Tattoo Ink: Mislabeled, Minimally Regulated, and Permanent – Is There Cause for Concern?

 Tattoo Ink: Mislabeled, Minimally Regulated, and Permanent – Is There Cause for Concern?

Originally published by
A Voice For Choice Advocacy on February 29, 2024.

EDITOR’S SUMMARY: Nobody has your tattoo, especially if you didn’t pick your design out of a notebook of stock images from your local tattoo shop. Your colors, the way it moves on your body, and the unique symbolism it represents are all yours. This is special; this is art. Donning tattoos is part of mainstream culture; no longer relegated to musicians, nonconformists, or other stereotyped individuals or communities. To assess the health risks of ink exposure, consider the research, and stay on top of best-known practices. 

Getting a tattoo can be a rite of passage—an empowering act of self-actualization. It’s also a way to express yourself through a medium of artwork where the canvas happens to be your skin. You can mark memories, set milestones, or pay homage to loved ones who’ve passed. Colors abound as you use your imagination to create a scenario, and allow the tattoo artist to paint their magic.

Tattooing has been around for thousands of years, and body art has become more mainstream of late: According to a 2023 Pew Research survey, 32% of Americans have at least one tattoo, including a whopping 56% of women ages 18-29. Between the lengthy history of tattoos, and the increasing number of avid takers, you’d think safety data on tattoo ink would be abundant, but it’s sorely lacking. 

How Tattoos Work and Why They Stick Around

A tattoo makes its home in your skin when a tattoo artist uses a needle to poke through the epidermis—your outer layer of skin—into the layer below, the dermis, where capillaries draw in the ink. From there, white blood cells known as macrophages come rushing in to tend to your body’s perceived injury (repeated needle piercing), and basically eat up the invader (the ink). 

When the macrophages die, they release the previously gobbled-up ink particles, and new blood cells come in to take over, once again absorbing the “foreign” ink. Because dermal (skin) macrophages don’t move around the body like some other immune cells do, the design remains where it was created. The recent discovery of this cellular turnover could explain why tattoos tend to fade over time. It’s possible that some color is lost as the old cells die, and the new ones reabsorb the released pigments.

However, the ink particles don’t always stay put. A 2017 study, “Synchrotron-based ν-XRF mapping and μ-FTIR microscopy enable to look into the fate and effects of tattoo pigments in human skin,” found that particles from the tattooed skin were sometimes transported to the lymph nodes, “which leads to chronic enlargement of the respective lymph node and lifelong exposure.” Toxic elements found in the subjects’ tattoos, such as chromium and nickel, were also found in the lymph nodes. 

This particular study was quite small, using samples from only six people; four tattooed, two not. Two of the four tattooed donors had pigments that had permeated the lymph nodes, but that doesn’t necessarily imply that half of the tattooed population has pigment in their lymphatic system. It does, however, reveal that pigments are not as restricted to the tattoo site as previously thought, and at the very least, merits further investigation into this concern. 

From “Nanoparticles from tattoos travel inside the body, scientists find,” at ScienceDaily, the author’s thoughts on traveling pigments: 

“… what we didn’t know is that they do it in a nano form, which implies that they may not have the same behaviour as the particles at a micro level. And that is the problem: we don’t know how nanoparticles react.”  

Some inks contain substances also used in car paint and printers. Chances are, if you’re interacting with industrial paint or printer ink, you’re wearing gloves or thoroughly washing your hands afterward, so the idea of such components residing within your skin for life may not sit well. The Swierk Research Group, an organization out of Binghamton University in New York, has been researching tattoo ink ingredients, with disturbing findings. 

Researchers tested nearly 100 inks, and found that although tattoo ink manufacturers in the U.S. are supposed to provide an ingredient list, some of the products contained ingredients not declared on the label. Among the inks they tested, 23 showed evidence of azo-containing dye. Azo, in and of itself is not necessarily a health concern, but when compromised by bacteria or ultraviolet (UV) light, azo particles can break down and become carcinogens.

Some pigment particles were found to be smaller than 100 nanometers, posing a size concern. Said John Swierk, the study’s principal investigator: 

“When you get down to that size regime, you start to have concerns about nanoparticles penetrating into cells, getting into the nucleus and doing damage, possibly causing cancer.” 

Juliet Morrison, a virologist at UC Riverside, wonders if those white blood cells may miss other dangers such as pathogens if they’re stuck tending to foreign pigments. But French immunologist Sandrine Henri, whose team discovered the macrophage-eating-ink process, hypothesized that those white blood cells could send signals for and receive assistance from other macrophages, in the case of a bigger immune threat. Though both scientists made their best guesses, much remains unknown.

Why Don’t We Know More?

Tattoo ink regulations in the U.S. fall under the U.S. Food and Drug Administration (FDA). However, the FDA has deemed tattoo ink a purely cosmetic product. If you find this designation a bit baffling, you’re not alone. While products like eyeshadow and foundation can certainly seep into skin pores, that’s a far cry from being applied to the dermis via needle. It seems some distinction here would be wise.

There are products, such as fluoride toothpaste, that fall under a sort of cosmetic-drug combo, subjecting them to greater FDA oversight. You’d think if ever a product would qualify for this designation, it would be tattoo ink. But no such luck. As it stands, the FDA reserves its involvement for specific issues like product contamination rather than long-term exposure.9 In fact, no inks are FDA-approved for injection into the skin. 

A baby step in the right direction, the Modernization of Cosmetics Regulation Act of 2022 (MoCRA), issues guidance to tattoo ink manufacturers. Under this law, manufacturing facilities must register with the FDA, and they must list each cosmetic product marketed, including ingredients, as well as provide annual updates to the FDA. However, in terms of safety, MoCRA states that “neither the law nor FDA regulations require specific tests to demonstrate the safety of individual products or ingredients.”

Fast forward to February 2024. While researchers out of Binghamton University were investigating [“What’s in My Ink: An Analysis of Commercial Tattoo Ink on the US Market”] how light affects tattoos and their chemical components, they came across a unique discovery. Looking at 54 samples of ink in a variety of colors from U.S. manufacturers, 90% showed significant variances from the ingredients identified on their labels

These unlisted substances included hidden additives. Clearly, manufacturers need to raise their standards and tighten up their processes. From “Most tattoo ink bottles contain mislabeled ingredients, may harm organs”:

“Surprisingly, more than half of the samples contained polyethylene glycol, a compound that could lead to organ damage with repeated exposure. Other findings included propylene glycol, a known allergen, an antibiotic used for urinary tract infections, and 2-phenoxyethanol, which poses risks to nursing infants.”

On the Flip Side … Over-Regulation?

On the other end of the spectrum, tattoo artists in the European Union (EU) are upset over what they perceive as excessive regulation. In 2022, the EU banned pigments Blue 15:3 and Green 7 over concerns about possible carcinogenic or mutagenic dangers. However, the data remains a bit ambiguous.

Ines Schreiver, a tattoo ink researcher at the German Federal Institute for Risk Assessment, recently studied the two pigments and concluded that they had a “comparatively low level of toxicity.” Tattoo artists fear their businesses will be gravely affected by the new regulations, seeing as the blue and green ban doesn’t mean just losing those two colors, but also shades to which they contribute, such as purples and browns.

Is this kind of ban sensible caution or overkill? Jan Homolak, a Ph.D. student in pharmacology at the University of Zagreb in Croatia, takes a more nuanced approach to specific pigments in tattoo ink. He cites the example of copper, arguing that Cu copper in soluble form is indeed an “impurity,” but that another form of copper, CuPC, or copper phthalocyanine, “is characterized by extremely low toxicity.”

So much so, in fact, it’s an FDA-approved additive, both in foods and in a medical capacity (contact lenses and sutures). This would seem an important distinction among blues and greens when it comes to safety regulations. Regardless of color, scientists have expressed concern over the heavy metals in some tattoo inks. In 2022, a group of Indian researchers studying such inks wrote:

“Heavy metals, namely, cadmium, lead, mercury, antimony, beryllium, and arsenic are responsible for cancer, neurodegenerative diseases, cardiovascular, gastrointestinal, lungs, kidneys, liver, endocrine, and bone diseases. Mercury, cobalt sulphate, other soluble cobalt salts, and carbon black are in Group 2B, which means they may cause cancer in humans.”

However, some of these substances are categorized this way based on industrial use, often through inhalation or applying other cosmetics. Little is known about their effects when the exposure is via tattoo. Without thorough research, it’s hard to define regulations, and without regulations, you are left to your own best judgment. 

Beyond Toxicity Concerns

If you’ve already gone down the tattoo route, there’s a little-known caution to keep in mind. Although rare, the magnetism from an MRI (magnetic resonance imaging) can interact with metals in your ink. This means pigment particles such as iron can essentially serve as electrical conductors, potentially causing discomfort, or even burns at your tattoo site. 

Burns are infrequent, but a few characteristics can put you at greater risk: color, shape, and location. Red tattoos may pose the greatest risk because of their tendency to include iron oxides. According to Moriel NessAiver, a physicist who teaches MRI safety, because iron is magnetic, it can be especially susceptible to the machine’s magnetic fields. Regarding shape, he cautions:

“If the tattoo is in the shape of a loop, it can act like an antenna, and can also get increasingly hotter as the ink pigments pick up more energy from the magnets.”

Tattoos on the eyes, like permanent eyeliner, can pose additional risk because of the eyes’ particular sensitivity to heat. A case study of a young woman with tattooed eyeliner reports that she suffered first degree burns from a cranial MRI. Although medical personnel immediately stopped the procedure upon complaints of a burning sensation, she spent the next three days in the hospital. Thankfully, by the end of her stay, her eyelids had returned to normal. As for the ink used in her tattoo, the manufacturer’s certificate of analysis reported components such as lead, copper, zinc, chrome, arsenic, cadmium, barium, and mercury.

If burning loops and danger to your eyelids have you thoroughly freaked out, keep in mind these occurrences are not common. A six-year study in London followed 330 people with tattoos who underwent MRIs. Of those, only one reported a warm, tight feeling around the tattoo site, at which point the MRI was stopped, and the sensation resolved within 24 hours. Granted, this study excluded people with tattoos over five percent of their bodies, or larger than 20 cm, as well as those with tattoos on their heads, necks, or groins. Still, researchers concluded that the probability of an adverse reaction was 0.17%.

Diagnostic Issues

Aside from safety concerns when it comes to medical procedures and tattoos, there’s also the possibility of diagnostic issues. Pigment particles traveling to and sticking around lymph nodes can mimic enlargement, or appear similar to calcification, indicating possible medical problems.

If you go in for a mammogram and that pigment has ended up in your axillary (armpit) lymph nodes, it may give that tissue an abnormal appearance. This finding is often indicative of metastatic disease (i.e. breast cancer that has spread to the nearby lymph nodes) and could lead to a misdiagnosis.

Even in surgery, pigmented tissue can be mistaken for malignant tissue. Another concern is skin cancer—not in terms of increased risk due to tattooing, but rather, making diagnosis more difficult by obscuring moles and other signs of melanoma.

Tattoo Removal

If you have tattoos, and feel worried about mysterious compounds residing in your skin for life, there’s always the idea of removal. But will removing your tattoo make a significant difference, and alleviate all health risks? The answer is … It depends.

Tattoos are most commonly removed by laser, breaking down the ink particles so they’re small enough for your immune system to carry them away. But making pigments smaller can also make them freer to end up in various parts of your body. Since intact ink particles can be found in nano form, just how small do they become when blasted by a laser, and where do they go? Unfortunately, little research exists to answer this. 

In a 2018 letter to the “Journal of Investigative Dermatology,” a group of scientists concluded that laser treatment of certain tattoo pigments (in this case, orange and yellow) formed hazardous substances; some carcinogenic (potentially cancer-causing). While it may be troubling to think about heavy metals or cancer-causing remnants making a trip around your body, at this point, doctors believe that the broken-down pigments are mostly excreted through sweat, urine, and feces.

The colors of your tattoo can also affect removal. Doctors use different lasers to rid your skin of specific colors. White ink generally doesn’t respond well to lasers, and can actually turn darker because white reflects light. Darker colors absorb certain ranges of light, making them easier to remove.

Red poses the most danger if you’re already sensitive to it. Dr. Glenn Messina, doctor of aesthetic medicine, addressed red ink in tattoos: 

“When we laser it, and we start shattering that red ink and exposing your immune system to that red ink, you’re giving it a tremendous antigen load, and there’s a risk of having an allergic reaction right there.” 

He cautions that a reaction could be as mild as hives, or as serious as anaphylaxis, and it could happen during the procedure, or hours later as the pigments make their way through your body. This is mostly a concern when there’s a “preponderance of red ink.” If that’s the case for you, it’s best to do removal in small sections, and see how your body reacts so it doesn’t get overwhelmed.

There are other removal methods such as dermabrasion and chemical peels. Instead of blasting the ink, they remove the outer layers of skin containing the ink particles. Dermabrasion can be painful, but a local or even general anesthesia may be used, and it results in an open wound that can take 10–14 days to heal. Chemical peels generally heal within a week.

If a tattoo is small enough, a doctor might use surgical excision, removing the tattooed area and bringing the surrounding skin back together. This method usually creates a scar at the removal site.

What About Henna and Less-Synthetic Options?

If the siren song of body art calls to you, one option you might consider is tattoo’s less permanent cousin, henna. Henna has been used for thousands of years to dye hair, skin, and nails. Derived from the henna tree, it contains lawsone, an acid that reacts with the keratin in your skin, aiding in the dyeing process. When your skin (or hair) sheds the lawsone-containing layer, the color goes with it

Henna has its limitations: It lasts an average of one to two weeks, and its color is primarily an orange-red-brown. If you find a different shade of henna, use caution: Substances must be added to darken henna’s natural color, and one of those may be p-phenylenediamine (PPD), an ingredient that the FDA says can cause dangerous skin reactions in some people.

If you’re looking to try out self-expression in a safer, less-committed way, there are more options than ever for temporary tattoos. Tattly is one company offering a variety of designs by professional artists, printed using vegetable-based ink compliant with FDA regulations.

For a slightly-longer-lasting-but-still-temporary experience, Inkbox offers tattoos that last a week or two. They’re forthcoming with their ingredient list, and declare that their ink meets cosmetic guidelines and has been clinically tested. Their offerings contain no animal products, and are cruelty-free. They even offer a “freehand tattoo marker” if you want to draw your own tattoo right on your skin.

If you decide a full-fledged, everlasting tattoo is still for you, take a few precautions. Choose your artist carefully. Make sure the tattoo shop you use is fully licensed (if your state regulates them). Inquire about their inks before going in for the actual procedure. Tattify suggests recommended inks, and “What’s in My Ink” breaks down ingredients for a variety of inks. “Ink Instructor” lists specific brands and ingredients to avoid, such as mercury, nickel, and lead, to name a few.

If you’re in the market for ink that is vegan, quite a few have entered the field. One of the most transparent is Intenze. Their inks are sterile, FDA-compliant, and their bottles are now made of PET plastic (nontoxic and more environmentally-friendly than PVC). Their website offers testing certificates for each color.

Beyond the actual tattooing experience, inform medical practitioners of any tattoos you have prior to a relevant procedure. This will help ensure proper precautions are taken for your safety, and for accurate diagnosis of any issues.

If you’re currently adorned with illustrative body art, and want to minimize trouble from your ink, your best strategy may be using organic sunscreen generously (use awareness with chemical-laden, conventional brands). Sunlight is a great source of vitamin D production, but since much of the concern with tattoo pigments is what happens when they break down, and light is a primary cause of that, it makes sense to pay extra attention to protecting your tattooed skin as much as possible.

With the growing number of diverse populations partaking in tattoos, hopefully scientists and the FDA will take greater interest in the safety of inks used. Until then, if you decide on a permanent tattoo, choose wisely, and enjoy being unquestionably you.