Now you might think a dermatologist is anti-tattoo, but this one isn’t. I fully respect the artistic, cultural and personal significance tattoos carry as well as one’s choice to get inked or not. Historically, tattoos have been somewhat taboo in the US but now they are quite mainstream. Around 32% of people in the United States have a tattoo and yep, I’m one of them.
If you’re considering getting a tattoo, the important thing is to do your research. Part of the challenge is that the practice of tattooing is regulated differently depending upon where you live and done at a state and local level. While tattoo artists are required to have a license in all 50 states and the District of Columbia, tattoo ink is totally unregulated. The Food and Drug Administration (FDA) considers tattoo ink to be classified as a cosmetic. The FDA will investigate and act if a problem with an ink occurs to prevent any consumer illness or injury. The pigments used in the inks are color additives, which are subject to premarket approval under the Federal Food, Drug, and Cosmetic Act. But due to other competing public health priorities and a previous lack of data with safety problems associated with these pigments, the FDA traditionally has not exercised regulatory authority for color additives on pigments used in tattoo inks. In 2024, the FDA published a study which showed over 30% of tattoo ink and permanent makeup product samples were contaminated with bacteria. This spurred FDA guidelines on tattoo ink to help standardize practices. Nonetheless, it is up to the consumer to go to a tattoo studio with a sound reputation and self-report any complications to the FDA..
While getting a tattoo can be filled with excitement, there are some risks to consider. One risk of getting a tattoo is infection. Infections can occur from several reasons including improperly sterilized tools, ink diluted with liquids such as tap water, ink contaminated with bacteria or other microbes or poor after-care by the person receiving the tattoo. Your tattoo might be infected if you have pain and redness that worsens at the tattoo site, pus or open sores in the tattoo, or flu-like symptoms such as fever or chills. Tattoos can also cause allergic reactions, usually to a specific color. Red is often the culprit, but any color can cause an allergic reaction. Signs of an allergic reaction include redness, swelling, or itching at the site. If you’re allergic, you might even develop pimple-like bumps or blisters. Some tattoos can also scar or keloid or have granulomas form within them. And one more thing–If you’re getting an MRI, let your technician know. There have been reports of MRI burns in tattoos.
So what are some don’ts with tattoos? Don’t tattoo over a skin cancer scar. While many people tattoo over old injuries like a dog bite, it’s not a good idea to tat your scar from a skin cancer. Why, you ask? Well, as a dermatologist, I am always rechecking skin cancer scar sites for recurrence. A tattoo can cover up a recurrence or make it more difficult to detect. You also want to avoid tattooing over moles. When a mole is tattooed over, it makes it harder to appreciate changes in size, shape and especially color. Talk with your tattoo artist to work around moles or integrate them into the design.
What do the one in four Americans that have a tattoo and now regret it? Well, there are options for removal but FDA approved lasers are still the most effective. Lasers work by breaking up the ink into smaller particles so your body can get rid of the pigment. Multiple treatments are typically needed. Blue and black tattoos are usually easier to remove since they are better at absorbing light. Larger tattoos will take longer to remove and may require several sessions before they are completely removed. Some tattoos are not completely removed but just significantly lighter so they are less noticeable. You can also have a tattoo surgically removed (best for small tattoos) or treated with dermabrasion, salabrasion or chemical peels. Salabrasion is the process whereby the top layers of the skin are removed with gauze soaked in saline and then salt is rubbed into the skin to help remove the tattoo ink. As you might expect, this is very painful and may lead to serious infection and of course, incomplete removal. And finally–tattoo removal creams. First, it’s important to know that there are no FDA approved tattoo removal creams and I typically don’t recommend these for tattoo removal. These creams may contain ingredients like retinol, bleaching creams and agents that can peel the skin. These can be used at home but take several months and often with incomplete results. There is no great evidence that they are effective. They can cause chemical burns, skin irritation and allergic reactions.
Trotter’s Take: Getting a tattoo is a personal choice but do your homework first to make sure you are going to a reputable artist and if you regret your ink later then choose laser for removal.
Want more ink-spiration? Then listen to Dr. Walter Liszewski as we talk more about the trend to be inked and what you should know before going under the needle.
