The booming tattoo industry has decorated the skin of a growing population, especially young adults. Nearly 30% of Americans now have at least one tattoo, and almost half of millennials have gotten inked, according to recent surveys. But how safe are tattoos?

Background: When getting a tattoo, permanent ink is injected into the skin, so some complications—skin infections and allergic reactions, for example—can occur under certain conditions.

With modern hygiene and good safety practices, tattoos are generally safe for people in good health. But according to an article recently published in BMJ Case Reports, the experience of a patient in Scotland highlights another risk of getting decorative body art—especially for anyone with a weakened immune system.

Here’s what happened: Several years after receiving a double lung transplant, a woman got a tattoo on her thigh. Within weeks, disturbing symptoms, including hip and knee pain, emerged. The pain was severe enough that she needed to take strong painkillers. The patient also developed muscle weakness that required physical therapy. After extensive testing, a muscle biopsy showed inflammatory myopathy, a condition that causes chronic muscle inflammation, near the site of her tattoo. One year after her symptoms started, she began to improve. She was pain-free after three years.

With no other plausible causes found, the doctors concluded that the woman’s immune system, which was suppressed by the antirejection drugs she had taken to protect the donated lungs, made her susceptible to the muscle disease—a condition likely precipitated by the tattoo.

Similar health problems have been documented in people getting tattoos in the US. For example, a skin infection known as non-tuberculous mycobacterial (NTM) was reported in 2012 in at least 14 people who had received tattoos from a New York tattoo artist who was believed to have used nonsterile water to dilute the tattoo ink. This type of infection typically requires four to six months of treatment with powerful drugs that can have serious side effects or, in some cases, surgery to remove the infected tissue.

In addition, hepatitis C virus can be spread through unregulated tattooing. From 2004–2016, the FDA has received 363 “adverse event reports” involving tattoos.

To help protect consumers against such health risks, the CDC recommends that anyone getting a tattoo…

  • Use tattoo parlors approved/registered by their local jurisdictions.

The CDC further advises that tattoo artists should…

  • Not use inks or other products that are not intended for tattooing.
  • Not dilute ink before tattooing—if dilution is needed, only sterile water should be used.
  • Not use nonsterile water to rinse equipment (for example, needles) during tattooing.
  • Use aseptic technique during tattooing (for example, maintain hand hygiene and use clean, disposable gloves properly).

Another concern: In rare cases, people with tattoos have developed swelling or burning when receiving a magnetic resonance imaging (MRI) scan due to metals in the ink and the size of the tattoo.

Bottom line: It is not just people who have received organ transplants who have to worry about infections or other complications from tattoos.

Especially people with weakened immunity—either because of an underlying illness or a medication—should also be concerned. For example, people taking long-term steroids or biologic medications for diseases such as rheumatoid arthritis or inflammatory bowel disease may be at higher risk for tattoo complications.

If you’re going to get inked, beware of these hidden dangers!

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