Abstract:
Tattoos have a rich history as an expressive form of body modification and cultural symbolism, with
ancient practices deeply tied to spirituality and social identity. In modern society, tattoos are a growing form of personal expression, with 32% of Americans having at least one tattoo as of 2023, and prevalence reaching 41% among individuals under 30 years of age. The U.S. Food and Drug Administration (FDA) regularly receives reports of adverse health effects associated with tattoo ink,
including infections, allergic reactions, and other systemic effects. In response, the FDA issued a safety alert in 2019 and released a draft guidance in 2023 to assist manufacturers in improving product quality. The lack of comprehensive regulation over tattoo products in the United States has been further highlighted by the European Rapid Exchange of Information System (RAPEX), which reported a high frequency of safety alerts for US manufactured tattoo inks. Despite their popularity, potential health risks associated with tattoo inks remain largely underexamined. This literature review will characterize the hazard posed by tattoo inks by analyzing data and current literature on heavy metal content and microbial contamination as two potential sources of adverse systemic effects caused by tattoo inks. The findings underscore the need for further toxicological research to support regulatory action, ensure market safety, and protect public health.
A comprehensive search strategy of the recent literature was implemented by using PubMed. A series of searches were conducted to thoroughly assess and compare the literature, each utilizing the search key term “tattoo ink” combined with one of the additional search terms “heavy metal,” “microbial contamination,” or “systemic effects,” using the Boolean operator “AND”. These search terms were chosen due to FDA concerns about the sterility and identity of pigment ingredients found in tattoo ink and recent studies that report risk of systemic effects. These studies were filtered to be published between 2012 and 2024, which is a period in which the FDA saw an increased number of recalls of contaminated tattoo inks and the period where the global market research and consulting firm, Ipsos Group S.A., saw an increase in the popularity of tattooing. Exclusion criteria included studies published in languages other than English, studies published outside the specified time frame, and studies that did not have full-text manuscripts available
online.
Results of the literature search showed that heavy metal compounds and microbial contamination of tattoo inks can lead to increased cytotoxicity, pathogenic infections, and adverse systemic effects, such as allergic inflammation and lymphatic cancer. Without mandatory safety testing required by FDA, tattoo inks can expose individuals to toxicants and potential infectious agents that can lead to systemic toxicity, and long-term adverse health effects. This review highlights the need for improved regulations and consumer awareness to mitigate health risks associated with tattoo inks. Currently, no toxicological model for tattoo ink toxicity exists, therefore informed decision-making regarding potential health implications becomes increasingly important for consumers. Recommendations include long-term surveillance strategies for tattoo consumers, registering inks to ensure FDA compliance, providing standardization of manufacturing and handling of inks to ensure sterility, and further research into safer alternative pigments. By understanding the risks related to tattoo inks, individuals considering tattoos can reduce their likelihood of unexpected health complications.