It has been demonstrated with increasing clarity and frequency that the quality of ink is decisive in determining the occurrence of side effects upon tattoo removal, regardless of the method used.
Nowadays nobody with a tattoo knows what dye was applied to their body, nor what the dye contains or where it came from. Mostly, not even the original tattooist knows exactly what is involved. One thing is clear: a few years after the tattoo is applied, there is practically no way to ascertain what kind of dye was injected into the skin. In addition, according to Dr. Klaus Hoffmann, head of the department of Cosmetic Medicine and Surgery and Cosmetic Dermatology at the St. Josef Hospital in Bochum, every tattoo is problematic because “Sixty to eighty per cent of the ink that is injected does not end up in the tattoo, but instead accumulates elsewhere in the body.” (1). The safety data sheets that are mandated by the European Cosmetic Directive are rarely available for each individual ink in the tattoo parlour. If the authorities monitor compliance with the regulations at all, they only do so extremely rarely. The BfR (the Federal Office for Risk Assessment in Germany) noted in an official statement: “According to a study by Klügl et al (2010) around two thirds of all people with tattoos develop associated skin conditions, which are chronic and enduring in around six per cent.” (2)
A study by the University of Northern Arizona has recently demonstrated that the ingredients and raw materials of dyes from different manufacturers can have entirely different compositions (3). Isabelle Catoni, a dermatologist from Paris, wrote in the French Huffington Post: “Some Asian wholesalers use paints or polycyclic aromatic hydrocarbons to increase the intensity of their colours.” Tattoo artists compete with one another and one competitive aspect is the brightness of their tattoos. Accordingly a tattooist will usually use his or her own “secret” mixture, i.e., each artist prepares his or her own colour cocktail. Once a tattoo has been inked, the composition of the ink is almost impossible to determine.
Over the last few years, multiple studies into toxic ingredients in tattoo ink have been carried out, and to date none of the studies has reported positive findings. The list of ingredients in tattoo inks is frightening:
The results of ongoing scientific studies will only be available in a few years’ time, due to the scope of the studies and the observations that must take place over the course of several years. (9)
In any event, it is clear that multiple clinical observations have demonstrated the effects of tattoo ink on the human organism. Nanoparticles can for instance enter the bloodstream and disrupt the function of vital organs such as the liver. Several studies on both living and deceased human subjects have shown that the lymph nodes of tattooed individuals to some extent contain a range of multi-coloured tattoo inks, thereby blocking the vascular openings internally and thus severely limiting the function of the lymph nodes.
Particularly severe allergic reactions occur in individuals who suffer from psoriasis and vitiligo (skin depigmentation). The Paris-based licensing authority for medicines in France, ANSM, recently warned strongly against instances of itching, swelling and eczema following contact with metallic pigments (see above).
Allergies often manifest themselves in the form of necrosis, hyperpigmentation and hypertrophic scars. Dr. Jacques Bazex, a dermatologist and expert court witness based in Paris adds that certain allergic reactions such as granulomatosis or sarcoidosis (inflammatory diseases of blood vessels in the organs such as tissue nodules in the lungs) may not occur until much later. Pseudo-lymphomas (enlarged lymph nodes) can present with pathological effects as much as 32 years after the original exposure to tattoo ink.
Toxic pigments can trigger eczema and psoriasis, etc. Persons who already suffer from these skin conditions should not be tattooed; otherwise these complaints may become chronic or may spread to other organs within the body.
The renowned laser researcher, Professor Wolfgang Bäumler, a laser specialist at the University Clinic of Regensburg further states: “Clearly allergic reactions to dyes and the impurities that they contain are always possible. Equally, foreign body granulomas can also develop.” (10)
According to Dr. Reinhard Dummer, a dermatologist at the University Hospital of Zurich, polycyclic aromatic hydrocarbons found in tattoo inks can cause leukaemia, lung or colon cancer. He warns that the popularity of tattoos is a time bomb, because the tattooed person experiences lifelong exposure to toxic chemicals and it is impossible to know when the bomb will go off. At the European Academy of Dermatology and Venereology (11) two Finnish patients were reported, each of whom had developed an asymmetrical melanoma (skin cancer) on the site of an old tattoo. To date around fifty cases of skin cancer on tattoos have been described and the trend is for this number to increase. Most of these melanomas develop on darker tattoos and they are therefore often not recognised until quite late.
In her ground-breaking dissertation “Determination and Quantitative Extraction of Red Tattoo Pigments” (Regensburg, 2007) (12) which is well worth reading, Eva Engel impressively demonstrated the carcinogenic effect of red tattoo inks.
The secondary health effects of tattoos have not yet been studied extensively. Due to the multiple instances of contact with simple rubbing alcohol for sterilisation, the permeability of the skin in the affected area is increased, potentially allowing chemicals to enter the bloodstream unhindered. This can cause cellular mutations in the skin and can act as a trigger for melanoma (skin cancer).
Scientists and doctors agree that the mere fact of applying tattoo ink to the skin increases risks to health. It is beyond doubt that skin conditions can be attributed to the toxicity of tattoo ink with a high degree of probability, or at least that this cannot be excluded in the majority of cases. Only a detailed chemical examination of the tattoo ink that is used can provide a definitive answer, however.
People with tattoos entirely lack the means to assess the dermatological consequences of their choice with any degree of reliability whatsoever, and the long-term risk is wholly underestimated, in part through the way in which tattoos have become socially unremarkable.
In every case where tattoos are removed, it is advisable that all toxic ink should leave the body to the fullest extent possible. Laser tattoo removal is not well suited to achieving this outcome, as the ink is only reduced in size and distributed throughout the entire body, even in the best case scenario. In isolated cases, the ink may even undergo chemical changes that could cause cancer. In the event that allergic reactions or pathological changes are already diagnosable, a medical professional should be involved in order to assess whether tattoo removal is suitable or whether it is preferable to abstain from removal altogether.
Researchers and practitioners are in agreement, and studies continue to confirm the contextual effects of toxic components of dyes, as these components are the cause of many of the side effects of all kinds of tattoo removal. Nevertheless, further long-term studies are necessary in order to understand the complex interactions better. Despite the overwhelming weight of evidence, people have hitherto been reluctant to draw the logical conclusions and take the actions that this evidence suggests.
Why should this be the case? A senior manager within the German public health authority, who did not wish to be named, compared the danger of tattoos to public health with that posed by alcohol and smoking, in that people knew for a long time how dangerous they could be. In those cases as well, the authorities failed to take substantive action and only token measures were taken. In any event, tattoos are a long-established and accepted practice within society at large and accordingly it would be unpopular, and perhaps unfeasible, to take action against them.
As natural methods of tattoo removal become more widespread, the dangers posed by the use of laser devices to remove tattoos will be mitigated further. The Skinial Method, alongside other natural methods that are sure to be developed in the coming years, will certainly have its part to play in achieving that outcome.
(1) Interview mit Dr. med. Klaus Hoffmann, Leiter der Abteilung für Ästhetisch Operative Medizin und kosmetische Dermatologie des St. Josef-Hospitals in Bochum in „Spiegel Online“ am 2.8.2013
(2) „Nickel in Tätowiermitteln kann Allergien auslösen“ Stellungnahme Nr. 012/2013 des BfR (Bundesamtes für Risikobewertung) vom 25. Oktober 2012
(3) Emma MORRIS, „Is Tattoo Ink Safe?“, BioED Online 2012
(4) Veröffentlichung des Public Health, England, London 10.2012
(5) Anne Marie Helmenstine, PH.D., Tattoo Ink Carrier Chemistry, About.com
(6) Workshop über « technical/sicientific and regulatory issues on the safety of tattoos, body piercing and of regulated practices » Europäische Gemeinschaft, 2003
(7) Zitat aus der Stellungnahme Nr. 012/2013 des Bfr vom 25. Oktober 2012 „ Nickel in Tätowierungen kann Allergien auslösen“ in dem auf folgende Studien Bezug genommen wird: Beatrice Bocca, Bioelements and Health Unit, Italian Ministry for Health, Roma „Heavy metasl in tattoo inks
(8) Forte G, Petrucci F, Bocca B (2008) Metall allergens of growing significance; epidemiology, immunotoxicology, strategies for testing and prevention. Inflammation & Allergy – Drug Targets 7, 1145 – 162; und Dänische EPA (2012) Chemical substances in tattoo ink. http://www.mst.dk/Publikationer/Publications/2012/June/978-87-92779-87-8.htm
(9) Linda M. Katz, M.D., M.P.H. Director, Office of Cosmetic and Colors U.S. Food and Drug Administation in “Regulations of Tattoo Inks in the US”, 2013
(10) Prof. Dr. rer. nat. Wolfgang Bäumler, Laserspezialist der universitätsklinik Regensburg in Biedersteiner Kolloquium „Haut und Allergie“, München, 2006 zitiert aus ÄP DermatologieAllergologie 1/2006 S 11-12
(11) European Academy of Dermatologe and Veneroloqy) (tt) – Kluger N et al. Melanoma on tattoos: two cases from Finland. P 441, EADV 2013 in Istanbul
(12) TATTOO PIGMENTS IN SKIN: Determination and Quantitative Extraction of Red Tattoo Pigments, Dissertation University Regensburg, Institut for Organic Chemistry von Eva Engel, 2007 (Prof. Dr. B. König) Link: http://d-nb.info/989763633/34
(13) „Tattooing, inks & cancer: Facts and Controversies“ Nicolas Kluger, University of Helsinki, Department of Dermatology, Allergologiy and Venereology Skin and allergy Hospital HYKS, Helsinki