The practice of tattooing has been around for thousands of years. These days, 21% of adults in the United States report having at least one piece of permanent artwork on their bodies.
Many people who receive these lasting tributes – to loved ones, to pop culture, to religion, or to whatever they’re into – generally know what to look for when selecting a reputable tattoo parlor. Does the artist wear gloves? Does the tattoo shop sterilize their equipment? Did the artist open a sterile needle in front of you? Are things like inks and ointments portioned out for individual use? If the artist can pass this mental checklist, most people feel pretty safe.
One question few people may consider, however, is “What exactly went into that ink you’re about to inject into my skin?” And even if the question was asked, there’s no guarantee that the artist could answer with any great certainty. Concentrated tattoo inks may be made from products that were never intended to be used for tattoos. Tattoo ink manufacturers may use products such as calligraphy ink, drawing ink, or even printer ink to make the products eventually used for tattooing. These manufacturers often sell their products online, and while their states may require them to hold a business license, there is no regulation or oversight of the product itself.
The Importance of Water
While the thought of sharing ink with your office printer might be unsettling all on its own, a key ingredient of concern is the water that is used to either create the tattoo ink product or to dilute the product in the tattoo parlor. Artists will often use water to dilute concentrated inks in order to get the specific shade the client requests. They may also use pre-diluted “gray washes,” which are black inks blended to produce different color intensities.
Some tattoo artists and tattoo ink manufacturers may believe that using distilled or reverse osmosis (a filtration method that removes large particles) water is sufficient to safely create or dilute tattoo ink products, but this is not the case. Any kind of non-sterile water can contaminate the ink with potentially harmful germs, which can lead to infections in those tattooed with the ink. This was the case earlier this year, when public health officials in New York received reports of non-tuberculous Mycobacterial (NTM) skin infections in at least 14 people who had been tattooed with the same pre-diluted gray ink.
Image of M. chelonae from PHIL
In January of 2012, the Monroe County Department of Public Health received a report from a dermatologist that a patient had developed a persistent rash on his arm after being tattooed by a local tattoo artist. Biopsy and culture confirmed that he was suffering from an NTM infection, and the tattoo artist reported that other clients had complained of similar reactions.
The artist noted that the rash seemed to follow the lines created by a pre-diluted gray ink and wasn’t present on areas of the tattoo that were created with other colors. This was an important observation because NTM infections typically don’t spread—the rash-like infection is usually localized to the area that was exposed. Using a list of all of the clients the artist could remember tattooing with the same gray wash, the health department was able to identify 18 additional infections, 14 of which were confirmed to be NTM infections.
The Ink Thins – The Plot Thickens
After being notified of the situation in New York, CDC issued a public health alert to try to identify additional tattoo-associated NTM skin infections. Two previously identified clusters were discovered in Washington, one in Iowa, and one in Colorado, and all were related to inks likely contaminated by non-sterile water either during the manufacturing process or during dilution by the tattoo artist just prior to tattooing a client.
Image of individual with NTM infection
Contamination of tattoo ink products by non-sterile water is an ongoing problem, and this group of identified clusters may represent a snapshot of what we could expect to find at any given time. Until tattoo ink manufacturers and tattoo artists fully understand the dangers of using non-sterile water to manufacture or dilute tattoo ink, these infections will continue to occur, and they can be far more serious than just an annoying rash.
NTM skin infections are very hard to treat, and often require 4-6 months of treatment with drugs that can cause serious side effects. While some people’s infections may resolve just from treatment with medication, others may require multiple surgeries to remove infected tissue and may lead to significant scarring.
So what should people do?
Because tattoo inks are injected directly into people’s skin, CDC recommends that ink manufacturers produce sterile inks. To protect their clients, tattoo artists should do the following:
- Don’t use inks or other products that are not intended for tattooing
- Don’t dilute ink before tattooing; if dilution is needed, use only sterile water
- Don’t use non-sterile water to rinse equipment (for example, needles) during tattooing
- Use aseptic technique during tattooing (e.g., maintain hand hygiene, use clean disposable gloves properly)
To reduce their risk of infection, consumers should:
- Use tattoo parlors approved/registered by their local jurisdictions
- Request inks that are manufactured specifically for tattoos
- Ensure that tattoo artists follow appropriate hygienic practices
- Be aware of the potential for infection after tattooing and promptly seek medical care if skin problems occur
Notify the tattoo artist and FDA’s MedWatch program if you have a problem after getting a tattoo. You can read more in the Morbidity and Mortality Weekly Report.
Leave a Comment: Thinking about getting a tattoo, what are your concerns? Or maybe you already have one, what was your experience like?
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Public Comments
Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this blog is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».
August 23, 2012 at 9:15 am ET - Cumberland Man
All tattoo inks should be required to meet USP standards. That’s an area that I WANT the government involved in.
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August 23, 2012 at 1:08 pm ET - Danielle
I have many tattoos now and only had one get infected my first one. The artist who did it was not sterile and did not know how to propeely care for the tattoo once it was done. A friend looked at it and told me being red and ichy was not normal. You have to look into where you ant to go and ask people around for there oppinions. After diing my home work I have had no more issues and am looking to get another one.
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August 23, 2012 at 2:43 pm ET - Avis
Thank you for this very informative article. I will never get a tattoo and so far, have been successful to discourage my children against getting one as well. I shared this article with a friend who is considering a tattoo and now she’s having second thoughts. I am glad to see articles like this one that will help individuals to make an informed decision about tattooing.
Thanks for all of the great things that you all are doing to protect the residents and visitors to the U.S. and U.S. territories.
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August 23, 2012 at 3:36 pm ET - Jose Gomes Ruiz
Dangers in tattoos.
The largest of them is that they are not conducted by dermatological professionals and good and healthy sterile conditions and there are cases in which the tattoos are done with unsterile needles. Doctors believe that the tattoo may turn out to be serious and with very serious consequences, but here in Brazil, the majority of young people have a tattoo. The incidence is less with older people, but it does present one in 100 cases. Tie dye, can offer risk, not being very well balanced risk offering. Can cause skin Dermatitis, eczemas, inside the body can cause hepatitis B and c. The consequence is that tattoos are performed under antissanitárias. The procedure is more offensive in places where medical authorities do not pay attention to the subject. Here in Brazil the incidence of tattoos by body is huge, there are cases in which we note the entire body tattooed, and cases in which people want and do tattoos even in their most intimate parts.
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August 23, 2012 at 7:27 pm ET - Nicole
I am a professional tattoo artist who cares about the well being of our clients and our staff. All of the inks that we use claim to be sterilized on the bottles labels so I am hopeful that the inks that have caused this bacterial infection are not the ones that we use. However, how are we, the tattoo industry able to make sure that what we are using is the safest possible product? These brands were not released by name, we were never contacted by our health department. This information is very important to us and necessary.
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August 23, 2012 at 9:15 pm ET - panupong pudthasa
that very good news to alert the people all around the world
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August 23, 2012 at 9:49 pm ET - Kathy
Please pass this article on to whoever has the deathly wish of getting a tatoo. The information is from the Centers for Disease Control.
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August 27, 2012 at 12:37 pm ET - neil
Tell me where i can buy sterile water???????????????????????
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August 27, 2012 at 4:43 pm ET - David
I used to inspect tattoo parlors for my state. This was a weak program, we did little to really protect health of individuals getting tattoos. I came away convinced tattooing is really a surgery and we shouldn’t let non-medical providers do them. There is no way to really have confidence they are safe. Never mind that they are completely disgusting years later and most regret them. There is a reason most tattoo parlors are near where people drink and open late hours…
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September 4, 2012 at 3:17 pm ET - Andrea
You should be able to purchase sterile water at any medical supply store.
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September 11, 2012 at 8:25 am ET - a mom
My son has A LOT of tattoos. I was not happy with his choice at first, but he has NEVER once been infected during or after the tattoo process. He loves every one and has a reason why he chose that face/symbol/ect. I am proud to call him my son. From the comments and article I feel confident he has chosen wisely. I hope the media continues to update the public on this very real concern. Our future depends on PEOPLE; tattooed individuals, the ARTISTS who tattooed them, and the rest of us, both old and young, we all deserve better. WV sends-Best wishes to all !
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September 13, 2012 at 8:16 am ET - andy
The largest of them is that they are not conducted by dermatological professionals and good and healthy sterile conditions and there are cases in which the tattoos are done with unsterile needles. Doctors believe that the tattoo may turn out to be serious and with very serious consequences, but here in Brazil, the majority of young people have a tattoo. The incidence is less with older people, but it does present one in 100 cases. Tie dye, can offer risk, not being very well balanced risk offering. Can cause skin Dermatitis, eczemas, inside the body can cause hepatitis B and c. The consequence is that tattoos are performed under antissanitárias. The procedure is more offensive in places where medical authorities do not pay attention to the subject. Here in Brazil the incidence of tattoos by body is huge, there are cases in which we note the entire body tattooed, and cases in which people want and do tattoos even in their most intimate parts.
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September 17, 2012 at 9:07 am ET - Pat Sinatra
To allay the fears and bias of many who posted here, tattooing can be quite safe in the hands of responsible professionals. I find it interesting, being a New York State tattoo artist and former president of the Alliance of Professional Tattooists, that I nor my studio was contacted by my local health department regarding this recent problem. I learned of these infections on Facebook and through the tattooers grapevine. I also learned the name of the manufacturer, whom I happen to know personally. These infections took place in November and December of 2011, according to what I read here on the CDC’s website. But it wasnt until the media made this an issue did it come to light.
Distilled water has been a mainstay in our profession. I have been tattooing for 36 years without incident. The APT reccommends using distilled water over tap water for the same reasons -to avoid possible microorganisms in the water. We use distilled water in our studios to run our autoclaves. My concern is how did the non tubercular mycobacterium get into the distilled water? This, to me, seems of greater concern to the public at large, than to the 21% of the population with tattoos. Distilled water is used in many products, not just tattoo related ones.
I agree with the suggestion of using sterile water for rinsing needles and for dilution, but, once the container is open and the water decanted into cups or other containers (usually disposable plastics) we can no longer guarantee the sterility. And the open container is no longer considered sterile after a 24-hour period. I like to think it’s already compromised upon opening.
Before rushing to judgment about the 21% of us who appreciate tattooing as a form of expression and as art, please consider there are many of us who are responsible professionals not sequestered into the “adult business” zones in many towns across the globe. We take our work seriously and do strive to continue to make tattooing safe for everyone.
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