Tattoo inks are toxicological risks to human health: A systematic review of their ingredients,fate inside skin,toxicity due to polycyclic aromatic hydrocarbons,primary aromatic amines,metals,and overview of regulatory frameworks
Restricted accessReview articleFirst published online July, 2022
Tattoo inks are toxicological risks to human health: A systematic review of their ingredients,fate inside skin,toxicity due to polycyclic aromatic hydrocarbons,primary aromatic amines,metals,and overview of regulatory frameworks
Today, tattooing has become very popular among people all over the world. Tattooists, with the help of tiny needles, place tattoo ink inside the skin surface and unintentionally introduce a large number of unknown ingredients. These ingredients include polycyclic aromatic hydrocarbons (PAHs), heavy metals, and primary aromatic amines (PAAs), which are either unintentionally introduced along with the ink or produced inside the skin by different types of processes for example cleavage, metabolism and photodecomposition. These could pose toxicological risks to human health, if present beyond permissible limits. PAH such as Benzo(a)pyrene is present in carbon black ink. PAAs could be formed inside the skin as a result of reductive cleavage of organic azo dyes. They are reported to be highly carcinogenic by environmental protection agencies. Heavy metals, namely, cadmium, lead, mercury, antimony, beryllium, and arsenic are responsible for cancer, neurodegenerative diseases, cardiovascular, gastrointestinal, lungs, kidneys, liver, endocrine, and bone diseases. Mercury, cobalt sulphate, other soluble cobalt salts, and carbon black are in Group 2B, which means they may cause cancer in humans. Cadmium and compounds of cadmium, on the other hand, are in Group 1 (carcinogenic to humans). The present article addresses the various ingredients of tattoo inks, their metabolic fate inside human skin and unintentionally added impurities that could pose toxicological risk to human health. Public awareness and regulations that are warranted to be implemented globally for improving the safety of tattooing.
BauerE MScibettaE VCecchettiD, et al. (2020) Treatments of a phthalocyanine-based green ink for tattoo removal purposes: generation of toxic fragments and potentially harmful morphologies. Archives of Toxicology94: 2359–2375.
3.
BäumlerW (2015) Absorption, distribution, metabolism and excretion of tattoo colorants and ingredients in mouse and man: the known and the unknown. Current Problems In Dermatology26(48): 176–184.
4.
BoccaBPetrucciFAlimontiA (2013) National Institute for Health, Roma, Italy. Heavy Metals in Tattoo Inks. BfR-Symposium. In: 1st International Conference on Tattoo Safety, Berlin, Germany, 6–7 June 2013.
5.
BoccaBSenofonteOPetrucciF (2018) Hexavalent chromium in tattoo inks: Dermal exposure and systemic risk. Contact Dermatitis79(4): 218–225.
6.
BoltHMHengstlerJG (2020) Tattoo toxicology, an upcoming complex scientific issue. Archives of Toxicology94: 2273–2274.
7.
CarsonS (1984) Skin Painting Studies in Mice with 14 FD&C and D&C Colors: FD&C Blue no. 1, Red No. 3, and Yellow No. 5, D&C Red No. 7, Red No. 9, Red No. 10, Red No. 19, Red No. 21, Red No. 27, Red No. 31, Red No. 36, Orange No. 5, Orange No. 10, and Orange No. 17. Journal of Toxicology: Cutaneous and Ocular Toxicology3(4): 357–370.
8.
Centers for Disease Control and Prevention (CDC) (2006) Methicillin-resistant Staphylococcus aureus skin infections among tattoo recipients--Ohio, Kentucky, and Vermont, 2004-2005. MMWR. Morbidity and Mortality Weekly Report55: 677–679.
9.
CerhanJRVajdicCMSpinelliJJ (2017) The non-Hodgkin lymphomas. In: Schottenfeld and Fraumeni Cancer Epidemiology and Prevention. Fourth Edition. Oxford, UK: Oxford University Press, 767–796.
CuiYChurchwellMICouchLH, et al. (2005) Metabolism of pigment yellow 74 by rat and human microsomal proteins. Drug Metabolism and Disposition33(10): 1459–1465.
12.
CulYSpannAPCouchLH, et al. (2004) Phtodeceomposition of Pigment Yellow 74, a Pigment Used in Tattoo Inks. Photochemistry and Photobiology80(2): 175–184.
13.
De CuyperC (2008) Permanent makeup: indications and complications. Clinics in Dermatology26: 30–34.
14.
De CuyperCCossioL (2009) Dermatologic Complications with Body Art. Berlin, Heidelberg: Springer, pp. 29–41.Tattooing and Scarring: Technique and Complications.
15.
De CuyperCD’hollanderD (2018) Materials used in body art. In: Dermatologic Complications with Body Art. Cham, Switzerland: Springer, 21–48.
16.
EngelESantarelliFVasoldR, et al. (2008) Modern tattoos cause high concentrations of hazardous pigments in skin. Contact Dermatitis58(4): 228–233. DOI: 10.1111/j.1600-0536.2007.01301.x.
17.
Environmental Protection Agency, U.S. (US-EPA) (2008) Polycyclic Aromatic Hydrocarbons (PAHs) — EPA Fact Sheet. Washington, DC: National Center for Environmental Assessment, Office of Research and Development.
18.
Environmental Protection Agency,U.S. (US-EPA-IRIS) (2010) Development of a Relative Potency Factor (RPF) Approach for Polycyclic Aromatic Hydrocarbon (PAH) Mixtures (External Review Draft, Suspended). Washington, DC: U.S. Environmental Protection Agency. EPA/635/R-08/012A.
19.
Environment Protection Agency, New Zeland (NZ-EPA) (2012) (Te Mana Rauhi Taiao) Guidelines for Tattoo and Permanent Makeup Substances. Wellington, New Zealand: NZ-EPA, Ministry of Health.
20.
European Chemical Agency (ECHA, Annexure XV, (2017) Proposal for restriction, substances in tattoo inks and permanent make up. Version 1.2.
21.
European Chemicals Agency (ECHA) (2019) Committee for Risk Assessment (RAC) Committee for Socio-Economic Analysis (SEAC) - Opinion on an Annex XV Dossier Proposing Restrictions on Substances Used in Tattoo Inks and Permanent Make-Up. Helsinki, Finland: ECHA. Available at: https://echa.europa.eu/documents/10162/dc3d6ea4-df3f-f53d-eff0-540ff3a5b1a0.
22.
European Commission, Scientific Committee on Food EC-SCF (2002) Polycyclic Aromatic Hydrocarbons–Occurrence in foods, dietary exposure and health effects. SCF/CS/CNTM/PAH/29 ADD1 Final 4 December 2002 SCF ⁄ CS ⁄ CNTM ⁄ PAH ⁄ 29 ADD1 2002. Available at: http://europa.eu.int/comm/food/fs/sc/scf/index_en.html.
23.
European Commission regulation (2008) EC no.1333/2008 of the European Parliament and of the Council of 16 Dec 2008 on Food Additives. Brussels, Belgium: European Commission regulation.
24.
European Commission regulation (2020) EU) 2020/2081 of 14 December 2020 Amending Annex XVII to Regulation (EC) No 1907/2006 of the European Parliament and of the Council Concerning the Registration. Brussels, Belgium: European Commission regulation. Evaluation, Authorisation and Restriction of Chemicals (REACH) as regards substances in tattoo inks or permanent make-up. Available at: https://eurlex.europa.eu/legalcontent/EN/TXT/?uri=CELEX%3A32020R2081&qid=1609761602759.
European Council (2008) Resolution ResAP (2008) 1 on Requirements and Criteria for the Safety of Tattoos and Permanent Make-Up. Brussels, Belgium: European Council. Available at: https://rm.coe.int/16805d3dc4.
27.
European Council (2012) Harmonised Classification CLH: Guidance on the Application of the CLP Criteria. Guidance to Regulation (EC) No1272/2008 on Classification, Labelling and Packaging (CLP) of Substances and Mixtures. Brussels, Belgium: European Council. Version 3.0 November 2012.
ForteGPetrucciFCristaudoA, et al. (2009) Market survey on toxic metals contained in tattoo inks. Science of the total environment407(23): 5997–6002. DOI: 10.1016/j.scitotenv.2009.08.034.
32.
FuPPXiaQSunX, et al. (2012) Phototoxicity and environmental transformation of polycyclic aromatic hydrocarbons (PAHs)-light-induced reactive oxygen species, lipid peroxidation, and DNA damage. Journal of Environmental Science and Health, Part C30(1): 1–41.
33.
GiulbudagianMSchreiverISinghAV, et al. (2020) Safety of tattoos and permanent make-up: a regulatory view. Archives of Toxicology94(2): 357–369.
34.
GopeeNVCuiYOlsonG, et al. (2005) Response of mouse skin to tattooing: use of SKH-1 mice as a surrogate model for human tattooing. Toxicology and Applied Pharmacology209(2): 145–158. DOI: 10.1016/j.taap.2005.04.003.
35.
HauriU (2011) Inks for Tattoos and PMU (Permanent Make-Up): Organic Pigments, Preservatives and Impurities Such as Primary Aromatic Amines and Nitrosamines. Basel, Switzerland: Kantonales Laboratorium Basel-Stadt.
36.
HauriU (2014) Inks for Tattoos and Permanent Make-Up–Pigments, Preservatives, Aromatic Amines, Polyaromatic Hydrocarbons and Nitrosamines. Switzerland: Swiss National Investigation Campaign.
37.
HeringHSungAYRöderN, et al. (2018) Laser Irradiation of Organic Tattoo Pigments Releases Carcinogens with 3,3′-Dichlorobenzidine Inducing DNA Strand Breaks in Human Skin Cells. Journal of Investigative Dermatology138(12): 2687–2690.
38.
HeringHZoschkeCKühnM, et al. (2020) TatS: a novel in vitro tattooed human skin model for improved pigment toxicology research. Archives of Toxicology94(7): 2423–2434.
39.
HøgsbergTLöschnerKLöfD, et al. (2011) Tattoo inks in general usage contain nanoparticles. The British Journal of Dermatology165(6): 1210–1218.
40.
HøgsbergTSaunteDMFrimodtMøllerN, et al. (2013) Microbial status and product labelling of 58 original tattoo inks. Journal of the European Academy of Dermatology and Venereology27(1): 73–80.
41.
HøgsbergTThomsenBMSerupJ (2015) Histopathology and immune histochemistry of red tattoo reactions. Skin Research and Technology21(4): 449–458.
42.
Hutton CarlsenKSerupJ (2014) Photosensitivity and photodynamic events in black, red and blue tattoos are common: A 'Beach Study'. Journal of the European Academy of Dermatology and Venereology28(2): 231–237.
InesSLuchA (2020) Tattooing: overriding the skin barrier and the journey into the unknown. Archives of Toxicology. Archiv für Toxikologie94(2): 647–648.
45.
IziksonLAvramMAndersonRR (2008) Transient immunoreactivity after laser tattoo removal: report of two cases. Lasers in Surgery and Medicine40(4): 231–232.
46.
JRC (2015) Safety of Tattoos and Permanent Make-Up: Compilation of Information on Legislative Framework and Analytical Methods. Luxembourg, Europe: Publication Office European Union. DOI: 10.2788/542617.
47.
JRC (2016a) Safety of Tattoos and Permanent Make-Up. Adverse Health Effects and Experience with the Council of Europe Resolution (2008). Luxembourg, Europe: Publication Office European Union. DOI: 10.2788/177900.
48.
JRC (2016b) Safety of tattoos and permanent make-up: final report. EUR27947. DOI: 10.2788/011817.
49.
KarregatJJJPRustemeyerTBentSAS, et al. (2021) Assessment of cytotoxicity and sensitization potential of intradermally injected tattoo inks in reconstructed human skin. Contact Dermatitis85: 324–339.
50.
KennedyBSBedardBYoungeM, et al. (2012) Outbreak ofMycobacterium chelonaeInfection Associated with Tattoo Ink. The New England Journal of Medicine367(11): 1020–1024.
51.
KirbyWChenCLDesaiA, et al. (2013) Causes and recommendations for unanticipated ink retention following tattoo removal treatment. The Journal of Clinical and Aesthetic Dermatology6(7): 27–31.
52.
KlüglIHillerKALandthalerM, et al. (2010) Incidence of health problems associated with tattooed skin: a nation-wide survey in German-speaking countries. Dermatology221(1): 43–50.
53.
KlugerNSeitéSTaiebC (2019) The prevalence of tattooing and motivations in five major countries over the world. Journal of the European Academy of Dermatology and Venereology : JEADV33(12): e484–e486.
54.
LauxPTralauTTentschertJ, et al. (2016) A medical-toxicological view of tattooing. Lancet387(10016): 395–402. DOI: 10.1016/s0140-6736(15)60215–x.
55.
LehnerKSantarelliFVasoldR, et al. (2011) Black tattoo inks are a source of problematic substances such as dibutyl phthalate. Contact Dermatitis65(4): 231–238.
56.
LehnerKSantarelliFVasoldR, et al (2014) Black tattoos entail substantial uptake of genotoxicpolycyclic aromatic hydrocarbons (PAH) in human skin and regional lymph nodes. Plos One9(3): e92787–e92795.
57.
LoomisDGuhaNHallAL, et al. (2018) Identifying occupational carcinogens: an update from the IARC Monographs. Occupational and Environmental Medicine75(8): 593–603.
58.
MaaroufMSaberianCSegalRJ, et al. (2019) A new era for tattoos, with new potential complications. The Journal of Clinical and Aesthetic Dermatology12(2): 37–38.
59.
MansoMPessanhaSGuerraM, et al (2019) Assessment of toxic metals and hazardous substances in tattoo inks using Sy-XRF, AAS, and raman spectroscopy. Biological Trace Element Research187(2): 596–601.
60.
MinghettiPMusazziUMDoratiR, et al. (2019) The safety of tattoo inks: possible options for a common regulatory framework. The Science of the Total Environment651: 634–637.
MontanerBO'DonovanPReelfsO, et al (2007) Reactive oxygen‐mediated damage to a human DNA replication and repair protein. EMBO Reports8(11): 1074–1079.
63.
MujtabaSFDwivediAMudiamMKR, et al. (2011) Production of ROS by Photosensitized Anthracene Under Sunlight and UV-R at Ambient Environmental Intensities. Photochemistry and Photobiology87(5): 1067–1076.
64.
NisbetICTLagoyPK (1992) Toxic equivalency factors (TEFs) for polycyclic aromatic hydrocarbons (PAHs). Regulatory Toxicology and Pharmacology16(3): 290–300.
65.
PapameletiouDSchwelaDZeniA (2003) Recommendations for Regulatory Action in the EU on the Safety of Tattoos, Body Piercing and of Related Practices in the EU, Ispra (VA) , Italy, European Commission, Joint Research Centre (JRC) , Institute for Health and Consumer Protection (IHCP) , Physical and Chemical Exposure (PCE) Unit, 2003.
66.
PazosM DHuYElaniY, et al. (2021) Tattoo inks for optical biosensing in interstitial fluid. Advanced Healthcare Materials10(21): 2101238. DOI: 10.1002/adhm.202101238.
67.
PetersenHLeweD (2015) Chemical purity and toxicology of pigments used in tattoo inks. Current Problems in Dermatology48: 136–141.
68.
PiccininiPPakalinSContorL, et al. (2016) Safety of tattoos and permanent make-up. Final report. EUR27947.
69.
RAC (2018) Opinion on an Annex XV Dossier Proposing Restrictions on Substances Used in Tattoo Inks and Permanent Make-Up. Helsinki, Finland: European Chemicals Agency.
70.
RegensburgerJLehnerKMaischT, et al. (2010) Tattoo inks contain polycyclic aromatic hydrocarbons that additionally generate deleterious singlet oxygen. Experimental Dermatology19(8): e275–e281. DOI: 10.1111/j.1600-0625.2010.01068.x.
71.
RossJRMatavaMJ (2011) Tattoo-induced skin "Burn" During magnetic resonance imaging in a professional Football Player. Sports Health: A Multidisciplinary Approach3(5): 431–434.
72.
RubioLGuerraEGarcia-JaresC, et al. (2019) Body-decorating products: Ingredients of permanent and temporary tattoos from analytical and european regulatory perspectives. Analytica Chimica Acta41079: 59–72.
73.
SaduraFWróbelMSKarpienkoK (2021) Colored tattoo ink screening method with optical tissue phantoms and raman spectroscopy. Materials14(12): 3147–3159.
74.
SCCNFP (2000) Opinion of the scientific committee on cosmetic products and non-food products (SCCNFP) intended for consumers concerning the safety of tattoos adopted during the 11th Plenary Meeting of 17 February, 2000.
75.
SchreiverILuchA (2016) At the dark end of the rainbow: data gaps in tattoo toxicology. Archives of Toxicology90(7): 1763–1765.
76.
SchreiverIHesseBSeimC, et al. (2019) Distribution of nickel and chromium containing particles from tattoo needle wear in humans and its possible impact on allergic reactions. Particle and Fibre Toxicology16(1): 33.
77.
SerupJKlugerNBaumlerW (2015) Tattooed skin and health. Current Problems in Dermatology48: 118–127.
78.
SerupJHutton CarlsenKDommershausenN, et al (2020) Identification of pigments related to allergic tattoo reactions in 104 human skin biopsies. Contact Dermatitis82(2): 73–82.
79.
SrivastavAKAgnihotrySMujtabaSF, et al. (2018) PAHs and Phototoxicity. In: RayRHaldarCDwivediA, et al. (eds) Photocarcinogenesis & Photoprotection. Singapore: Springer. DOI: 10.1007/978-981-10-5493-8_9.
80.
StraifKBenbrahim-TallaaLBaanR, et al. (2009) A review of human carcinogens-Part C: metals, arsenic, dusts, and fibres. The Lancet Oncology10(5): 453–454.
81.
TigheM ELibbyD KDornS K, et al (2017) A survey of metals found in tattoo inks. Journal of Environmental Protection08(11): 1243–1253.
82.
VasoldRNaarmannNUlrichH, et al (2004) Tattoo Pigments are Cleaved by Laser Light-The Chemical Analysis In Vitro Provide Evidence for Hazardous Compounds¶. Photochemistry and Photobiology80(2): 185–190.
83.
VasoldREngelEKönigB, et al. (2008) Health risks of tattoo colors. Analytical and Bioanalytical Chemistry391(1): 9–13.
84.
WangSShengYFengM, et al. (2007) Light-induced cytotoxicity of 16 polycyclic aromatic hydrocarbons on the US EPA priority pollutant list in human skin HaCaT keratinocytes: Relationship between phototoxicity and excited state properties. Environmental Toxicology22(3): 318–327.
85.
WangXJosefssonLMeschnarkS, et al. (2021) Analytical survey of tattoo inks-A chemical and legal perspective with focus on sensitizing substances. Contact Dermatitis85: 340–353. DOI: 10.1111/cod.13913 (accessed 5 June 2021).
86.
YanJWangLFuPP, et al. (2004) Photomutagenicity of 16 polycyclic aromatic hydrocarbons from the US EPA priority pollutant list. Mutation Research/Genetic Toxicology and Environmental Mutagenesis557(1): 99–108.
87.
YashimZI (2017) Determination of heavy metals in black tattoo ink sold within Zaria, Nigeria. Fuw Trends in Science & Technology Journal2(1A): 122–125.
88.
YuH (2002) Environmental carcinogenic polycyclic aromatic hydrocarbons: photochemistry and phototoxicity. Journal of Environmental Science and Health, Part C20(2): 149–183.
89.
YuHXiaQYanJ, et al. (2006) Photoirradiation of polycyclic aromatic hydrocarbons with UVA Light - A pathway leading to the generation of reactive oxygen species, lipid peroxidation, and DNA damage. International Journal of Environmental Research and Public Health3(4): 348–354.
90.
ZemtsovAWilsonL (1997) CO2 laser treatment causes local tattoo allergic reaction to become generalized. Acta Dermato-Venereologica77(6): 497.
