Complications of Tattooing

Granuloma

There are many complications of tattooing. The most common adverse event is infections, due to bacteria (mainly Staphylococcus and Streptococcus), viruses (hepatitis B and C or HIV), or fungi. The second most common complication is an inflammatory response to the pigment, usually manifesting as a granulomatous reaction. In rare cases, a granuloma found within at tattoo can reveal an existing sarcoidosis. Mercury (red) and cadmium (yellow) pigments are particularly likely to induce allergic reactions, though reactions tn chromium (green), cobalt (blue), and beige pigments have also been reported. ln the case of cadmium, the trigger is often sun exposure, which appears to trigger a photo-allergic reaction. Since red tattoos often contain traces of yellow, they may also induce photo-toxic reactions.

Melanoma

Keratoacanthomas and other skin tumors, including melanoma, have also been reported after tattooing. Due to the million of tattoos annually performed and the very small number of tumors reported, a causal relationship is difficult to ascertain. However, particular care is needed when a melanoma arises within or near a tattoo, as the black tattoo pigment can mask a developing melanoma. In addition, the common finding of tattoo pigment in the lymph nodes draining a tattoo site can complicate the staging of melanoma during nodal dissection, or even mimic melanoma.

Allergic reaction to red ink

Tattoo toxicity was recently studied by Baumler et al. as a function of pigment concentration in the tissue. The group introduced red pigment PR22 at 98% purity into human or porcine skin and measured the concentration of the pigment in various locations. Based on the distribution profile of this marker ink, they concluded that dyes which are potential carcinogens may reach levels in the skin that could lead to potential health problem.