Tattoos have risen to mainstream status while maintaining their rebellious appeal. According to a 2015 Harris Poll, nearly 50% of millennials and 40% of individuals under the age of 35 have at least one tattoo.
Despite their prominence, tattoos are not as safe as most consumers assume. Research regarding their safety has lagged behind their popularity; however, medical science is raising new concerns about toxin exposure and subsequent health risks. These risks may not be clarified or manifest in exposed individuals for years to come.
The United States Food and Drug Administration encourages people to “Think Before You Ink,” however, it does not effectively regulate tattoo ink or its composition. Though it has “not approved any pigments for injection into the skin for cosmetic purposes,” there are no product labeling requirements, leaving consumers at the mercy of ink manufacturers. The FDA acknowledges that tattoo inks may contain industrial strength pigments formulated for printers or automobile paint.
Tattooing is more akin to a medical procedure than many consumers recognize, without a thorough disclosure or understanding of the potential harms. It is important to note that the placement of body ink prompts an immune system response and increases systemic vulnerability to toxin exposure. The European Chemicals Agency (ECHA), a European Union equivalent to the FDA, remarked in 2018 that it is “well known that tattoo inks can and do contain substances of concern such as identified carcinogens.” Carcinogens are chemicals known to cause cancer.
In 2018, the ECHA also proposed legal restrictions to establish concentration limits and regulate the use of more than 4,000 chemicals found in body ink. Chemicals within the scope of the proposed restriction included carcinogenic, mutagenic and reproductively toxic substances as well as heavy metals. Each of these has been shown to be present in tattoo ink. Later, in March of 2019, the agency adopted the resolution.
Parlors may also use their own proprietary pigments containing various admixtures of heavy metals and carriers. No legal obligation exists to disclose the specific ink composition to consumers; its constituent components may be unknown even to artists. Despite the promotion of “organic” or “vegan” inks, the case remains that there are no known safe tattoo inks due to a lack of safety studies involving these compounds and their permanent deposition in human tissues.
In Europe, from 2007 to 2017, 190 tattoo inks and permanent makeup products (including many imported from the U.S.) were banned or removed from the market following safety alerts by the European Rapid Alert System.
Black ink has been shown to contain high levels of carcinogenic hydrocarbons including Benzo(a)pyrene, which is also present in cigarettes. Black pigments are also particularly rich in nanomaterials and carbon-black nanoparticles have demonstrated cell toxicity and harm to various organ systems in animal models.
Heavy metals, such as mercury, cadmium, lead and arsenic, are another source of body ink toxicity. The heavy metals identified in tattoo inks carry known risks of cancer and reproductive toxicity. Animal and human studies have also shown that tattoo ink migrates from the site of placement into the bloodstream, lymph nodes and liver. Cancer patients with enlarged lymph nodes have demonstrated tattoo pigment in surgically extracted lymph node specimens, mimicking metastases.
In September 2018, the FDA advised consumers of the following: “[The] FDA continues to evaluate the extent and severity of adverse events associated with tattooing and is conducting research on tattoo inks. As new information is assessed, we will consider whether additional actions are necessary to protect public health.”
It remains indeterminate as to whether tattoo ink causes cancer; more research is needed to better characterize these risks. We may not have a clear idea for years.
But there’s enough smoke to suspect the presence of fire. The FDA should move beyond ‘Think Before You Ink’ and make ink manufacturers accountable for the safety of their product composition. Tattoos are a highly prevalent part of American culture and consumers deserve the protection of legislation to minimize the risks to their health.
Smith is a physician specializing in male reproductive medicine and surgery at the University of Virginia.