Tattoo Ink Research Articles

Link Established Between Tattoos and Risk of Lymphoma—Authors Cite Need for Regulatory Measures on Composition of Tattoo Ink

Twelve case studies are presented showing results following laser tattoo removal with Nd:YAG, ruby and alexandrite lasers utilising both nanosecond and picosecond pulsewidth modes in a range of applied radiant exposures (fluences). The lockdowns around the world during the COVID-19 pandemic in 2020 and 2021 resulted in a situation where many laser treatments stopped – sometimes for many months. On returning to treatment, many anecdotal reports began to circulate pointing out ‘exceptional’ ink clearance since the previous laser treatments. The data and photographs presented here were compiled from nine centres in the UK, USA and Canada.

Permanent tattooing is the invasive introduction of tattoo ink (pigments) into the dermis. The ink and aftercare cosmetics applied on pre-damaged skin may contain skin sensitisers. To identify patient characteristics and the pattern of sensitisation in tattooed patients patch tested within the Information Network of Departments of Dermatology (IVDK). Comparative analysis of patient characteristics and reaction frequencies to baseline series allergens in 1648 consecutive patients with and 8045 consecutive patients without permanent tattoos. Non-overlapping 95%-confidence intervals were considered as significant. Having permanent tattoos was related with female sex, age <40 years, tobacco smoking, atopic dermatitis, (occupational) hand dermatitis and being employed in particular occupational groups (e.g., healthcare workers, mechanics, hairdressers). Sensitisation to nickel was increased in tattooed patients and associated with female sex (OR 4.23 [95%-CI, 3.48-5.18]), age ≥40 years (OR 1.26 [95%-CI, 1.08-1.49]), tobacco smoking (OR 1.19 [95%-CI, 1.01-1.40]) and having permanent tattoos (OR 1.27 [95%-CI, 1.05-1.53]). The association between nickel sensitisation and permanent tattoos is probably confounded by past reactions to pierced costume jewellery. Socio-economic factors most probably contribute to the connection between tattoos, tobacco smoking, occupational or hand dermatitis, and being employed in particular occupational groups.

The pressing need for FDA regulation of tattoo ink

The rising popularity of tattooing and permanent makeup (PMU) has led to increased reports of ink-related infections. This study is the first to investigate the presence of both aerobic and anaerobic bacteria in commercial tattoo and PMU inks under aerobic and anaerobic conditions. Our findings reveal that unopened and sealed tattoo inks can harbor anaerobic bacteria, known to thrive in low-oxygen environments, such as the dermal layer of the skin, alongside aerobic bacteria. This suggests that contaminated tattoo inks could be a source of infection from both types of bacteria. The results emphasize the importance of monitoring these products for both aerobic and anaerobic bacteria, including possibly pathogenic microorganisms.

The role of sentinel lymph node biopsy (SLNB) in locally advanced breast cancer (LABC) post-neoadjuvant chemotherapy (NACT) is debatable. We conducted a novel pilot study in which pre-NACT tattooing of breast lumps in LABC patients resulted in black tattoos being deposited in the axillary node. We hypothesized that this black node was the sentinel node. The identification rate (IR) of the black node in our pilot study was 100%, and the false-negative rate (FNR) was 0%. This study aims to evaluate our hypothesis that the black node is the sentinel node in post-NACT LABC patients after pre-NACT breast tattooing. This is a cross-sectional study of prospectively collected data of women with LABC undergoing surgery after NACT. Patients underwent tattooing of breast primarily using black tattoo ink prior to NACT. Women who progressed on NACT were excluded. All patients underwent axillary dissection. Intraoperatively identified black nodes were sent separately for pathological evaluation. The accuracy of the black nodes was assessed using IR and FNR. Of the 214 patients, a complete clinical response was present in 36%. Black node IR was 88.8% and FNR was 17.4%. In pre-NACT cN0 and cN1 patients, IR was 100% and 96.6%, and FNR was 0% and 4.63%, respectively. SLNB using pre-NACT tattooing in LABC patients has a high IR and FNR. In the subset with low pre-NACT axillary burden (cN0 or cN1), SLNB by pre-NACT breast tattooing has a high IR and low FNR.

Abstract A 61-year-old man presented with a 2-week history of a rash affecting tattooed skin. Following an initial 48-h period of fevers, a papular eruption developed within tattoos. Within 1 week it significantly progressed and was associated with itch and skin hyperalgesia. He had a background of BRAF-mutant resected stage III malignant melanoma, for which he was taking dabrafenib and trametinib daily starting 5 months earlier. He had an excellent performance status and no evidence of disseminated metastatic disease on updated imaging. His only other medication was perindopril. He had no history of dermatological issues or any relevant dermatoses in his family history. Review of systems was noncontributory. On examination, there were erythematous papules and plaques confined to the black ink of tattoos, with slight extension beyond the tattoo boundaries and secondary desquamation. Coloured ink was unaffected. There was no mucosal involvement, blistering, skin fragility, ulceration or evidence of infection. Skin biopsy demonstrated granulomatous inflammation surrounding black pigmented material. Laboratory tests including full blood count, inflammatory markers, and renal and liver profiles were normal. Antinuclear antibodies were negative. Serum angiotensin-converting enzyme was low, and no pulmonary findings were noted on imaging. Dabrafenib and trametinib were paused after the initial fever. Clobetasol propionate ointment was initiated to treat affected areas topically. BRAF and MEK inhibitor therapy (BRAF/MEKi) was recommenced at a reduced dose 4 weeks later when the rash had resolved. Subtle dermal thickening within black tattoo ink was noted within 1 week of restarting therapy, although this subsided, and the patient has continued on BRAF/MEKi without symptoms since. Few cases of cutaneous tattoo reactions to BRAF/MEKi have been reported. They have been recognized in those on immunotherapy, as a manifestation of immune restoration syndrome in the context of antiretroviral therapy for HIV, and in sarcoidosis (Kluger N. Tattoo reactions associated with targeted therapies and immune checkpoint inhibitors for advanced cancers: a brief review. Dermatology 2019; 235: 522–4). In previously reported cases of tattoo reactions due to BRAF/MEKi, like in this case, it was particularly black ink affected, and most patients tolerated treatment recommencement. The pathophysiology is not fully understood, although it may represent innate immune ­system activation, T-cell dysfunction, or BRAK/MEKi-induced paradoxical granuloma formation through activation of the AKT/mTOR pathway (Kluger). Distinguishing sarcoidosis-associated tattoo reactions from other granulomatous tattoo reactions can be challenging, although it has been reported that the extension of erythema beyond tattoo borders is less frequently seen in sarcoidosis (Kluger). In summary, this case illustrates a rare manifestation of reaction to targeted therapy for melanoma, which may be more frequently encountered as therapeutic indications expand for neoadjuvant use and in earlier stages of disease.

The number of patients with tattoos and which are operated is increasing significantly in recent years. Some complications, mainly in neuraxial anesthesia, have been reported are unconvincing due to the lack of real evidence-based material. Tissue coring and deposition of epithelial cells in the CSF is a known entity. However, the theoretical risk exists and the anesthesiologist questions whether to puncture the neuraxial in patients with a tattoo at the puncture site. More organic pigments are being used and the precise composition of tattoo inks remains unknown. As a conduct for asepsis and antisepsis during spinal puncture (lumbar and thoracic), 14 steps were described to avoid neurological complications during spinal anesthesia. This approach during anesthesia in the neuraxial area meant that I never had a neurological complication, nor the appearance of an epidermoid tumor. Thus, a total of 17 steps that must be followed exactly when performing the puncture on the back of tattoo patients. If there is no pigment-free skin area available, a superficial skin incision is the method of choice.

Abstract A 3D‐printed array of hollow microneedles (HMNs) is designed and fabricated using a high‐resolution stereolithography 3D printer and assembled with a 3D‐printed reservoir that incorporates a Luer lock mechanism, ensuring standard and secure connection to syringes. The proof‐of‐concept needle designs consist of half‐eccentric and concentric conical tip shapes, each arrayed with two different interspacing values. After the geometrical features of the devices are characterized, the devices are tested ex vivo in porcine skin to evaluate the impact of tip shape and interspacing on the depth of penetration and the efficacy of the devices in delivering fluids (such as tattoo ink) into the dermis. Overall, the 3D‐printed HMNs can deliver fluids into the target layer of skin. Refinement of the design is ongoing with the ultimate aim to provide alternatives for intradermal drug delivery and diagnostic imaging, such as superficial lymphography.

The popularity of tattoos has increased dramatically over the last few decades. Tattoo ink often contains carcinogenic chemicals, e.g., primary aromatic amines, polycyclic aromatic hydrocarbons, and metals. The tattooing process invokes an immunologic response that causes translocation of tattoo ink from the injection site. Deposition of tattoo pigment in lymph nodes has been confirmed but the long-term health effects remain unexplored. We used Swedish National Authority Registers with full population coverage to investigate the association between tattoo exposure and overall malignant lymphoma as well as lymphoma subtypes. We performed a case-control study where we identified all incident cases of malignant lymphoma diagnosed between 2007 and 2017 in individuals aged 20-60 years in the Swedish National Cancer Register. Three random age- and sex-matched controls per case were sampled from the Total Population Register using incidence density sampling. We assessed exposure through a questionnaire in 2021, and data on potential confounders were retrieved from registers. We used multivariable logistic regression to estimate the incidence rate ratio (IRR) of malignant lymphoma in tattooed individuals. The study population consisted of 11,905 individuals, and the response rate was 54% among cases (n=1398) and 47% among controls (n=4193). The tattoo prevalence was 21% among cases and 18% among controls. Tattooed individuals had a higher adjusted risk of overall lymphoma (IRR=1.21; 95% CI 0.99-1.48). The risk of lymphoma was highest in individuals with less than two years between their first tattoo and the index year (IRR=1.81; 95% CI 1.03-3.20). The risk decreased with intermediate exposure duration (three to ten years) but increased again in individuals who received their first tattoo ≥11 years before the index year (IRR=1.19; 95% CI 0.94-1.50). We found no evidence of increasing risk with a larger area of total tattooed body surface. The risk associated with tattoo exposure seemed to be highest for diffuse large B-cell lymphoma (IRR 1.30; 95% CI 0.99-1.71) and follicular lymphoma (IRR 1.29; 95% CI 0.92-1.82). Our findings suggested that tattoo exposure was associated with an increased risk of malignant lymphoma. More epidemiologic research is urgently needed to establish causality. The Swedish Research Council for Health, Working Life and Welfare.

Tattooing has been part of the human culture for thousands of years, yet only in the past decades has it entered the mainstream of the society. With the rise in popularity, tattoos also gained attention among researchers, with the aim to better understand the health risks posed by their application. 'A medical-toxicological view of tattooing'-a work published in The Lancet almost a decade ago, resulted from the international collaboration of various experts in the field. Since then, much understanding has been achieved regarding adverse effects, treatment of complications, as well as their regulation for improving public health. Yet major knowledge gaps remain. This review article results from the Second International Conference on Tattoo Safety hosted by the German Federal Institute for Risk Assessment (BfR) and provides a glimpse from the medical-toxicological perspective, regulatory strategies and advances in the analysis of tattoo inks.

Tattoos, an ancient form of body art with roots dating back 5000 years, have evolved from cultural markers to mainstream symbols of self-expression. While historically significant figures like Amunet and Captain James Cook contributed to tattoo lore, modern celebrities like David Beckham and Kat Von D have propelled tattoos into popular culture. However, alongside their rise in popularity, tattoos also bring health risks. Research indicates that up to 67% of individuals with tattoos experience complications, with infections, allergic reactions, and scarring being common concerns. Moreover, tattoos can exacerbate existing medical conditions, particularly in individuals with diabetes, heart conditions, or immunosuppressive disorders. Individuals who are pregnant or breastfeeding face additional risks due to physiological changes affecting wound healing and immune response. The chemical composition of tattoo ink, especially in complex styles like tridimensional matryoshka tattoos, poses further health concerns, including heavy metal toxicity and infection risks. Adequate safety measures, including choosing reputable artists, proper aftercare, and thorough pre-tattoo screening, can mitigate these risks. Prompt medical intervention is crucial in severe complications, emphasizing the importance of awareness and precaution in tattooing. Additionally, tattoo removal methods come with their own set of risks and considerations, with laser therapy being the primary choice but not assuring complete removal.

The main objective of this research and art creation is to create and present the work "Designing Fineline Tattoos as a Form of Self-Expression at Ingkeu Ink Tattoo Studio" as a representation of arts and culture education. Fineline tattoo is a style of tattoo that involves creating a design with very thin and smooth lines. These tattoos are often minimalist and subtle, with intricate and detailed designs that require a skilled artist to execute. This creation is research-based, so the method consists of two inseparable parts, namely the research method and the creation method. The technique for implementing MBKM internship/work practice activities at Ingkeu ink tattoo studio is carried out using a project based learning model. In designing this tattoo design, it begins with brainstorming together to collect the concepts and topics that will be discussed. After getting a mature concept, students can continue to the stages of the work process. In this research the author will describe the Fineline Tattoo design process as a form of self-expression at Ingkeu ink tattoo studio along with an analysis of the design results. The data in this research was obtained directly from Ingkeu ink tattoo studio as a partner who has a project to be featured in the internship report using several methods. The results of the tattoos done by the author are also uploaded by partners on social media and TikTok, in this way the partners believe they are very effective in attracting client interest.

Transdermal tattoos offer a potential avenue for administering drugs externally into the dermis, resulting in the creation of a lasting mark. Analyzing complex samples is crucial to assess the presence of ingredients, ensuring the safety of cosmetic products that contribute to health protection. This investigation aims to formulate and assess tattoo ink for treating allergies and inflammation. The study proposes a comprehensive analytical approach, encompassing physical appearance, homogeneity, pH, spreadability, viscosity, and antibacterial evaluation to characterize samples of henna and annatto. Standardizing herbal formulations is imperative to evaluate drug quality based on the concentration of active principles. This paper focuses on the standardization of Henna (Lawsonia inermis Linn) from the Lythraceae family and Annatto from the plant Bixa Orellana. Annatto, known for its lower toxicity and improved biodegradability, can be extracted using water or organic solvents to obtain pigment, tocotrienol, and geranylgeraniol components. These compounds exhibit antibacterial activity, inhibit certain types of cancer, and demonstrate hypocholesterolemic effects, among other properties.

Invisible ink tattoos (IITs) avoid cosmetic permanence of visible ink tattoos (VITs) while serving as more reliable landmarks for radiation setup than tattooless setups. This trial evaluated patient-reported preference and feasibility of IIT implementation. In an IRB-approved, single institution, prospective trial, patients receiving proton therapy underwent IIT-based treatment setup. A survey tool assessed patient preference on tattoos using a Likert scale. Matched patients treated using our institutional standard tattooless setup were identified; treatment times and image guidance requirements were evaluated between tattooless and IIT-based alignment approaches. Distribution differences were estimated using Wilcoxon rank-sum tests or Chi-square tests. Of 94 eligible patients enrolled, median age was 58 years, and 58.5% were female. Most common treatment sites were breast (18.1%), lung (17.0%) and pelvic (14.9%). Patients preferred to receive IITs versus VITs (79.8% pre-treatment and 75.5% post-treatment, respectively). Patients were willing to travel farther from home to avoid VITs versus IITs (p<0.01). Females were willing to travel (45.5% vs. 23.1%; p=0.04) and pay additional money to avoid VITs (34.5% vs. 5.1%; p<0.01). Per-fraction average +treatment time and time from on table/in room to first beam were shorter with IIT-based vs. tattooless setup (12.3min vs. 14.1min; p=0.04 and 24.1min vs. 26.2min; p=0.02, respectively). In the largest prospective trial on IIT-based radiotherapy setup to date, we found that patients prefer IITs to VITs. Additionally, IIT-based alignment is an effective and efficient strategy in comparison with tattooless setup. Standard incorporation of IITs for patient setup should be strongly considered.

Abstract Background: Carcinogens have been observed in many tattoo inks which can form new carcinogenic compounds when exposed to ultraviolet radiation and can accumulate in the lymph nodes and other organs. Tattooing can result in short- and long-term inflammatory and immune responses. At least 38 cases of melanoma have been reported in tattoos. The incidence of melanoma in Utah is the highest in the U.S., and potentially modifiable risk factors are of public health interest. In this study, we evaluated associations between tattooing and melanoma risk. Methods: We utilized a population-based case-control study of 514 incident in situ (284 men and 230 women) and 534 invasive (285 men and 249 women) melanoma cases diagnosed in Utah between 2020-2021. Controls (n=5,240) were selected from respondents to the Utah Behavioral Risk Factor Surveillance System (BRFSS) survey and frequency matched to cases in a 5:1 ratio on sex, age, race, and ethnicity. We fit logistic regression models to compute odds ratios (ORs) and 95% confidence intervals (CIs) associating ever tattooing with in situ and invasive melanoma risk, adjusting for age, education level, race, and ethnicity, separately for women and men. We then fit logistic models stratified by education level (&amp;lt; four-year college degree/four-year college degree or more) and models stratified by age (&amp;lt; 50 years/50+ years), separately for women and men. Results: Among men, the prevalence of tattooing was 7% for both in situ and invasive cases, and 11% for controls. Among women, tattooing prevalence was 20% for in situ cases, 15% for invasive cases, and 18% for controls. Ever tattooing was associated with decreased invasive melanoma risk among men (OR=0.62 [95% CI: 0.37-1.02]), particularly among those who had less than a four-year college degree (0.52 [0.28-0.99]), and among ages 50+ (0.36 [0.16-0.84]). Among men, the OR for ever tattooing and in situ melanoma was in the same direction as invasive melanoma, but the estimate was statistically imprecise (0.73 [0.45-1.19]). Among women, we did not observe an association between ever tattooing and invasive melanoma (0.83 [0.56-1.20]), while the association between ever tattooing and in situ melanoma was statistically imprecise (1.25 [0.87-1.80]). However, ever tattooing was associated with a nearly two-fold increased risk of in situ melanoma among women with a four-year college degree (1.98 [1.21-3.26]), but not for those without a college degree (0.89 [0.52-1.50]). Conclusion: These findings do not suggest that there is an association between tattooing and melanoma. Associations between tattooing and health-seeking behaviors, which may vary by sex and other demographic factors, may influence associations with melanoma diagnosis, particularly for in situ melanoma. This study is the first step in investigating whether reported cases of melanoma arising in tattoos are coincidental or whether tattoos may be associated with an increased risk of melanoma. Citation Format: Rachel D. McCarty, Britton Trabert, Morgan M. Millar, David Kriebel, Laurie Grieshober, Mollie E. Barnard, Lindsay J. Collin, Katherine A. Lawson-Michod, Jeffrey A. Gilreath, Douglas Grossman, John Hyngstrom, Paul J. Shami, Jennifer A. Doherty. Tattooing and risk of melanoma: A population-based case-control study in Utah [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2209.

Unlisted ingredients found in tattoo inks

Abstract Development of new non‐toxic pigments of a wide range of applications (from coloring of bone cements to aesthetic cosmetology, including tattooing) of blue and green shades is an urgent task. In the present work, colored compounds with apatite structure were synthesized by solid‐phase method. The obtained products were crystallized in hexagonal syngony of P 6 3 / m space group. The alloying elements – chromophores Mn 5+ and Cr 5+ in tetrahedrally coordinated positions – were responsible for sky‐blue and turquoise colors of the compounds, respectively. The conducted complex study (crystal structure, IR spectroscopy, color measurements, diffuse reflectance spectroscopy, electron paramagnetic resonance, cytotoxicity, surface morphology) of the colored compounds opens new opportunities for the development of alternative pigments of similar color range and expansion of the field of application of pigments based on compounds of apatite structural type. The results of in vitro study of cytotoxicity demonstrated the potential suitability of sky‐blue color compound (Mn‐containing apatite) for further creation of cold pigments on its basis for tattoo ink and bone cement coloring.

Introduction: Pigments of tattoo inks may over time migrate to other parts of the body. Inks kinetics are still poorly understood and little studied. The aim of this first study was to investigate the kinetics of tattoo inks pigment in tattooed porcine skin, which is closer to human skin than mouse skin studied in the past. Methods: Three animals were tattooed on the inner thigh and one animal served as untreated control. Skin biopsies were taken on days 7, 14, and 28 after tattooing. Animals were sacrificed on day 28 and homogenate samples of the liver, spleen, kidney, and brain, as well the local lymph nodes were prepared. All samples were analyzed for ink components using inductively coupled plasma-mass spectrometry. The ink itself was characterized by dynamic light scattering and matrix-assisted laser desorption-ionization mass analysis. Results: Titanium (212 g/kg), copper (6 g/kg), aluminum (1 mg/kg), zirconium (1 mg/kg), and chromium (3 mg/kg) were found in the ink. Significant deposits of ink elements were detected in the tattooed skin when compared to non-tattooed skin from the same animal (mean ± standard deviation: titanium 240 ± 81 mg/kg, copper 95 ± 39 mg/kg, aluminum 115 ± 63 mg/kg, zirconium 23 ± 12 mg/kg, and chromium 1.0 ± 0.2 mg/kg; p < 0.05). Lymph node concentrations of titanium, copper, aluminum, zirconium, and chromium were 42 ± 2 mg/kg, 69 ± 25 mg/kg, 49 ± 18 mg/kg, 0.3 ± 0.2 mg/kg, 0.5 ± 0.2 mg/kg, respectively. Conclusion: Deposits in skin were unchanged from days 7–28 indicating no redistribution or elimination. No significant deposits of ink elements were found in the liver, spleen, kidney, and brain. In conclusion, our findings confirmed distribution of elements from tattoos to regional lymph nodes, but neither to excretory organs, e.g., liver and kidney, nor to spleen and brain. Thus systemic internal organ exposure was not found.

As tattoos continue to rise in popularity, the demand for tattoo ink has surged. Historically, tattoo inks have been underregulated in the US market. This study analyzes inks from nine different brands that are common in the United States, ranging from major to small manufacturers. Out of 54 inks, 45 contained unlisted additives and/or pigments. Major, unlisted adulterants include poly(ethylene glycol), propylene glycol, and higher alkanes. Many of the adulterants pose possible allergic or other health risks. Taken together, the results from this study highlight the potential for a significant issue around inaccurate tattoo ink labeling in the United States.