Chapter 14. Allergies and Infections
Tattoo and Piercing Health Risks
Body art procedures can pose health risks to practitioners and clients. The inks used in tattooing contains one or more colorants, a carrier, and some additives. The inks and the needles can be contaminated, and sterilization of electrical devices is not always easy.
Body piercing and tattooing can cause localized pain and itching, and the skin reactions may include mild erythema (superficial reddening of the skin, usually in patches, as a result of injury or irritation causing dilatation of the blood capillaries), swelling, mild bleeding, crusting, exudation (oozing).
Allergies (or hypersensitivity) of tattooing can become apparent months (or even years) after the skin has been tattooed. Red inks (and sometimes yellow inks) seem to cause the most allergic reactions. Some components found in the inks, such as formaldehyde, nickel, manganese, cadmium, and antimony, could eventually act as chemical triggers. The risk of a generalized allergic reaction in a nickel-sensitive person is controversial but must be considered. Tattoo inks could trigger severe systemic reactions and even anaphylaxis. Laser-induced pigment decomposition can cause allergic reactions.
Allergies can include:
- Urticaria (hives – outbreak of swollen, pale red bumps or plaques on the skin that appear suddenly),
- Eczematous dermatitis (red and itchy skin),
- Lichenoid reaction (skin eruptions that can range from mild to severe and cause itching and discomfort), 25
- Granulomatous hypersensitivity reaction (DD sarcoidosis),
- Foreign body reaction,
- Vasculitis (inflammation of the blood vessels),
- Photosensitivity,
- Erythema nodosum (skin inflammation that is located in a part of the fatty layer of skin, resulting in reddish, painful, tender lumps most commonly located in the front of the legs below the knees. The tender lumps, or nodules, of erythema nodosum range in size from a dime to a quarter).
Bacterial infections are more common after piercing procedures, and are caused by pathogens (such as Streptococcus pyogenes and Staphylococcus aureus). Secondary infections caused by Streptococcus pyogenes, Staphylococcus aureus, Pseudomonas, and E. coli can occur when the procedure is performed in poor hygienic conditions, and can include:
- Erysipelas (infection of the upper dermis and superficial lymphatics, typically with a skin rash, usually on any of the legs and toes, face, arms, and fingers),
- Cellulitis (common, potentially serious bacterial skin infection, in which the affected skin appears swollen and red and is typically painful and warm to the touch. Cellulitis usually affects the skin on the lower legs, but it can occur in the face, arms and other areas ),
- Sepsis (a potentially life-threatening condition caused by the body’s response to an infection. The body normally releases chemicals into the bloodstream to fight an infection. Sepsis occurs when the body’s response to these chemicals is out of balance, triggering changes that can damage multiple organ systems),
- Spinal abscesses (a rare condition than can cause permanent damage to the spinal cord. An abscess is a swollen area in tissues that contains a buildup of pus. It happens when injured tissues becomes infected. The body’s immune system sends white blood cells to help fight off infection).
Viral infections that can be transmitted include:
- Papillomavirus-induced warts, (Verruca vulgaris is the common wart caused by infection with human papillomavirus and frequently infects the cuticle (the skin at the base of the nail) and sometimes the area beneath the nail). Verruca vulgaris is seven times more likely to appear in black ink tattoos vis-à-vis colored ink tattoos and non-tattooed skin, which would suggest that local immunity may be suppressed by the carbon pigment.
- Molluscum contagiosum (viral infection of the skin that results in round, firm, painless bumps ranging in size from a pinhead to a pencil eraser),
- Herpes simplex (infection that causes herpes in various parts of the body, most commonly on the genitals or mouth). There are two types of the herpes simplex virus. HSV-1: primarily causes oral herpes, and is generally responsible for cold sores and fever blisters around the mouth and on the face. HSV-2: primarily causes genital herpes, and is generally responsible for genital herpes outbreaks.
- Hepatitis (inflammation of the liver)
- HIV (human immunodeficiency virus, which harms the immune system by destroying the white blood cells that fight infection, putting a person at risk for serious infections and certain cancers. The final stage of infection with HIV is AIDS (acquired immunodeficiency syndrome).
Tattoos containing metallic (iron) components can interfere with diagnostic procedures. Rare complications that have been reported in patients undergoing magnetic resonance imaging (MRI) included tingling and burning sensations and even burns.
The metallic components in the tattoo itself can interfere with the quality of the images. Artifacts and foreign bodies within a patient’s body may distort MRI and lead to diagnostic confusion or reduce the quality of examinations.
Cosmetic procedures such as permanent makeup and tattoos and materials such as piercings, prostheses, metallic clips, etc. can produce severe distortion of the magnetic field.
Body Artists should know the risks of body-modifying procedures and be able to recognize and handle complications in order to avoid irreparable consequences, especially for adolescents. Risks of the procedures are bleeding, swelling, infection, and contact allergy. Lip and tongue piercings can damage the gums and teeth.
Individuals allergic to nickel can use the “dimethylglyoxime test” to check nickel release from objects and jewels. The test kit consists of a bottle with dimethylglyoxime. A drop of the product must be applied on a cotton tip. The suspected metallic item must be rubbed with this moistened cotton tip. If a pink-red color appears, the item contains and releases nickel.
Although cobalt release from jewelry has been demonstrated and a cobalt test is available, there is no restriction imposed.
| Ink Color | May Contain | Possible Side Effects | |
| Black | Logwood (Chrome), Charcoal, Carbon | PAH (carcinogenic), ROS induction | |
| Brown | Ferric oxide, ferric sulfate, cadmium sulfide | Paradoxical darkening (Fe) | |
| White | Lead carbonate, Zinc oxide, Titanium dioxide | Paradoxical darkening (TiO2) | |
| Violet | Manganese | ||
| Purple / Lilac | Manganese oxide | Rare allergic reactions | |
| Flesh | Ferric oxide | Paradoxical darkening | |
| Green | Chlorinated copper (phthalocyanine), Chromium oxide (Casalic green), Hydrous chromium oxides (Guignets green), Chromium sesquioxide (Viridian) | Allergies for hexavalent chromium | |
| Red | Mercury sulfide (cinnabar), Cadmium selenide, Sienna, brazilin, carmine, Cochinilla red, Santalin | Allergic reactions to mercury | |
| Yellow | Cadmium sulfide | Phototoxic reactions | |
| Blue | Cobalt, Copper (phthalocyanine), Indigo | Granulomatous reactions (Co) | |
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