Tattoos raise an inkling of concern
FDA investigates whether chemicals in ink could cause skin cancer
BROOKLYN, N.Y. — The End Is Near tattoo parlor in South Park Slope could pass for one of the neighborhood's upscale boutiques.
Local artwork covers the light blue walls. Ornate body jewelry fills a glass showcase. A stuffed badger greets visitors. There's just one thing that gives the parlor away – the unmistakable electric hum of a tattoo needle.
"We're not the seedy underground that used to be," said Trischa, the shop's one-named manager, whose fair skin, revealed by a black tank top, is almost completely painted with ink.
As tattoo shops turn chic, ink's allure has spread into the mainstream. Despite the well-known risks of infection, allergies and scarring, an estimated 45 million people in the United States – including 36 percent of adults in their late 20s – have at least one tattoo, according to estimates by the U.S. Food and Drug Administration and a Harris Interactive Poll .
Although sleazy "scratcher shops" with unskilled artists and dubious safety records are becoming a thing of the past, scientists are growing concerned about what's going into tattooed skin, not just how it got there.
New research has turned up troubling findings about toxic chemicals in tattoo inks, including some phthalates, metals, and hydrocarbons that are carcinogens and endocrine disruptors.
Tattoo ink trouble is nothing new. The inks, which are injected into skin with small needles, have caused allergic rashes, chronic skin reactions, infection and inflammation from sun exposure, said Elizabeth Tanzi, co-director of the Washington Institute of Dermatologic Laser Surgery in Washington, D.C.
Now a new study published in July suggests that phthalates and other chemical ingredients may be responsible for those problems.
More concerning, these newfound chemicals raise unanswered questions about more serious, long-term risks such as skin cancer.
As tattoo shops turn chic, ink's allure has spread into the mainstream.
An estimated 45 million people in the United States, including more than one-third of people in their late 20s, have at least one tattoo.
One of the chemicals found in black tattoo inks – benzo(a)pyrene – is a potent carcinogen that causes skin cancer in animal tests. Dermatologists have published reports in medical journals on rare, perhaps coincidental cases where melanomas and other malignant tumors are found in tattoos.
Could these chemicals increase the risk of skin cancer in people with tattoos?
"It's possible and definitely warrants additional investigation by the FDA," Tanzi said.
Recently, the FDA launched new studies to investigate the long-term safety of the inks, including what happens when they break down in the body or interact with light. Research already has shown that tattoo inks can migrate into people’s lymph nodes.
For now the long-term health risks – if any – from tattoo inks remain murky.
"The short answer is we don't know if the chemicals in tattoo inks represent a health hazard," said Joseph Braun, an environmental epidemiologist at Harvard University in Boston, Mass., who was is not involved in the new studies.
In July, scientists reported their discovery that the chemical dibutyl phthalate, a common plasticizer, along with other substances, are found in black tattoo inks. In the study of 14 commercially available inks, they found low levels of dibutyl phthalate in all of them.
"The substances found in the inks might be partially responsible for adverse skin reactions to tattoos," wrote the dermatologists from Germany’s University of Regensburg.
For phthalates, which can mimic estrogen or disrupt testosterone, exposure of fetuses and infants is the major concern. In infant boys, prenatal exposure to dibutyl phthalate has been linked to feminization of the reproductive tract. In men, phthalate exposure has been linked to sperm defects and altered thyroid hormones .
But phthalates in tattoo inks may not carry the same risk.
"Phthalates are cleared from the body within hours, and unlike many phthalate exposures, those from tattooing will not be continuous," said Shanna Swan, a reproductive epidemiologist at the Mount Sinai School of Medicine in New York who studied the effects of phthalates on infant boys.
Phthalates applied to the skin in a lotion were absorbed and metabolized in a 2007 study, and the same thing is likely to happen with phthalates in tattoo inks, Swan said.
"While this is a potential source of high exposure, it might not last very long and may not present a risk to health," Braun added.
Nevertheless, Swan said pregnant and nursing women should minimize any exposure to phthalates.
Lead found in inks
In addition to phthalates, heavy metals such as lead, which can harm the reproductive and nervous systems, also were found in a study of 17 different black inks from five manufacturers.
Colored inks often contain lead, cadmium, chromium, nickel, titanium and other heavy metals that could trigger allergies or diseases, scientists say . Some pigments are industrial grade colors that are "suitable for printers' ink or automobile paint,” according to an FDA fact sheet .
Black tattoo inks, often made of soot, also contain products of combustion called polycyclic aromatic hydrocarbons (PAHs), according to a 2010 study by the German scientists.
The FDA and scientists say colored inks often contain lead, cadmium, chromium, nickel, titanium and other heavy metals. Some are industrial grade colors suitable for printers' ink or automobile paint. Black tattoo inks often are made of soot so they contain known carcinogens called PAHs.
"Tattooing with black inks entails an injection of substantial amounts of phenol and PAHs into skin. Most of these PAHs are carcinogenic and may additionally generate deleterious singlet oxygen inside the dermis when skin is exposed to UVA (e.g. solar radiation)," wrote the study authors.
They said the PAHs could "stay lifelong in skin" and "may affect skin integrity," which could lead to skin aging and cancer.The PAHs in the inks include benzo(a)pyrene, which was identified in an Environmental Protection Agency toxicity report as "among the most potent and well-documented skin carcinogens." It is so potent that it is routinely used in animal tests to grow tumors. Also, it has been linked to skin cancer in shale oil workers, and the EPA has classified it as a probable human carcinogen.
Scientists are debating the possible tattoo-cancer link, based so far on a handful of malignant skin tumors found in tattoos and reported in medical literature.
"Even though cases of malignancies such as melanoma, basal cell carcinomas, squamous cell carcinomas and keratoacanthomas have been reported for the past 40 years, it remains unclear what role tattoos play in their pathogenesis," wrote scientists from France’s University of Montpellier in a 2008 study, "Skin Cancers Arising in Tattoos: Coincidental or Not?"
Dr. Wolfgang Bäumler, a dermatology professor at the University of Regensburg who was involved in the phthalate and PAH studies, said that "substances such as phthalates and also the PAHs should increase the health risk" for chronic health problems such as cancer. But the extent is unknown, Bäumler said, because "epidemiological studies are missing."
Epidemiological studies won't be easy. In theory, scientists could track a large number of tattooed people and see whether they developed problems such as skin cancer near their tattoos. But that's impractical, said Geoffrey Kabat, an epidemiologist at the Albert Einstein College of Medicine in the Bronx, N.Y.
That's because getting a tattoo still is considered a risky behavior, and following a group of people who may have risk-taking behaviors – smoking or riding motorcycles – would compromise a study, Kabat said.
"This would also make an epidemiologic study a fool's errand,” Kabat said.
The FDA has the power to regulate tattoo inks and any added colorings under the Federal Food, Drug, and Cosmetic Act. But the agency has never flexed its regulatory power, citing lack of evidence of safety concerns and other public health priorities.
"Because the dyes and inks used in tattoos have not been approved by FDA, we do not know the specific composition of what these inks and dyes may contain," an FDA spokesperson told Environmental Health News. "Therefore, we are unable to evaluate for chronic health concerns, such as cancer."
One major question investigated by the FDA is where does the ink go when the tattoo fades over time or from sun exposure?
Now, the FDA is getting curious about the ingredients. In 2003 and 2004, the FDA received its largest cluster of complaints, more than 150, from people on the giving and receiving end of tattoos. Since that time the FDA has begun more research on tattoo inks to answer fundamental questions, according to the FDA spokesperson.
Preliminary results show that a common pigment in yellow tattoo inks, Pigment Yellow 74, may be broken down by the body's enzymes, according to the FDA. Sunlight also breaks it down into colorless components of unknown toxicity. Also, when skin cells containing ink are killed by sunlight or laser light, the ink breakdown products could spread throughout the body.
Previous studies have shown that tattoo inks move into people's lymph nodes, but “whether the migration of tattoo ink has health consequences or not is still unknown,” according to a 2009 FDA consumer update . Lymph nodes are part of the body’s system for filtering out disease-causing organisms.
The FDA said "as new information is assessed, the agency considers whether additional actions are necessary to protect public health."
Because of the chemicals involved, California requires all tattoo shops to warn customers. A state law, known as Prop 65, requires warnings whenever people are exposed to chemicals linked to cancer, birth defects or other reproductive harm. The warning is included in the release forms that people sign before getting tattooed in California.
Business not affected
The lack of FDA regulation and the California warnings haven't slowed the tattoo business, where respected artists command between $125 and $200 per hour. Artists today build relationships with dedicated clients, who rarely ask about the long-term risks of tattoo inks.
"I don't have any clients that ask me that," said tattoo artist Jorell Elie of The Honorable Society in West Hollywood, Calif. "I don't really tattoo as many one-time clients anymore so most of my clients are fully aware of any – if any – risks that go into getting tattoos."
One of Elie's clients, Eric Blevens, of Brooklyn, has nearly a dozen tattoos. His latest, done by Elie, is a tribute to his pit bull, named Kweli, and covers most of the left side of his torso. During a recent vacation, Blevens said Elie constantly bugged him about keeping his tattoos shielded from the sun, which could cause the art to fade.
Aside from a small reaction to pink pigments, Blevens hasn't had any problems with tattoo inks and said he considers them safe. Through his relationship with Elie, any safety concerns he may have had in the past have faded.
"I genuinely trust him," Blevens said. "He shows a lot of concern and care for his work."
Even people with more simple tastes don't seem concerned about the safety of tattoo inks. Melissa Taylor, a 30-year-old mother and banker in Warner Robins, Ga., said she hasn't worried much about her ink. She got a small butterfly tattoo, about the size of a 50-cent piece, on her left hip when she was 19 and hasn't had any problems.
"I did a little bit of research because I wanted to go to a good, reputable place, not some hole-in-the-wall," Taylor said.
That kind of research is exactly what Jordan Bayley, manager of Fly Rite Studios in Brooklyn, recommends. Every artist is different, and cities and states have different regulations since the act of tattooing is regulated at the state and local level.
The dangers of putting tattoo needle to skin have been widely publicized and are taken seriously by tattoo artists. Disposable needles are the norm. Surfaces are sterilized with hospital-grade cleaners.
Most customers, however, are more concerned with how the tattoo will look years down the road.
"People usually don't come in worried about health concerns," said Mario Delgado, the owner of Moth and Dagger Tattoo Studio in San Francisco, Calif. "People are more concerned about getting a good tattoo."
Reprinted by permission of The Center for Public Integrity.