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Skin Infections Linked to Tattoo Ink

Dozens of Cases Traced to Unsterile Pre-Mixed Inks
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WebMD Health News
Reviewed by Louise Chang, MD

Aug. 22, 2012 -- When it comes to tattoos, here’s the rub: The tattoo parlor may be spotless; the tattoo artist may be using sterile techniques; but you can still wind up with a nasty infection from ink that was contaminated before it arrived at the shop, new studies show.

The first study is published in the New England Journal of Medicine. It describes an outbreak of 19 skin infections in New York State that were traced to the same pre-mixed tattoo ink.

When health officials took their investigation nationwide, they found 32 other suspicious skin rashes linked to four brands of ink. Those findings are described in a study in the CDC’s Morbidity and Mortality Weekly Report. In addition to the cluster in New York, cases were confirmed in Colorado, Washington, and Iowa.

“You can do everything right at the tattoo parlor, there are still potential risks that folks need to be aware of,” says researcher Byron S. Kennedy, MD, PhD, MPH. Kennedy is deputy director of the Monroe County Department of Public Health in Rochester, N.Y.

Public health officials became aware of the problem after a healthy 20-year-old man developed a tenacious rash around a recent tattoo. A dermatologist cultured bacteria from red bumps on his arm and alerted the state health department.

Germs in Tattoo Ink

The infection was caused by Mycobacterium chelonae, which is related to the same germs that cause leprosy and tuberculosis. Mycobacterium chelonae like to hang out in water. They usually don’t cause a problem for people with strong immune systems.

But injecting the ink under the skin to make a tattoo bypasses many of body’s natural defenses and can allow these germs to set up shop. 

Once established, mycobacterial infections are stubborn. They often require months of treatment with antibiotics to clear.

After an extensive investigation, researchers traced the source of the outbreak to an unopened bottle of gray ink. Gray ink is used to create a smudgy, shaded effect around tattoos. It’s made by diluting black ink with water.  

“It appears that probably in this case it was diluted with tap water or non-sterile water, but we’re not sure,” says Linda Katz, MD, MPH, director of the Office of Cosmetics and Colors at the FDA.

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