Be Smart About Getting Ink Today, Dermatologists Joshua Fox and John Triccoli on Tattoo Health Risks and Precautions

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One in eight Americans now has a tattoo, including nearly 40% of people ages 20 to 25. While some tattoos are an impulsive choice, for those considering the decision, dermatologist Joshua Fox, M.D., medical director of Advanced Dermatology PC, and John Triccoli, MD, offer precautions for getting a tattoo and minimizing the health risks.

Getting inked has gone mainstream: One in eight Americans now has a tattoo, including nearly 40% of people ages 20 to 25. While some tattoos are an impulsive choice, for those considering the decision, dermatologist Joshua Fox, M.D., medical director of Advanced Dermatology PC, and John Triccoli, MD, offer precautions for getting a tattoo and minimizing the health risks.

What are the risks? The Center for Disease Control and Prevention regards tattooing as risky in principle, but doesn't see any evidence of widespread transmission of disease. According to a recent report published in the American Society for Dermatologic Surgery, the rising popularity of cosmetic tattoos has led to a greater number of adverse reactions. Increasing consumer complaints has prompted a Food and Drug Administration (FDA) investigation into the safety of tattoo inks, which contain phthalates, metals and carcinogenic hydrocarbons.

Can tattoos pose a skin cancer risk? “You should never have a tattoo placed too close to or over a mole,” Dr. Fox warns. “Changes occurring in a mole may be warning signs that the lesion is becoming a melanoma or another skin cancer; it’s critical that the mole be completely visible, or it could delay or prevent detection.” Dermatologists have not found an increased prevalence of skin cancer in individuals with tattoos. However, scientists are debating the possible tattoo-cancer link based on rare, perhaps coincidental cases, of malignant skin tumors found in tattoos.

Will my skin react to the dye? Tattoos breach the skin, which means that skin infections and other complications are possible. Dr. Fox outlines some of the risks:

Allergic reactions. The dyes — especially red, green, yellow and blue dyes — can cause allergic responses, such as an itchy rash, even years later. Yellow and red tattoos that are exposed to the sun can cause an allergic reaction because they contain cadmium which can cause a phototoxic reaction when exposed to the sun.

Skin infections and other reactions. A skin infection — which might cause redness, swelling, pain, and drainage — is possible. Sometimes bumps called granulomas form around the ink, which can also lead to keloids — raised areas caused by an overgrowth of scar tissue. People that are prone to keloids, which are more common in darker skinned individuals, should avoid getting tattoos because keloids can occur from tattoo needles piercing the skin.

Bloodborne diseases. If the equipment is contaminated with infected blood, perhaps from a previous client who had a disease which they did not know about, you can contract various bloodborne diseases — including tetanus, hepatitis B and C, HIV and others.

MRI complications. In rare cases, tattoos can cause swelling or burning in the affected areas during magnetic resonance imaging.

What if I change my mind? The biggest side effect to getting a tattoo is remorse. According to an article in US News and World Report, upwards of 50 percent of those who get tattoos later wish they hadn't. There are several options for removing tattoos, but most are now removed with lasers. “Lasers break up the inks so that the immune system can rid the body of these foreign substances,” says Dr. Fox. “But some tattoos are most difficult if not impossible to remove usually because of the colors involved.” There are several types of lasers; however, the Q-switched ruby, Q-switched ND Yag and Q-switched Alexandrite are the most effective. The removal is typically done over a period of months; it can require six to 12 treatments to remove a tattoo. “It requires less treatment, according to Dr. Troccoli, to treat a non professional tattoo.”

Are there any dangers to removing a tattoo? There can be loss of skin color or skin darkening and change in skin texture at the site. Scarring is also a remote possibility if appropriate lasers are not used. Dermatologists will perform a test spot, treating a small part of the tattoo and monitoring what skin reactions occur on that small area before proceeding. The laser treatment itself may create a wound that can become infected. Many tattoo removal kits are available online, but the U. S. Food and Drug Administration (FDA) warns that it does not regulate these products. Some kits contain acid and have caused permanent injuries and scarring.

I still want to get one. What precautions should I take? If you ultimately decide to get inked, visit a reputable tattooing studio that employs only properly trained employees. Regulation requirements and licensing standards vary from state to state, so check with your health department. Make sure the tattoo artist washes his or her hands and wears a fresh pair of protective gloves for each procedure. Ensure that the tattoo artist removes the needle and tubes from sealed packages before your procedure begins. Any pigments, trays or containers should be unused as well.

How should I care for my new artwork? Apply broad-spectrum sunscreen every day before going outdoors. The ultraviolet (UV) light from the sun fades some tattoo inks. Pay attention to rashes and sunburn-like reactions. Newly tattooed skin can be very sensitive. Some people develop an intense sunburn-like reaction on their tattooed skin. Stay out of tanning beds and away from sunlamps. In some people, the UV light reacts with the tattoo ink, causing a painful skin reaction. The UV light also can cause inks in tattoos to fade. If you have a skin reaction or see your tattooed skin changing, see a dermatologist as soon as possible. “Skin can react to the ink immediately after getting a tattoo or years later,” says Dr. Troccoli. “A change also could be a sign of skin disease.”

Dr. Fox: Joshua L. Fox, M.D., F.A.A.D., A Fellow of the American Academy of Dermatology, Dr. Fox is a leading authority in the field of dermatology. He is the founder and medical director of Advanced Dermatology, P.C. of New York and New Jersey and the Center for Laser and Cosmetic Surgery and is a spokesman for both the American Academy of Dermatology and the American Society of Dermatologic Surgery.

Dr. Fox is also the founder and President of The New Age Skin Research Foundation, a national, non-profit [501 (C) (3)] health organization committed to improving the quality of life of those with skin conditions through research and education.

John Troccoli, M.D., F.A.A.D., attended Yale University where he graduated summa cum laude and earned his Medical Degree from Harvard University. Dr. Troccoli is board certified in dermatology and is a Fellow of the American Academy of Dermatology. He has worked as an associate at Advanced Dermatology and the Center for Laser and Cosmetic Surgery since 1997. Dr. Troccoli has traveled extensively throughout the world and is fluent in Spanish.

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