Related Terms

• Dermal pigmentation, electric tattoo machine, laser tattoo removal, skin pigmentation, tattoo ink, tattoo pigment.

Background

• A tattoo is a usually decorative mark visible on the surface of the skin. Tattoos are created by inserting pigment in the form of dyes or ink between the top two layers of the skin.

• The removal of tattoos usually occurs with specialized lasers that break down the visible pigments. It is not always possible to completely eliminate the appearance of the pigment under the skin. For this reason, some people choose to conceal an old tattoo by having a newer one put over it.

• Tattooing has been practiced since prehistoric times. The reasons for tattooing vary considerably in different time periods and cultures. The English word "tattoo" is thought to have its origin in the Tahitian language.

• Currently in the United States, tattooing occurs for cosmetic, religious, sentimental, and aesthetic reasons. Tattooing is also popular to symbolize affiliation, such as to a gang, the military, or an ethnic group.

• In the United States, both state and local municipalities govern the legal aspects of tattooing, such as licensing and health education requirements of tattoo artists and individuals who remove tattoos. The regulations for the removal of tattoos using lasers are more strictly enforced.

• In recent years, tattooing has become a more accepted practice among many Americans. However, an increasing number of individuals are also seeking to have their tattoos altered or removed. In addition, some local governments pay for former gang members to have their tattooed symbols of affiliation removed.

Technique

• Before tattooing: Some individuals come to tattoo studios with an idea of the design they would like to have, while others choose one at the tattoo studio. Tattoo artists will tell a patron if their desired image can be rendered as a tattoo. At times, a patron's image may contain too much small detail, and as a result the inks used for the tattoo are likely to blur and become unattractive. In these cases, the tattoo artist may recreate the image so that it appears more attractive and identifiable once applied to the skin. After the final image is rendered, the tattoo artist will ask the patron to approve the location, size, and pigmentation of the design.

• Women are generally advised to not have tattoos on their abdomens or breasts because these areas of the body swell considerably during pregnancy, and the tattoo will become distorted as a result of this process.

• The table that the tattoo artist will use to rest tools used during the procedure is sanitized, as is the skin of the patron's body in the area where the tattoo will be rendered. The tattoo artist then washes their hands, puts on gloves, opens sterile tattoo needles, and opens new bottles of pigment.

• Skin pigmentation: To create a tattoo, pigment is inserted with a needle into the connective tissue layer of the skin, called the dermis (skin layer located underneath the epidermis). Pigment is a term used to describe the coloring and contrast medium that makes the tattoo. Inserting pigment into the skin causes mild damage to the tissue. This damage causes the dispersion of the pigment into the upper dermis as well as the epidermis. The presence of the pigment activates the body's immune system, and specialized cells called phagocytes engulf most of the microscopic particles of the foreign substance. In the dermis layer of the skin, the pigment used to create a tattoo remains permanently trapped in connective tissue cells called fibroblasts. Though the pigment is trapped in fibroblasts, it is still visible on the surface of the skin.

• The immune reaction to the pigment quickly leads to the healing of the skin. The epidermis that was damaged by the needle and pigment is replaced by new identical epidermis skin cells, and the old epidermis cells flake away.

• As time passes, the pigment used to create a tattoo may move slightly deeper into the dermis, away from the surface of the skin and the epidermis. The fibroblasts that contain the pigment may move, and the pigment might also leech out of the fibroblasts and diffuse. This process causes tattoos to fade over time. Tattoos also fade from repeated sun exposure. For this reason, most tattoo artists recommend applying sunscreen to a tattoo whenever outdoor activities that will expose the tattoo are planned.

• Tattooing process: The safest and most detailed way of receiving a tattoo involves an electric tattoo machine. These tools use disposable needles, which repeatedly puncture the skin at a rate of 80 or 150 times per second. Each time the skin is punctured, the pigment is inserted into the dermis and epidermis layers of the skin.

• Creating a tattoo without an electric tattoo machine is a much less specialized process that involves a significantly higher risk of infection and the spread of disease. The skin is punctured, scraped, or cut with a sharp object, and ash or pen ink is repeatedly wiped over the surface. This process is more popular among individuals who may not have access to safer tattooing processes.

• Regardless of the method used, tattooing does involve some amount of bleeding.

• Removal: Tattoo removal is usually possible to some extent. This process involves having specialized lasers pass over the surface of the skin. These lasers cause changes in the chemical structure of the pigment that was used to create the tattoo, which may cause the pigment to break down or fade. As a result, the original design of the tattoo becomes less visible. Tattoo removal may require many visits and involve more pain than the process of getting a tattoo.

• Rather than having a tattoo removed, some individuals choose to conceal the original skin pigmentation by having a second tattoo put over the area. To successfully conceal the old tattoo, the second tattoo is usually made larger than the original design, and darker colors may need to be used.

• The United States Food and Drug Administration (FDA) regulates the legality of tattoo inks used in the United States. However, they do not regulate the specific policies tattoo artists must follow. Laws regulating tattoo artists vary by state and local government. In many areas, there is no licensing body for technicians who perform permanent tattoos. For most technicians, licensing is voluntary. A blood borne diseases class is all that is required for tattoo artists to practice legally in many areas of the United States.

• Engel et al. dissolved tattoo pigments in solvent to determine the influence of either UVB radiation or sunlight on the cleavage of pigment molecules. Pigments exposed to natural sunlight completely decomposed.

• Levy et al. examined the connection between the hepatitis C epidemic in Australian prisons and practices of amateur tattooing among inmates. Amateur tattooing is the creation of a tattoo by a nonprofessional, usually without sterilized tattooing instruments. The team suggested introducing tattoo needle exchange programs or professional tattoo parlors as ways to contain the spread of hepatitis C, a blood borne pathogen.

Safety

• The person performing the tattoo should always follow universal precautions, a set of practices that minimize the possibility of infection and disease for both the artist and the recipient. Universal precautions include wearing gloves, sterilizing the area where the tattoo is to be placed, and disposing of all materials that may contain blood in appropriate biohazard containers. Each tattoo process should be done with sterile materials. Because tattoos bleed, the blood should be removed using a disposable towel, which should be disposed of in a biohazard container and not reused for multiple wipings.

• Individuals wishing to be tattooed should make sure that the tattoo artist practices universal precautions. In addition, many individuals find it helpful to ask the artist about blood borne pathogen training.

• Because tattoo instruments come into contact with blood and other bodily fluids, there is a high risk of spreading disease and infection unless all pathogens, such as bacteria and viruses, are cleaned from the tools. Use of pre-sterilized, single use tattoo needles and other protective measures prevents the possibility of the pathogens in the blood of one person infecting another person during the tattoo process. For amateur tattoos, it is important to sterilize the skin and the tattoo instruments before beginning the process.

• Individuals who receive tattoos outside of a studio, such as in prison, experience a much higher risk of infection.

• Infections that can be spread from one person to another by blood and other body fluids are called blood borne pathogens. Blood borne pathogens that may be transmitted from one person to another by using unsterilized tattoo equipment include surface skin infections, fungal infections, hepatitis, herpes, tetanus, bacterial infection, and HIV/AIDS.

• Some people experience allergic reactions to tattoo pigments, most commonly to some brands of red and green pigment. This type of reaction usually involves skin swelling, itching, or oozing of cellular fluid at the area of the tattoo.

• People who are allergic to latex should ask their tattoo artist to use non-latex gloves.

Author Information

• This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

1. Engel E, Spannberger A, Vasold R, et al. Photochemical cleavage of a tattoo pigment by UVB radiation or natural sunlight. J Dtsch Dermatol Ges. 2007 Jul;5(7):583-589.View Abstract

2. Food and Drug Administration. www.fda.gov.

3. Levy MH, Treloar C, McDonald RM, et al. Prisons, hepatitis C and harm minimisation. Med J Aust. 2007 Jun 18;186(12):647-9.View Abstract