Tattoos Toxic?

Dear Dr. Dave and Dr. Dee,

Should I let my 12 year old daughter get a small butterfly tattooed on her ankle? Tattoos remind me of motorcycle guys, so was a little put off when she first asked. Am I being old fashioned?

Signed,

Tattoo Troubles

Dear Tattoo Troubles,

Tattoos are popular with both males and females, among many different age groups, and all walks of life. The decision to allow your daughter to have a tattoo is a personal one.

However, before deciding on any procedure, especially one that is basically permanent, it's important to understand the health risks involved such as infection and scarring.

You should also explain to your daughter that a tattoo is not simply painting picture onto the skin. To get a tattoo, a needle is used and hundreds of puncture wounds puts dye into the layers of the skin, which will sting and bleed during the procedure.

One concern with children having a tattoo is that they are not mature, tastes change, and they may not like their tattoo when they are adults. A common problem with tattoos is the desire to have them removed later in life. Tattoo removal can be very difficult and expensive, possibly leaving a permanent scar.

In addition, although the inks used in tattoos are subject to regulation by U.S. Food and Drug Administration (FDA), the FDA has stated that it does not regulate the inks and prefers such matters be handled through local laws (2008).

The FDA (2008) reported that they are concerned about the increasing variety of pigments and diluents (dilutant or thinner) being used in tattoo parlors (over 50 different pigments). The FDA points out that color additives are not approved for injection into the skin and many pigments are not approved for skin contact at all. Studies have found lead and other hazardous chemicals in tattoo inks (Lyon, U.S. News & World Report, 2008).

HEALTH RISKS INVOLVED IN TATTOOING

The FDA (www.fda.gov) lists six primary complications that can result from tattooing:

1. INFECTION: Unsterile tattooing equipment and needles can transmit infectious diseases, such as hepatitis [and HIV]. The risk of infection is the reason the American Association of Blood Banks requires a one-year wait between getting a tattoo and donating blood.

It is extremely important to make sure that all tattooing equipment is clean and sterilized before use. In addition, the person who receives a tattoo must be sure to care for the tattooed area properly during the first week or so after the pigments are injected.

2. ALLERGIC REACTIONS: Although allergic reactions to tattoo pigments are rare, when they happen they may be particularly troublesome because the pigments can be hard to remove. Occasionally, people may develop an allergic reaction to tattoos they have had for years.

3. GRANULOMAS: These are nodules that may form around material that the body perceives as foreign, such as particles of tattoo pigment.

4. KELOID FORMATION: If you are prone to developing keloids -- scars that grow beyond normal boundaries -- you are at risk of keloid formation from a tattoo.

5. MRI COMPLICATIONS: Although rare, there have been reports of people with tattoos or permanent makeup who experienced swelling or burning in the affected areas when they underwent magnetic resonance imaging (MRI).

There also have been reports of tattoo pigments interfering with the quality of the image. This seems to occur mainly when a person with permanent eyeliner undergoes MRI of the eyes.

Instead of avoiding an MRI, individuals who have tattoos or permanent makeup should inform the radiologist or technician of this fact in order to take appropriate precautions, avoid complications, and assure the best results.

6. REMOVAL PROBLEMS: Despite advances in laser technology, removing a tattoo is a painstaking process, usually involving several treatments and considerable expense. Complete removal without scarring may be impossible.

For more information, see www.fda.gov