteria.
Seong-Jae (Peter) Kim, a microbiologist with the FDA's National Center for Toxicological Research and the corresponding author of the July 2 report published in Applied and Environmental Microbiology, highlighted the importance of monitoring these products. "In light of our study results, we want to emphasize the importance of continuously monitoring these products to ensure the microbial safety of tattoo inks," Kim stated.
The concern stems from the ink being injected deep into the skin, where bacteria can thrive. Linda Katz, the director of the FDA's Office of Cosmetics and Colors, warned, "Pathogens or other harmful substances in these inks can travel from the injection site through the blood and lymphatic systems to other parts of the body." Such spreading can lead to severe health complications, including life-threatening conditions like endocarditis and septic shock.
Sepsis, an extreme response to infection, can lead to tissue damage, organ failure, and even death if not treated promptly, according to the US Centers for Disease Control and Prevention.
Common symptoms of tattoo ink infections may include injection-site rashes, impetigo, a highly contagious bacterial skin infection, erysipelas, a bright red and tender rash, and cellulitis, a deep infection of the skin requiring antibiotics.
Those with multiple or large tattoos may face higher risks. Katz explained, "People with multiple or large tattoos are at higher risk from contaminated ink because larger tattoos increase the likelihood of exposure to microorganisms." Permanent makeup, especially around sensitive areas like the eyes, poses additional risks.
John Swierk, an assistant chemistry professor at Binghamton University, not involved in the study, pointed out that contamination in tattoo inks is a known issue. "We know that contamination in tattoo inks is a common occurrence," he noted, attributing the problem to the lack of standardized sterilization methods.
Nevertheless, the tattoo industry is making strides toward better safety practices. Selina Medina, director of research at the Alliance of Professional Tattooists, mentioned that manufacturers are investing in advanced sterilization technologies and using clean rooms to minimize contamination risks.
Researchers tested 75 samples of sealed tattoo and permanent makeup ink from 14 manufacturers, finding that 35% of the samples had bacterial contamination. Some samples even contained bacterial counts as high as 100,000 bacteria per gram – a stark contrast to the zero bacteria count that infectious disease expert Dr. Robert Schooley from the University of California, San Diego, considers acceptable for materials injected into the skin.
Aside from bacterial infections, tattoos can also be associated with viral infections like hepatitis C, hepatitis B, and HIV.
Artists are advised to maintain transparency with their clients about the measures they take to ensure ink safety. Some studios conduct their own microbial tests or seek proof of testing from suppliers before using new ink batches. "Artists should communicate openly about the steps they take to ensure ink safety and address any concerns clients may have," Medina emphasized.
Using an autoclave to sterilize inks before application and ensuring proper handling of the ink and equipment during tattooing are crucial to avoid contamination. Proper storage and handling of ink bottles can further mitigate risks.
The ultimate solution lies in stringent regulations mandating testing and certification before market release. The Modernization of Cosmetics Regulation Act (MoCRA) of 2022 is a step in that direction, aiming for phased implementation to regulate tattoo inks in the US. The FDA's draft guidance for the tattoo industry, released in June 2023, includes quality control measures and sterilization protocols for manufacturers to follow.
As the tattoo culture continues to thrive, balancing tradition with safety becomes paramount. Implementing standardized manufacturing processes and stringent testing will ensure that the canvas of skin remains a safe domain for artistic expression.
