Some are pretty. Some creative. Some are evocative for all sorts of reasons. Tattoos have gone from being a relative rarity to a common form of expression, be it hidden or readily visible. Over a third of Gen Xers and nearly half of millennials are marked somewhere with tattoos, and many have more than one, so body art is something that children are being exposed to more frequently as a result of a new generation of parents. Knowing that children follow the habits of the adults around them, tattooing will likely only become more popular.
Of course, not all common behaviors are without risk. Most people who get a tattoo will suffer no health consequences. That is true about almost everything we do to our bodies. Yet, risk is tricky. Driving without a seat belt, experimenting with an addictive substance, stopping over the railroad tracks — most of the time, these things go well. It is the other, less frequent risk occurrences that can be serious or hard to recover from that we need to be aware of. Tattoos can be like that — sometimes things do not go right and we should be prepared for that.
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The tattoo causes local trauma, so most people will experience some degree of pain, redness and swelling, but these effects are usually short term, resolving in a few days. Still, infection is a real concern. Most of my patients who show me their unique designs after they get them (and sometimes before their parents know) tell me that their tattoo artists used clean needles or washed them in bleach. Unfortunately, that is not enough.
We do not know the exact proportion of tattoos that result in complications. It is estimated that some 5 percent of tattoos result in an infection, usually bacterial, but viral and fungal infections are also possible. Besides the needles, which should be discarded after each use, the ink itself can be contaminated, as confirmed in a recent study that sampled open and unopened bottles. Bacteria was recovered from both, indicating that in some cases, the ink is contaminated at the point of manufacture. To get the right color, artists may dilute ink with water, which is another potential source of infection, as the studio may not use sterile water in single “dose” containers. In other cases, patients have become infected after the tattoo is inked, as the skin is inflamed, allowing easier access to microbes in the environment.
Infection may be local and can cause scarring. This is particularly concerning when the area is large or on the face, such as occurs with make-up tattooing to provide color to the eyes, or lip, or to augment the eyebrows. Less often, but more worrisome is that the infection can expand, such as with impetigo or cellulitis, and can seed into the bloodstream with the potential to cause sepsis. Once in the bloodstream, infection can head anywhere, including the heart. There have been case reports of endocarditis caused by tattoos. Endocarditis is an extremely dangerous infection in the heart tissue, which is hard to treat. It is more common in those with an immunodeficiency or who have irregularity of the heart valves.
Other risks include allergic reactions, photosensitivity, and delayed hypersensitivity, which may occur months or years after getting a tattoo. Those with a history of dermatitis, immune disorders (including autoimmune disease), even if in remission, should think twice before getting a tattoo and have a conversation with their healthcare provider.
Most people who get tattoos are passionate about the design they choose that they feel defines them or symbolizes someone or something they love. They are certain at that moment that they will want that tattoo forever. Yet, even passion and love sometimes lead to regrets. Many chose a tattoo for fashion reasons, yet even fashion changes. What proportion of people with tattoos who regret their decision is not well established but research suggests it may be approximately two out of five, and the younger one is at the time of tattooing, the more likely regret will eventually set in. Of those who choose to remove a tattoo, the average wait is long — 14 years between when they begin to dislike their tattoo and when they decide to actually remove it. That likely has much to do with access to tattoo removal, which is not a common procedure and not usually covered by insurance. Most tattoos will require 4 to 10 treatments to result in removal.
So, deciding to get a tattoo because you “love” the idea, want to show your love or devotion, have a broken heart due to loss, or simply because you think it looks good may not be enough reason to put you at risk of infection, scarring, heart disease, or years of heart-panged regret. Think it through and talk to your doctor about your risk.