The trouble with tattoos

Because tattooing involves breaking the skin barrier with a needle and injection of a pigment, it has health risks, including infections and allergic reactions. (AP Photo/Lawrence Jackson)

By Rima Himelstein, M.D.

A flower on the ankle ... a butterfly on the lower back ... a Chinese symbol on the chest ... a tribal sign on the upper arm ... more and more teens are sporting tattoos.

In the United States, an estimated 10 percent of teens have tattoos. As with everything teenagers do, there is no one reason. A teen may get a tattoo as part of his or her search for identity ... to be unique ...  or because of the influence of friends. Tattoos may represent something very personal, like “RIP” for someone they have loved and lost.

Parental reaction ranges from shrug (they may have their own tattoos!) to shock. But whatever you think about tattoos—art, far from art, or somewhere in between—here are the medical facts:

What exactly is a tattoo? It’s a design formed by small needle-puncture wounds deep into the skin that are filled with pigment (“ink” or “dye”). Commercial tattoos are usually made using a handheld, electric-powered machine, which has one or more needles moving up and down between 50 and 3,000 times per minute. The needles puncture about 1/8 inch into the second deepest level of skin, known as the dermis, and insert the pigment. The level of pain varies, and bleeding may occur.

What is the trouble with tattoos? Because tattooing involves breaking the skin barrier with a needle and injection of a pigment, it has health risks, including infections and allergic reactions:

  • Infections of the skin: Tattooing can transmit infections from viruses or bacteria such as staph, including MRSA  (methicillin-resistant staph aureus). Localized skin infections are the most common complications of tattoos and cause redness, warmth, swelling and oozing.
  • Infections spread through the bloodstream: Because tattooing involves a needle coming into contact with your blood, infections like HIV as well as the viral liver infections hepatitis B and C can also be transmitted. In the United States, hepatitis C is about four times more common than HIV and is the leading reason for liver transplants. Most people infected with hepatitis C don’t even know that they have it.   

Allergic reactions: Tattoo pigments are not regulated by the FDA, so they contain non-standardized ingredients. Allergic skin reactions may occur after tattooing, especially with red or yellow dye. Signs include redness and swelling at the tattoo site and possibly even trouble breathing.

No license required? Unlike hair stylists or nail technicians who don’t do anything as invasive as a needle stick, tattoo artists may not be required to complete any formal training or even to have a license. Laws vary by state and city. So don’t take anything for granted when agreeing to a tattoo. FYI, most reputable salons require the permission and the presence of a parent or guardian to tattoo anyone under the age of 18.

Who should definitely not get a tattoo? For some teenagers it is especially risky to get a tattoo: Such as those with heart disease, skin disorders or conditions that affect the immune system—and they should check with their doctors before getting one. If someone tends to get keloids (overgrowth of scar tissue) after skin injuries, it’s also best to avoid tattoos.

Removing a tattoo. Unlike a teenager’s first love or braces, a tattoo is meant to last forever. Laser tattoo removal is more expensive and requires more visits than getting the tattoo in the first place, and the skin may not look normal afterwards.

My advice:

  • Talk about tattoos.
  • Make sure teenagers know the medical risks.
  • Make sure that their tetanus and hepatitis B immunizations are up to date (there are no vaccines for HIV or hepatitis C yet)
  • Talk about the possibility that it may make it harder to get a job.

If they decide they still want a tattoo, how can we help them to do it safely?

  • Find an experienced tattoo artist who has done an apprenticeship, is licensed, and follows health and safety guidelines, like those required by the Philadelphia Board of Health.
  • The after-care is very important. First, listen to the tattoo artist and keep it bandaged as long as they recommend (up to 24 hours).  Clean it gently and apply antibacterial ointment as directed.  Most important: be on the look-out for any signs of infection or allergy! 

Rima Himelstein, M.D., is a Crozer-Keystone Health System pediatrician and adolescent medicine specialist.

Has your teen talked about getting a tattoo—or already come home with one. If so, what’s your reaction?