Another Good Reason to Avoid Tattoos

I'm tattoo averse, I freely admit on this week's PodMed.  Rick responds that one in five Americans would disagree with me, since that's how many currently have tattoos.  But based on a study in this week's New England Journal of Medicine, perhaps an increasing number of people will choose not to have a tattoo it they're worried about infectious disease.  So what's the story?

The article is a report of an outbreak of Mycobacterium chelonae, a non-tuberculosis species of the organism, in 19 people who had tattoos applied ? implanted? at a specific tattoo parlor in Rochester, NY, between October and December 2011.   The investigators were alerted to a potential problem after receiving an intital report from a dermatologist of a 20 year old man with several previous tattoos, who had developed a persistent granulomatous rash at the site of his most recent tattoo (see pix).  The rash failed to resolve after glucocorticoid treatment by a primary care physician and the patient was referred to the dermatologist who made the report.

Public health types then conducted an admirable sleuthing expedition, visiting the tattoo parlor and interviewing the tattoo artist.  Various facts came to light: in the spring of 2011 the artist had begun using a new, hand-blended ink first purchased at a trade show that came in various dilutions, and had ordered more of the same.  The artist used this to achieve a three dimensional quality in tattoos designed to resemble photographs or portraits, currently the rage  (who knew?).  This ink was no longer used after December 2011.

Since using this ink several people tattooed by this artist had experienced reactions: 19 in fact. The investigators were able to determine this by getting in touch by telephone with the artist's clients and conducting an interview.  Infection was confirmed in the majority of cases by biopsy and appropriate antibiotic therapy was offered. One person declined follow-up.

Both the FDA and the CDC weighed in on this case, with the FDA inspecting the ink manufacturing facility, obtaining samples of the ink and its ingredients and packaging, and the CDC culturing them.  Here's one take home point about this report: while the FDA is empowered to participate in such an investigation, the agency cannot take measures to prevent such potential infections, since tattoo ink is considered a cosmetic, and therefore outside the FDA's purview. Hmmmm.

The tattoo parlor and the artist cannot be faulted in this case as all recommended precautions regarding sterility and prophylaxis had been taken.  So how can those desiring tattoos avoid such a risk?  It seems unlikely that consumers will be able to do so on their own, since inks cannot be filtered without taking away a lot of the pigment.  For now, until and unless such products do come under FDA regulation, it seems a risk that just comes with obtaining a tattoo, and as I opine, one more reason to give such an idea a miss, especially in light of data we've discussed in the past indicating that the majority of people who get tattoos subsequently wish to have them removed.

Other topics this week include the long term impact of allowing babies to 'cry it out,' in Pediatrics, the risk of NSAIDs in people who've had a heart attack in Circulation, and ovarian cancer screening guidelines in Annals of Internal Medicine.  Until next week, y'all live well.

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Stephen in FL April 8, 2013 at 10:40 pm

Well, given the remarks made by the U.S. Centers for Disease Control and Prevention (CDC) last year, I do hope that more people at least have some idea of what hepatitis C is and what the risks are (especially if you are a member of the baby boomer generation). I know that it may seem unlikely that you could contract hepatitis C through tattoos, but this is a risk that the public should be aware of.


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