Are Tattoos Safe?

In-depth examination of the short and longterm health effects of temporary or permanent tattoos as outlined in published case studies and a large-scale population study involving 11,000+ participants over a 10 year period.

You have undoubtedly noticed that the popularity of tattoos has increased astronomically in recent years.

They’ve even become somewhat acceptable in a professional setting, which was definitely not the case when I worked in corporate America.

I’ve been wanting to write an article about the health effects of tattoos for many years, but have held off until a major study was finally published about the long-term health effects.

While common sense would seem to indicate that tattoos are unsafe, without some concrete, published research, many people continue to get them without a second thought, even those who are otherwise quite health conscious!

Let’s dig into the specifics about the health effects of tattoos and what a major population study just revealed about the long-term risks.

This is particularly important since getting a tattoo is usually a permanent decision.

How Many People Have Tattoos?

According to the most recent Pew Research conducted in 2023, 32% of American adults have a tattoo with 22% having more than one. (1)

Not surprisingly, most of those who sport tattoos are younger.

Roughly 41% of those under 30 have at least one tattoo, with slightly more (46%) of those ages 30 to 49 sporting a “tat”. (2)

This indicates that perhaps the popularity of tattoos is starting to wane slightly, with younger millennials and Gen Z more often choosing to remain tattoo-free.

What has really surprised me is how many otherwise health-conscious people have tattoos with whole sleeves a common sight in shoppers at healthfood stores and farmers markets.

This indicates, at least to me, that while people get tattoos for a wide variety of reasons, they are often a sign of a rebellious spirit, albeit an underresearched one!

Short-Term Health Risks

When it comes to short-term health risks from tattoos, the most obvious is from contaminated needles and ink.

According to the CDC, transmission of infectious diseases, particularly Hepatitis C, is possible when poor infection-control practices are used during tattooing or piercing”. (3)

Thus, tattoos only from licensed and reputable tattoo facilities that have proper sanitary practices in place is of paramount importance.

Long-Term Tattoo Dangers

What about longer term health risks from tattoos?

Certainly, it would seem logical that deep injection into the skin of chemical inks that are often not even affected by severe burns has a detrimental effect on health.

As it turns out, it most definitely does.

Chemicals Galore

A wide variety of toxic chemicals are present in tattoo inks. Depending on the color and ink manufacturer, these include:

• Neurotoxic formaldehyde
• Heavy metals
• Hormone-disrupting phthalates
• Antifreeze
• Printer toner
• Metallic salts (oxides, sulfides, selenides)
• Carcinogenic amines
• Chemicals used in car paint (not even kidding)

Most shocking is that the FDA has not studied nor does it even regulate what’s allowed in these dyes!

Because of other public health priorities and a previous lack of evidence of safety concerns, FDA has not traditionally regulated tattoo inks or the pigments used in them. (4)

The fact that tattoo ingredients and manufacturing are unregulated was perhaps the biggest shock for me doing research for this article.

For example, a study in 2011 found that 10% of unopened tattoo ink bottles were contaminated with bacteria. (5)

While the FDA will issue contamination alerts and guidance to tattoo ink manufacturers, as of this writing there are still not any safety regulations in place!

Alarming Changes in How the Skin Sweats

A study in 2017 found that compared to natural skin, inked skin excretes about 50% less sweat.

Maurie Luetkemeier, a professor of physiology at Alma College in Michigan, also found that the salt level in sweat from tattooed skin was significantly more concentrated. (6)

When your glands produce sweat, the skin tends to reabsorb sodium and other electrolytes from that perspiration before it appears on the surface of the skin.

This research may indicate that tattoos may partially block this important conservation of electrolytes by the body, with implications for deficiency.

While a person with a tiny tattoo would likely not experience much of a change, those with large amount of tattooed skin may be at grave risk for mineral depletion.

This important study indicates a likely need for increased intake of mineral-rich sea salt by those with a large amount of tattooed skin.

Anecdotally speaking, a good way to counteract this may be a proactive increase in electrolytes via daily intake of solé water.

Increased Risk for Melanoma

In years past, there were only case studies of people who developed cancer from tattoos.

In one such study, a man with a multi-colored tattoo developed a malignant melanoma only in the red-inked areas. (7)

Other small case studies indicate that skin cancer may result from the actual process of tattooing:

The process of tattooing involves the integration of metallic salts and organic dyes into the dermal layer of the skin… The resulting low-grade, chronic inflammation that can result from this could stimulate “malignant transformation. (8)

At Last! A Large Population Study on Tattoo Health Risks

While the short-term risks of infection from dirty needles and contaminated inks along with a few case studies on skin cancer are concerning, the truth is that until a long-term study was published, most people intent on getting a tattoo were likely to be undeterred.

In June 2024, this greatly anticipated study was finally available online in the Journal eClinicalMedicine published by the peer-reviewed Lancet. (9)

The large population study group consisted of 11,905 individuals and identified all cases of malignant lymphoma diagnosed between 2007 and 2017 in individuals aged 20–60 years in the Swedish National Cancer Register.

Tattoo prevalence was 21% among cases and 18% among controls.

The inked individuals had a significantly higher adjusted risk of overall malignant lymphoma.

The risk of lymphoma was highest in individuals with less than two years between their first tattoo and the study year.

The risk decreased with intermediate exposure duration (3-10 years) but increased again in individuals who received their first tattoo more than 11 years before the study year.

The most important data point to me from this study is that there was no evidence of increasing risk with a larger area of total tattooed body surface.

Thus, no matter whether a person has one small tattoo, permanent makeup, or a whole sleeve, the increased malignancy risk is the same.

The risk associated with tattoo exposure seemed to be highest for diffuse large B-cell lymphoma and follicular lymphoma.

The conclusions of the research suggest that exposure to inked skin is associated with an increased risk of malignant lymphoma and it does not matter the size or number of the tattoos.

What About Temporary Henna Tattoos?

While permanent tattooes now have established short and long-term health risks documented in the published literature, what about temporary tattoos using ink from natural henna?

Unfortunately, the ink in henna tattoos contains the dark brown dye para-phenylenediamine (PPD) as well as other toxic chemicals. (10)

In other words, it’s not just henna in temporary tattoo ink!

PPD in henna tattoos can trigger a delayed allergic reaction and hyper-sensitization that may permanently prohibit use of sulfa antibiotics, PABA sunscreens, benzocaine, and some personal care products such as hair color.

Fragrance sensitization may also occur. In some cases, this can trigger skin necrosis, scarring, and hypo-pigmentation.

Thus, while henna tattoos are likely better than permanent tats, they carry their own set of health risks and are not a “natural” tattoo as sometimes claimed.

What To Do If You Already Have Tats?

For those who may already have one or more tattoos and regret the decision, Dr. Peter McCullough MD suggests active surveillance for signs of developing lymphoma.

This would include new persistent rashes, fever, night sweats, recurrent illness, or swollen lymph nodes that do not resolve. (11)

Additional suggestions would be to eat and live as cleanly as possible with the implementation of consistent detoxification protocols to keep the body free of excessive toxins that could overwhelm the lymphatic system.

While tattoo removal may prove helpful, as of this writing there is not any solid research that supports it as anything more than a cosmetic procedure.

References

(1, 2) 32% of Americans have a tattoo, including 22% who have more than one

(3, 7, 8) The Hidden Dangers of Tattoos

(4, 10) The Truth About Tattoos: Health Risks, Toxicity and More

(5) Microbial status and product labeling of 58 original tattoo inks

(6) Skin Tattoos Alter Sweat Rate and Na+ Concentration

(9) Tattoos as Risk Factor for Malignant Lymphoma (a population-based control study)

(11) Tattoos Associated with Increased Risk of Lymphoma