Tattoos

A tattoo is a skin drawing, meant to be permanently visible throughout the person's life. Tattoos historically have had various functions, mainly aesthetic and more recently they have been used for permanent make-up. In order for the tattoo to be permanent, the ink has to be injected into the dermis, this is because the pigments that only reside on the epidermis will be removed by the natural skin regeneration process. During the skin tattooing, the ink will be deposited also on the epidermis, simply by virtue of the fact that the needle is on the way to the dermis and just passing through it. As we have seen in the picture, the tattooing process consists in delivering the pigments (tattoo ink) into the dermal layer. In the process of doing both the epidermal and dermal layer will be modified and injured causing an open wound. In the picture below we can see an example of how bright the finished tattoo work can be. This is because the pigments are also deposited onto the epidermis and most of the dermis is also exposed making the tattoo look at its brightest. When the area has healed completely, all the pigments deposited into the epidermis will have naturally been removed by the healing process. Therefore at that point, the pigments will not be present in the epidermal layer. The epidermal layer is transparent therefore the tattoo will still be clearly visible through it. However, the epidermal layer is not 100% transparent and it is slightly opaque. Therefore when the tattoo has healed the original brightness is apparently lost due to the fact that it will be visible through the opaque and transparent epidermal layer. In the picture below we can see the representative distribution of the tattoo pigments through the healing process. After the healing process, no pigmentation will be left on the epidermal layer. Therefore once the tattooed area has healed the tattoo is not as bright because the pigments have completely been removed from the epidermal layer. At that point, the tattoo on the dermal layer will only be visible through the transparent epidermal layer. Conversely, the tattoo will show its full brightness once the epidermal layer has been removed. This is normally done in the tattoo removal procedures using electrical arcing. As we have seen because tattoos are made by injecting the pigments into the dermal layer the tattoo making process involves deliberately causing a wound to the skin. When the tattoo has just been made, the treated area is literally an open wound which is required to heal properly, in order for the tattoo work to be preserved. Because of this, the end result of the tattooing process is not only dependent on the quality work of the tattoo artist but also reliant on the after-care routine to avoid infections and other adverse side effects. The healing process will likely last anywhere from three to four weeks, and special care will be required to be taken of the recently made new body art; this is to ensure the tattoo looks its best once that healing process has finished.

A fresh tattoo is essentially an open wound, therefore it has to be treated accordingly. The main risk during the healing process of a tattoo is the likelihood of contracting an inflammatory infection of the open wound. The risk of contracting any inflammatory infection or infections in general, during the healing period, can be minimised but never completely eliminated. Infections can be contracted in several ways due to the several sources of bacteria and viruses in our everyday environment. This is because it is relatively easy for bacteria to enter the open wound of a recently drawn tattoo. The signs of a possible infection are, oozing a strange liquid, pain, redness, swelling etc. If the infection is not treated appropriately the symptoms will worsen over time and lead to several long term undesirable effects. During the healing process, the area has to be kept infection free until the scabs have formed and fallen off by themselves. During the healing process, the client is required to make sure the area is kept clear and free from infections. Infections can be contracted during the healing process in may ways. In order to minimise these risks, the client can simply look after the tattooed part like any other open wound, using mild antiseptics and deliberately avoid those activities which will increase the likelihood of infections. In case of tattoo infections if they are treated early on there may not be devastating consequences for the tattoo. Therefore in case, it is suspected a tattoo is becoming infected it is best to seek medical advice immediately in order to minimise the possible detrimental effects of the infection. Usually, if the infection is treated appropriately it can be cured quickly without major consequences, therefore without compromising the final tattoo work. In the picture below we can see the devastating effects of the tattoo work which an infection can cause. An infection which is not properly looked after can lead to several undesired effects which could distort the tattoo work and even lead to fully fledged hypertrophic or atrophic permanent scars. Therefore if an infection is not treated promptly, effectively and with the right products the consequences could be permanent. In the above figure, the long-term effect of this type of infection can make the tattoo distorted and also lead to scarring.

Here are the most common symptoms of an infected tattoo. If your client is experiencing any of these, it is time to take action. Remember, if you are in doubt whether an infection is ongoing it is always advisable to consult a physician because General Practitioners are legally qualified to diagnose an infection and prescribe the medical treatment of each specific case. The tattoo artist, although will recognise an infected tattoo immediately, due to his vast experience, he may not be qualified to make a diagnosis and advise on the best medical treatment of each specific case. Legislation may vary from country to country.

• Redness. The area starts to redden and the redness may include the tattoo work itself and the edges too. The redness of the edges feathers out and it spreads further as the infection worsen over time if not treated properly.

• Swelling. It is normal for a tattoo to swell during the first 48 hours after the tattoo as being drawn, however, if the swelling increases over three to four days instead of decreasing, or begins to extend past the tattoo a fair distance, this is likely a sign of infection.
• Heat. An infected tattoo might feel hot to the touch. While it is normal for the tattoo to feel warm, especially during the first 48 hours, it should not feel very hot and the heat should fade away on its own accord. If it is infected, the whole tattoo and/or the area around it may feel hot to the touch, and if may also feel as if there is heat radiating from within the tattoo itself.
• Discharge. During the first 48 hours after the tattoo has just been drawn a slights discharge and some bleeding can occur and this is normal. However, if this continues or worsens after the first 48 hours it can be a clear sign of infection. The infected tattoo often has a slimy discharge oozing from them in various places; this may appear as a clear fluid with a golden colour or a thick yellow-green goo that sits within the tattoo. You might also see pus (white, yellow, or green).

• Odour. This a sure-fire sign that your tattoo is infected. Often the discharge from an infected tattoo will have a nasty smell or odour. The smell increases in intensity as the infection spreads or worsen.
• Pain. If you're experiencing mild or extreme pain that increases over the 3-5 days after your tattoo or has sharp, shooting pains from within the tattoo itself, it is likely an infection.
• Blistering. Blistering may also be a sign of infection, and it can occur on top of the tattoo, manifesting as red, raised sores filled with body fluids. If your tattoo is bubbly or bright red, then this is a sign of infection. This is not to be confused with the normal swelling occurring after the first 48 hours of receiving your tattoo, any raised areas should slowly level out and decrease to the height of the surrounding (non-tattooed) skin.
• Increased scab size. Due to abnormal levels of discharge, the scabs on an infected tattoo may appear thick and bulbous and have a yellow and green crust. This normally occurs when the infections are subsiding while the scabs are being formed. This is generally a better situation than the symptoms mentioned above.

• Fever and lethargy. This is possible in advanced stages of infection, also this can occur if the tattoo is relatively large and infected. An infection over a large area will trigger the natural feverish body reaction, which is designed to help the body combat bacterial infections. If you have a fever or feel lethargic and these symptoms are unrelated to other illnesses, then it's likely your body is working overtime to fight the infection coming from your tattoo. If you experience any of the symptoms above, fever is one of the surest signs of infection, even if your temperature is only slightly elevated. In fact, even a slight elevated temperature can be symptomatic of serious advanced state of a inflammatory skin infection. Skin infections rarely lead to high temperature fevers.
• Redness or streaking. This is an extremely severe case of an advanced stage of infection. As we have seen previously, if the tattoo or the skin around it is extremely red, you likely have an infection. If you see thin red lines radiating from your tattoo, you should go to the doctor immediately as streaking can be an early sign of blood poisoning.

As we have seen above, the tattoo is an open wound when it is just been drawn. The tattooing is a process which can last several weeks to reach its final permanent appearance.Understanding the healing stages of tattoos provides a better idea of what to expect in the days and weeks to come after the tattoo has been just made. The end result depends on the after-care and not only on the final tattoo work at the time it was drawn. In the video below you can have a quick overview of the tattoo healing process. The tattoo healing process can be divided into three main stages:

1. Stage one, healing the open wound. Most delicate part of the process, this is when an infection or diseases can be contracted through the open wound.
2. Stage two, scabbing or peeling process.
3. Stage three, pigments resettling.

Overall, the healing stages of tattoos stretch out over a three to four week period up to two to three months, and taking special care of the tattoo during this time is essential to preserve the wonderful work the tattoo artist has created. If you experience any symptoms beyond those mentioned here, contact your doctor (for medical advice) and tattoo artist straight away. Although your tattoo artist cannot provide medical advice, tattoo artists are very familiar with the signs of abnormal healing and the signs of a burgeoning infection. Remember that if in doubt you should always consult your doctor.

This initial stage of healing begins right after your tattoo is finished. At this point, you can consider the area, for what it is, an open wound, and it should be treated accordingly. Your artist will gently wash the area and bandage it to protect it from bacteria. Most artists recommend you keep the area covered for the first twenty-hours, although you will likely need to change the bandage because a fresh tattoo usually bleeds and can weep slightly. All fresh tattoos are temporarily covered bandaged to help prevent infection. This healing stage usually last about one week. If the bandage soak up too much fluid, it may wind up sticking to the newly tattooed skin, and this is definitely not good for the healing process. Many people describe a fresh tattoo as feeling similar to a sunburn. The area tends to sting, and it can become inflamed, a little raised and/or swollen. This is all a natural and normal reaction to the tattoo healing process. As we have seen the tattoo is an open wound caused by the injury inflicted by the tattooing procedure, and after any inflicted skin injury the skin can become inflamed and swell. This is, in fact, a normal reaction to being expected in the normal tattooing process. Inflammation and swelling are to be expected because the tattooing process deliberately inflicts a wound (injury) into the dermis therefore they are a normal skin reaction which often occurs soon after the tattooing. It normally begins immediately after the area has been tattooed, it lasts up to one to two days and it subsides on its own accord. Additionally, in certain cases, the swelling can be exacerbated by the individual skin reaction to the new external agent injected into the dermis (the tattoo ink colour/s). The swelling will subside on its own accord and normally two days after the treatment it will have subsided. If the swelling does not subside, this can be a clear sign of infection or some other side effect which will likely require medical attention. Scabs will begin to form over the tattooed area four to five days after the tattoo had been first made. No attempt must be made to remove them, any scabs must not be picked and should fall off by themselves. Just gently wash the area once or twice a day with a very mild soap, pat dry with a fresh paper towel. Gently dab on a light amount of the moisturising after-care lotion only if your tattoo artist recommends it. Do not apply any creams or product on the fresh tattoo other than those expressedly recommended by the tattoo artist as applying unsuitable products on an open wound, could easily lead to unnecessary complications. After all, a fresh tattoo is an open wound which is trying to heal by its own accord. Although people tend to heal at different rates, the first healing stage of a tattoo usually lasts about one week as long as an infection doesn't set in. Some people can experience some discomfort and even pain, in those cases the pain is more than expected, some over-the-counter pain reliever can be taken. In any case, if in doubt you can visit your doctor.

The second stage of healing usually brings the onset of scabbing, peeling and itching. After the first healing stage, the scabs are well formed and just beginning to flake off. This process will continue for about a week. The skin around the tattoo may become a bit dry. Most people experience some peeling, just as they would with a sunburn. The client has to avoid both picking the scabs and peeling the flaky skin intentionally, doing so can jeopardise the final tattoo results. Just allow it to slough off naturally and, by all means, do not scratch your tattoo. Scratching can cause damage and ultimately spoil the look of the tattoo work by the time healing is complete. Applying more after-care lotion to the area should bring some relief to the itching, however, please note that the itching is a natural reaction of the skin to the good healing of any skin injury (including tattooing).

Stage three brings the final healing of the area. By this point, most or all of the scabs have fallen away from the tattoo, although the area may still be slightly dry and mildly tender. At that point, some mild itchy feeling can be still felt and the tattoo does not look as vibrant as it did when it was first finished, and this is normal. There is typically still a layer of dead skin over the tattoo at this point that obscures it a bit, but once that layer naturally and slowly sloughs away the tattoo will look as it should see what your new tattoo really looks like. If you have managed to avoid infection and scratching, it probably looks great.

In any case, please follow the recommendations of your own tattoo artist. If you require any medical advice consult your doctor. The after-care has to be performed by the client and consequently, the client alone assumes all responsibilities to carry it out appropriately. Always wash your hands before touching your tattoo especially while the tattoo is still an open wound (stage one)! When you get home: Remove bandage within 2-3 hours after getting your tattoo. Re-bandage according to the instructions of your tattoo artist. On the first night, you may want to wrap your tattoo in saran wrap to prevent sticking to your bedding. Do not use any cloth bandages or pads, as the fibres of this material can adhere to your open tattoo and hinder the healing process. Wash your tattoo with an anti-bacterial liquid soap, use only the one suggested by your tattoo artist. Be gentle, do not use a wash cloth or anything that will ex-foliate your tattoo. Gently pat your tattoo dry with a clean cloth or paper towel. Do not rub, and do not use a fabric with a rough surface. The first 3-4 days: Apply a small amount of ointment on your tattoo as recommended by your tattoo artist. Please do not use antibiotic ointments as a means of preventing infections (this is because doing do will eventually induce a bacterial resistance to the specific antibiotic substance). Use a suitable antiseptic cream or ointment instead. Always use clean hands and do not place your fingers back into the antiseptic ointment (or cream) after touching your tattoo. Preferably you should use a clean ear bud (or similar) to place the ointment from the tab onto the tattoo, this is to minimise bacterial contamination of the ointment you are using. Make sure to rub the ointment in so that it is not shiny, or greasy– you want the thinnest amount possible. Pat off any excess ointment with a clean cloth or paper towel. Do not use petroleum jelly (Vaseline),  or Bag Balm. Wash, dry and apply ointment 3-5 times daily, as needed. Wear clean, soft clothing over your tattoo for the first 2 weeks– do not use any tight clothing, nothing abrasive or irritating (i.e. wool). For a foot tattoo: go barefoot as long as possible. If you must wear shoes, first wrap your clean tattoo in saran wrap, then cover with a clean cotton sock before putting on your shoe. Avoid sandals or flip flops for this period to prevent chafing and damage to the tattoo. After day 4 to 5: Your tattoo should begin to scab. This is normal and a good sign! Do not pick at the scabs. Begin using a mild, white, unscented lotion, free of dyes or Perfumes. Use lotion for minimum 2 weeks, 1-2 times daily.

• Do not apply any product not explicitly recommended by your tattoo artist as doing so especially during the healing phase (stage one) of the healing process could seriously jeopardise the tattoo work.
• Do not apply petroleum based skin products to your tattoo.
• You can shower, but you may not soak your tattoo for 2 weeks. No swimming, soaking or hot tub.Avoid swimming. In the swimming pool, Chlorine can leach colour and dry out the still tender skin around your tattoo. In the sea, the salty water could have undesirable effects on your tattooed area. Not hot tub.
• Do not wear tight, abrasive materials, jewellery, or shoes that rub against your tattoo.
• Do not let anyone touch your tattoo unless they wash their hands.
• Don't soak in the tub. This can allow bacteria to penetrate the unhealed needle wounds.
• Avoid exposing your new tattoo to direct sunlight. This can lead to fading and you could easily burn the unhealed skin.
• Do not pick at your scabs or scratch/rub your tattoo.
• Beware of gym equipment, wash it well before using it.

Even if the tattoo has been drawn correctly, using the best equipment available and the best possible quality pigmentation certain undesirable effects can still occur. They can be minimised but never eliminated altogether.

This is a side effect which is directly dependent on the type of pigmentation used during the tattooing procedure. The best quality pigments should not lead to an increased risk of cancer throughout life. Studies to document the effect of tattoos on the body and its relationship with cancer are still ongoing however several experts are of the opinion that tattoos can increase the likelihood of developing cancer later in life depending on the type of substances used in the pigments. Where earlier tattoos were made from natural dyes, today’s inks can be made from a variety of ingredients such as pigments suspended in a carrier solution for colour, of which the pigments are composed of plastics or metallic salts such as mercury sulfide, cobalt albuminate, cadmium, chromium and chromic oxides. It is also claimed that the nano particles from the tattoo ink can seep into the body’s major organs. Aluminium silicates and Barium sulphates are used to preserve some physical properties of the tattoo and ferrous oxides and titanium oxides are mixed as well for desired transparency. The toxicity of the inks, whose chemical composition is sometimes unknown and mostly unregulated, can travel through the bloodstream to accrue in the kidneys and the spleen. The most common health risk that you put yourself into when you get a tattoo would always be – skin cancer. Though not proven, tattoos do raise the risk of developing melanomas that is abnormal growth of cells. Now the actual amount and mixture of these constituents vary from parlour to carlour because it is considered a trade secret. These inks are injected below the skin layer for permanency and the toxic effect of these metals in your body,  even in in small amounts, cannot be ignored. From growth retardation, mild skin irritation and to affecting the cardiovascular systems, these can all be the potential side effects of just getting a tattoo.

This is an effect merely attributable to the specific safety standards of the tattoo parlour you are using to get your tattoo done. The use of non-sterile needles during the process of tattoo application can increase the risks of contracting transfusion-transmitted diseases such as tetanus, hepatitis B and C, herpes, tetanus, staph, syphilis and HIV due to simple needles "cross-contamination". Hence there are several places where prospective blood donors are screened out for tattoos. Therefore it is important that you visit an established and well-known shop which follows proper safety standards to prevent the spread of these diseases. New, sealed needles for every new tattoo, sterilizing hands and instruments regularly and using gloves are basic safety protocols every tattoo parlour is required to follow. Remember that while the tattoo is still an open wound (stage 1) although the tattoo work has been carried out in sterile conditions and there was no cross contamination you can still acquire most of the diseases mentioned above through contact of the open wound with the respective viruses and/or bacteria.

People prone to developing Keloids should avoid undergoing any form of tattooing. Scars are bound to occur during the initial healing phase of the tattooing (stage one) if the proper care steps are not followed properly or inflammatory infections develop. Keloids are a type of collagen overgrowth tissue formed at the site of a wound. They are firm and rubbery and pink to purplish in colour. In contrast to scars, keloids do not diminish with time and continue to grow. They can grow beyond the boundaries of the wounds which caused them; certain people are more prone to developing them than others depending on family history, hence they should avoid getting piercings or tattoos done. By getting a tattoo done people with past Keloidal history, put themselves at risk of growing new Keloids due to the injury inflicted by the tattooing process itself. Keloids can develop irrespective of the way the tattoos have been drawn and the after-care carried out during the healing phase. To know more about Keloids please click here.

Allergic Reactions to tattoos are quite common and there are different types of allergies that can be caused. Most often it is advisable to perform a patch test to determine whether your skin is too sensitive for the tattoo inks prior to actually getting it, but it may not always be a sure way of knowing. The main issue in order to prevent allergic reactions to tattoos is that, even if all ingredients are stated in the pigments packaging used, no one is always aware of all his/her possible reactions to each specific agent used in the tattoo colours or their mixture.

Allergic reactions have occurred with some of the many metals put into tattoo inks, nickel is one of the most common metal allergies. Others have reacted to the mercury in red cinnabar, to cobalt blue, and to cadmium sulfite when used as a yellow pigment. Some inks were found to have high levels of lead, some contained lithium, and the blue inks were full of copper. The long-term health effects of sustained allergic reactions to tattoos are still unknown due to the lack of regulation, testing, and long-term studies

 

Phototoxic reactions do occur, though not very common, considering the number of people who get tattoos done every year, where phototoxicity means having a reaction on exposure to sunlight. Inflammatory reactions caused primarily by the inks appear as swellings and red rashes which generally occurs for everyone and is expected to disappear within 2 to 4 weeks with proper attention and care.

Dermatitis caused due to allergic reactions to pigments is characterized by inflamed skin rashes and by the affected area becoming scaly or flaky. These allergic reactions do not always occur immediately after the tattoo has been applied, sometimes the effects can be delayed by months, even years. Itchiness and red bumps which can be caused due to changes in weather or body temperature often occur which will probably require a visit to your dermatologist or antibiotics.

Granulomas is a collection of immune cells known as histiocytes. Granulomas form when the immune system attempts to wall off substances it perceives as foreign but is unable to eliminate. Since tattoo ink particles are foreign material, granulomas can develop around or inside the tattooed tissue. Apart from granulomas, enlargement of the lymph nodes have also been reported as a side effect of tattoos. The pigments used, leak into the bloodstream, accumulating at the lymph nodes causing painful swellings in these regions. The major cause of concern due to these inflammations is the misdiagnosis of melanoma. In patients with cancer risks, a Radiologist is often unable to distinguish between the ink staining in the lymph node and the abnormal tissue growth.

Other side effects of tattooing maybe:

• Haematomas are bruises that can occur due to the puncturing of a blood vessel during the tattooing process.
• Keratoacanthoma is a skin tumour characterized by a dome-shaped inflamed skin which gradually increases in size and its developments risks increase with tattoos.
• Hyperkeratosis which is an excess growth of keratin in hair follicles are all examples of abnormal growth whose occurrence also will depend from person to person and also the tattoo artist.
• Hyperplasia can also occur, hyperplasia is an organ enlargement due to abnormal cell multiplication.

Since the inks used for tattooing contain metals, there have been complaints by people having tattoos, to experience a burning sensation, when they are undergoing an MRI scan. Though not conclusively verified, there have been reports of the MRI image’s quality getting affected by the pigments in the tattoo inks. An MRI or a magnetic resonance imaging creates pictures of the interior of the body using magnetic fields and radio frequency pulses. The concern for tattoo inks arises mainly due to the magnetic force which is extremely powerful and can affect the metal particles in the inks. Hence the MRI s done for people with tattoos requires more attention.