How Common Are Infections From Tattoo Ink?

A recent set of infections from tattoos has shed light on just how unregulated ink really is

This paper doll could end up with a nasty rash.
This paper doll could end up with a nasty rash. Cifo

Earlier this year, doctors in Rochester, N.Y., started seeing a pattern. Patients were coming in with odd rashes where they had recently gotten tattoos. Reactions to tattoos aren’t uncommon—you did just inject a needle into your skin thousands of times. But this time, the usual treatments weren’t working. Turns out, it wasn’t the standard tattoo rash. These were caused by infected ink. Discover explains:

The new color had come from a trade show in Arizona, and this particular artist was the only person using it in the county, as well as the only one whose clients came down with the rash. Since the tattoo artist ran a tidy shop—a health department inspection raised no red flags there—the investigators focused their attention on the ink. They called in the FDA, which requested samples from the ink manufacturer and had the CDC check to see whether the bacterium behind the infections was there. It was, in one of the three unopened bottles they tested. It must have crept in at some stage in the manufacturing process. No one really knows, though, how the bacterium got there.

The bacteria in question is Mycobacterium chelonae, a bacteria commonly found in tap water. This is not the first time the bacteria has shown up in tattooing. The first report was in 2003, when a butterfly tattoo came along with a nasty infection. Since then, several other cases have emerged: 48 patients in France, 24 cases in the state of Washington, two cases is Iowa and one in Colorado, 11 cases in San Antonio. In Europe, a study of tattoo ink looked at 58 bottles and found that ten percent of the unopened were contaminated with bacteria, as were 17 percent of the previously used stock bottles.

In the United States, each state has its own rules and regulations governing tattoo shops, but the ink itself isn’t really regulated. Basically, the FDA waits for a problem to happen, and then tries to address it, usually by recalling the material. The FDA says:

The pigments used in the inks are color additives, which are subject to premarket approval under the Federal Food, Drug, and Cosmetic Act. However, because of other competing public health priorities and a previous lack of evidence of safety problems specifically associated with these pigments, FDA traditionally has not exercised regulatory authority for color additives on the pigments used in tattoo inks. The actual practice of tattooing is regulated by local jurisdictions.

That’s simply not good enough, the doctors who treated these patients in New York argue. First, the infections that their patients were getting were bad for a couple of reasons:

Several features of nontuberculous mycobacteria make it particularly important to increase awareness about these types of tattoo ink–related infections. Nontuberculous mycobacterial infections may be difficult to diagnose and treat. Commonly reported symptoms of such infections associated with tattoo ink include lesions consisting of red papules solely in areas where the contaminated ink has been applied. Symptoms can be difficult to recognize, since other conditions (e.g., allergic reactions) may present with similar findings. Recovery of mycobacteria may be challenging, often requiring a skin biopsy, and special culture mediums may be required for diagnosis. Depending on the medium used, it can take up to 6 weeks to identify the organism. Because of these diagnostic challenges, infections may initially be misdiagnosed and patients may receive ineffective treatments. Antibiotic choices are limited by the susceptibility profile of the organism, and prolonged treatment may be necessary to clear the infection. Moreover, complications such as coinfection with pathogens such as methicillin-resistant Staphylococcus aureus may pose a further challenge to a patient’s full recovery.

And even if the tattoo parlor is clean as a whistle, it can’t really know whether its ink is contaminated. The ink in San Antonia was called “Dragon’s Blood Gray” and had come from New Jersey by way of California. The bottles had no lot number, which made it impossible trace. Now that around 21 percent of the adults in the United States have tattoos, it might be time for the FDA to take a closer look at what people are injecting into their skin.

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