Tattoos have been around for centuries in several cultures of the world, and became popular in the West through the voyages of sailors visiting various ports. However, over the last few years tattoos have become increasingly common, if not fashionable.

With this has come health and safety concerns, which have focused primarily on hygiene and the prevention of infection, whether locally in the skin, or in the bloodstream and liver.

However, more recent radiographic studies have shown that pigments in the ink used for the tattoos migrate from the skin down into the lymph nodes deep in the body, and this has led to the chronic (long-term) enlargement of these glands.

Further, doctors have been warned that tattoo ink may look like the spread of cancer to the lymph nodes on diagnostic imaging, and this may lead to unnecessary treatment or surgery. Despite this, however, the long-term effects of these findings have not yet been studied, and so this has led to speculation that tattoos could be a possible cause of cancer.

Long-term effects

We know that skin infections are a common side effect of getting a tattoo, and that individuals should therefore be up to date with tetanus and hepatitis vaccinations. Granuloma formation (mass of granulation tissue formed because of inflammation or a foreign substance) and allergies are also often reported to occur because of tattooing, as they appear directly in the tattooed skin area.

However, chronic health effects such as cancer are more complicated to track as they usually do not emerge until years after exposure, and so are difficult to link back to the tattoos or certain tattoo ingredients. Consequently, epidemiological data that tracks large cohorts of tattooed individuals for decades will be necessary (with comparison to others who are not tattooed), to show whether there is any connection between tattoo ingredients and long-term adverse effects.

A researcher from the European Synchrotron Radiation Facility in Grenoble, France, has reported that no research has ever been done on the depositing of elements from tattoo ink into lymph nodes. So currently, we do not know if tattoo ink has any long-term consequences inside the body. Therefore, rather than advising people that the colours in tattoo inks are safe, we should instead advise that with no research done as yet, there may be unknown, long-term risks associated with tattooing.

Advice to individuals

Since many teenagers and young people in the USA have been using tattoos as a form of body art, the American Academy of Pediatrics (AAP) recently offered its first guidance on tattoos.

It advised that doctors and parents should emphasise that tattoos are permanent, and trying to remove them can be both expensive and very painful. Usually, removal by laser is necessary and can cost US$600 or more for removal of a three-inch tattoo.

Consequently, AAP recommended that doctors pre-screen young persons on their first visit regarding whether they may be considering doing body piercing or getting a tattoo. This will provide a ‘jump-off’ point into the conversation. The psychological motivations for such body modifications will need to be explored.

Young people experiencing depression, anxiety, or mania (mental illness marked by periods of great excitement or euphoria) sometimes make choices that they later regret. It is therefore important to ascertain whether the desire for body piercing or a tattoo is a well-thought-through desire for the application of body art, or a more impulsive reaction that might reflect mental health and substance abuse problems.

Body piercings and tattoos

Body piercings (multiple piercings of ear lobes and other body parts) and tattoos can also cause keloids (overgrowth of fibrous tissue at the site of a scar or injury). Consequently, these should be discouraged and temporary or henna tattoos be recommended as being less hazardous.

Individuals should also be encouraged to consider whether safe places exist to get these done, what training the artists may have received, and whether proper safety and emergency protocols are in place at the facility.

Doctors have the obligation to raise awareness among people of the real possibility of complications with permanent sequelae to their actions. Individuals should be encouraged to also consider the social as well as physical implications of their actions, since body modifications can have negative consequences on the person’s future, including employment opportunities.

Many careers (for example the police and military) and some professions exclude people with visible tattoos on their skin, and stigma and discrimination in the workplace are likely to persist for many years to come. Individuals should therefore contemplate their long-term interests beyond their immediate, short-term goals and fanciful indulgences.

Derrick Aarons MD, PhD is a consultant bioethicist/family physician, a specialist in ethical issues in medicine, the life sciences and research, and is the Ethicist at the Caribbean Public Health Agency – CARPHA. (The views expressed here are not written on behalf of CARPHA)