Generate QR code
Open Access
Subscription Access
Toxicological aspects of tattoos
https://doi.org/10.30629/0023-2149-2025-103-7-513-520
Abstract
The work reflects the toxicological aspects of tattoos and their complications caused by an increase in the number of carriers, as well as the area of application and the number of tattoos, the expansion of their color range, etc. Inks, the composition and potential toxicity of which are not always known, contain complexes of pigments and auxiliaries, which, like the products of their transformation, can provoke the development of various types of skin and systemic reactions. The main factors determining the toxic risks of tattooing are given.
About the Authors
S. Kh. Sarmanaev
Academy of Postgraduate Education of the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency
Russian Federation
Russian Federation
Salavat Kh. Sarmanaev — Doctor of Medical Sciences, Professor, Head of the Department of Toxicology and Clinical Pharmacology
Moscow
V. B. Simonenko
Branch Military Medical Academy named after S.M. Kirov in Moscow of the Ministry of Defense of the Russia
Russian Federation
Russian Federation
Vladimir B. Simonenko — Doctor of Medical Sciences, Professor, Corresponding Member of the Russian Academy of Sciences, Professor of the Department of Emergency Medicine
Moscow
References
1. Kluger N., Misery L., Seité S. Tattooing: A national survey in the general population of France. J. Am. Acad. Dermatol. 2019;81(2):607–610.
2. Borkenhagen A. Verbreitung von Tätowierungen, Piercing und Körperhaarentfernung in Deutschland. Press release University of Leipzig: University of Leipzig. 2017.
3. Shannon-Missal L. Tattoo Takeover: Three in Ten Americans Have Tattoos, and Most Don’t Stop at Just One. In: Poll T.H., editor. URL: https://theharrispoll.com2016
4. Laumann A.E., Derick A.J. Tattoos and body piercings in the United States: a national data set. J Am Acad Dermatol. 2006;55:413–21.
5. Borkenhagen A., Mirastschijski U., Petrowski K. et al. Tattoos in der deutschen Bevölkerung – Prävalenzen, Soziodemografe und Gesundheitsorientierung. Bundesgesundheitsbl. 2019;62(9):1077–1082.
6. Laux P., Tralau T., Tentschert J. et al. A medical-toxicological view of tattooing. The Lancet. 2016;387(10016):395–402.
7. Giulbudagian M., Schreiver I., Singh A.V., et al. Safety of tattoos and permanent make-up: a regulatory view. Arch. Toxicol. 2020;94(2):357–369.
8. Piccinini P., Pakalin S., Contor L. et al. Safety of tattoos and permanent make-up. Adverse health effects and experience with the Council of Europe Resolution. Publications Office of the European Union. 2008.
9. European Council. Resolution ResAP(2008)1 on requirements an criteria for the safety of tattoos and permanent make-up. In: Products CoEoC, ed. 2008.
10. Tattoo and Permanent Makeup Substances Group Standard 2011. New Zealand Environmental Protection Authority.
11. FD&C Act Reference Information United States Code, Title 21.
12. The Code of Federal Regulations USA 21: 70–5(b) § 70.5 General restrictions on use of color additives.
13. Das Eidgenössische Departement des Innern (EDI). Verordnung über Gegenstände für den Schleimhaut-, Haut- und Haarkontakt sowie über Kerzen, Streichhölzer, Feuerzeuge und Scherzartikel (Verordnung über Gegenstände für den Humankontakt). Bern: Swiss Government. 2005:1–26.
14. Hauri U. Inks for tattoos and PMU (permanent make-up): organic pigments, preservatives and impurities such as primary aromatic amines and nitrosamines. Basel: Kantonales Laboratorium Basel-Stadt. 2011.
15. Serup J., Carlsen K.H., Dommershausen N. et al. Identification of pigments related to allergic tattoo reactions in 104 human skin biopsies. Contact Dermatitis. 2020;82(2):73–82.
16. Piccinini P., Pakalin S., Contor L. et al. JRC science for policy report: safety of tattoos and permanent make-up final. European commision technical report 2016. URL: https://core.ac.uk/download/pdf/45616482.pdf. Accessed May 27, 2024.
17. Hauri U., Hohl C. Photostability and breakdown products of pigments currently used in tattoo inks. Curr. Probl. Dermatol. 2015;48:164–9.
18. Desmedt B., Vanhamme M., Deconinck E The purity of tattoo inks, screening substances of high concern. Regul. Toxicol. Pharmacol. 2022;129:105-123.
19. Bäumler W. Chemical hazard of tattoo colorants. La Presse Mandeacute;dicale. 2020,
20. Tighe M.E., Libby D.K., Dorn S.K. et al. A survey of metals found in tattoo inks. J. Environ. Prot. 2017;8(11):1243–1253.
21. Regensburger J., Lehner K., Maisch T. et al. Tattoo inks contain polycyclic aromatic hydrocarbons that additionally generate deleterious singlet oxygen. Exp. Dermatol. 2010;19:e275–e281.
22. Bäumler W., Eibler E.T., Hohenleutner U. et al. Q-switch laser and tattoo pigments: first results of the chemical and photophysical analysis of 41 compounds. Lasers Surg. Med. 2000;26:13–21.
23. Schreiver I., Luch A. At the dark end of the rainbow: data gaps in tattoo toxicology. Arch. Toxicol. 2016;90(7):1763–5.
24. Jungmann S., Laux P., Bauer T.T. et al. From the Tattoo Studio to the Emergency Room. Dtsch. Arztebl. Int. 2016;7;113(40):672–675.
25. Karymov O.N. et al. Classification of tattoo complications. Clinical dermatology and venereology. 2018;17(6):98–107. (In Russian).
26. Agnello M., Fontana M. Survey on European studies of the chemical characterisation of tattoo ink products and the measurement of potentially harmful ingredients. Curr. Probl. Dermatol. 2015;48:142–51.
27. Wang X., Josefsson L., Meschnark S. et al. Analytical survey of tattoo inks — a chemical and legal perspective with focus on sensitizing substance. Contact Dermatitis. 2021;85(3):340–353.
28. IARC. Titanium dioxide. IARC monographs. 2010:93.
29. Moller P., Jensen D.M., Wils R.S. et al. Assessment of evidence for nanosized titanium dioxidegenerated DNA strand breaks and oxidatively damaged DNA in cells and animal models. Nanotoxicology. 2017;11:1237–56.
30. Colboc H., Bazin D. , Reguer S. et al. Chemical characterization of inks in skin reactions to tattoo. J. Synchrotron Radiat. 2022;1(29(Pt 6)):1436–1445.
31. IARC. Carbon black. IARC monographs. 2006:92.
32. Koreeda M., Moore P.D., Wislocki P.G. et al. Binding of benzo[a] pyrene 7,8-diol-9,10-epoxides to DNA, RNA, and protein of mouse skin occurs with high stereoselectivity. Science. 1978;199:778–81.
33. Gelboin H.V. Benzo[alpha]pyrene metabolism, activation and carcinogenesis: role and regulation of mixed-function oxidases and related enzymes. Physiological reviews. 1980;60:1107–66.
34. Moraitis A.G., Hewison M., Collins M. et al. Hypercalcemia associated with mineral oil-induced sclerosing paraffinomas. Endoc. Pract. 2013;19:e50-6.
35. Newman M.J., Light B.A., Weston A. et al. Detection and characterization of human serum antibodies to polycyclic aromatic hydrocarbon diol-epoxide DNA adducts. J. Clin. Invest. 1988;82:145–53.
36. Bizub D., Wood A.W., Skalka A.M. Mutagenesis of the Ha-ras oncogene in mouse skin tumors induced by polycyclic aromatic hydrocarbons. Proc. Natl. Acad. Sci. USA. 1986;83:6048–52.
37. Davila D.R., Romero D.L., Burchiel S.W. Human T cells are highly sensitive to suppression of mitogenesis by polycyclic aromatic hydrocarbons and this effect is differentially reversed by alpha-naphthoflavone. Toxicol. Appl. Pharmacol. 1996;139:333–41.
38. Jacobsen N.R., Clausen P.A. Carbon black nanoparticles and other problematic constituents of black ink and their potential to harm tattooed humans. Curr. Probl. Dermatol. 2015;48:170-5.
39. van Grevenynghe J. et al. Polycyclic aromatic hydrocarbons inhibit differentiation of human monocytes into macrophages. J. Immunol. 2003;170:2374–81.
40. Hutton Carlsen K., Sepehri M., Serup J. Tattooist-associated tattoo complications: “Overworked Tattoo”, “Pigment Overload” and infections producing early and late adverse events. Dermatology. 2019;9:1–8.
41. Sepehri M., Carlsen K.H., Serup J. Papulo-Nodular Reactions in Black Tattoos as Markers of Sarcoidosis: Study of 92 Tattoo Reactions from a Hospital Material. Dermatology. 2016. 232(6):679– 686.
42. Bagot M. Complications des tatouages: classification clinique, histologique, physiopathologique, cinétique des particules [Complications of tattoos: Clinical and pathological classification, pathophysiology, particle kinetics]. Bull. Acad. Natl. Med. 2020;204(6):607– 610.
43. Ma Т.P., Luo Q., Chen J. et al. Intraрeritoneal injection of magnetic Fe 3O4 — nanoparticle includes hepatic and renal tissue injury via oxidative stress in mice. Int. J. Nanomedicine. 2012;7:4809–4818.
44. Prior G. Tattoo inks: legislation, pigments, metals and chemical analysis. Current Problems in Dermatology. 2015;48:152–157.
45. Negi S., Bala L., Shukla S. et al. Tattoo inks are toxicological risks to human health: A systematic review of their ingredients, fate inside skin, toxicity due to polycyclic aromatic hydrocarbons, primary aromatic amines, metals, and overview of regulatory frameworks. Tоxicol. Ind. Health. 2022;38(7):417–434.
46. Karadagli S.S., Kaftan G., Cansever I. et al. Tattoo inks: evaluation of cellular responses and analysis of some trace metals. Biometals. 2024;37(2):495–505.
47. IARC. Cadmium. IARC monographs. 2012;58:100.
48. Liszewski W., Warshaw E.M. Pigments in American tattoo inks and their propensity to elicit allergic contact dermatitis. J. Am. Acad. Dermatol. 2019;81:379–385.
49. IARC. Mercury. IARC monographs. 1993:58.
50. Prantsidis A., Raikos N., Pantelakis Ι. et al. Unusual mercury poisoning from tattoo dye. Hippokratia. 2017;21(4):197–200.
51. IARC. Chromium VI. IARC monographs. 2012;Sup 7, 49, 100C.
52. Bocca B., Senofonte O., Petrucc F. Hexavalent chromium in tattoo inks: dermal exposure and systemic risk. Contact Dermatitis. 2018;79(4):218–225.
53. Cui Y., Spann A.P., Couch L.H. et al. Photodecomposition of Pigment Yellow 74, a pigment used in tattoo inks. Photochem. Photobiol. 2004;80:175–84.
54. Kluger N., Cribier B. Keratoacanthomas and Squamous Cell Carcinomas on Tattoos: A Review of 42 Cases. Dermatology. 2021;237(2):309–312.
55. European Chemicals Agency (ECHA). Substance Information. URL: https://echa.europa.eu/substance-information/-/substanceinfo/100.018.645. Accessed May 27, 2024.
56. Berrie B.H., Lomax S. Azo pigments: their history, synthesis, properties, and use in artists’ materials. Stud. Hist. Art. 1997;57(2):8–33.
57. Serup J., Sepehri M., Carlsen K.H. Classification of tattoo complications in a hospital material of 493 adverse events. Dermatology. 2016;232(6):668–678.
58. Lerche C.M., Heerfordt I.M., Serup J. et al. Red tattoos, ultraviolet radiation and skin cancer in mice. Exp. Dermatol. 2017;26(11):1091– 1096.
59. Agnese E.R., Folkes A., Fromowitz J. et al. Pink and Orange Tattoo Pigments: Two Occurrences of Squamous Cell Neoplasm. Cureus. 2024;16(4):e58998.
60. Manso M., Pessanha S., Guerra M. et al. Assessment of toxic metals and hazardous substances in tattoo inks using Sy-XRF, AAS, and Raman spectroscopy. Biol. Trace Elem. Res. 2019;187(2):596–601.
61. Battistini B., Petrucci F., De Angelis I. et al. Quantitative analysis of metals and metal-based nano- and submicron-particles in tattoo inks. Chemosphere. 2020;245:125667.
62. Bircher A.J. Metal allergy: other metals. In: M. Allergy, J.K. Chen, J.P. Thyssen, eds. Springer. 2018;467:479.
63. Bocca B., Forte G. The epidemiology of contact allergy to metals in the general population: prevalence and new evidences. Open Chem. Biomed. Methods J. 2009;2:26. -34.
64. Schreiver I., Hutzler C., Laux P. et al. Formation of highly toxic hydrogen cyanide upon ruby laser irradiation of the tattoo pigment phthalocyanine blue. Scientific reports. 2015;5:12915.
65. Schreiver I., Hutzler C., Andree S. et al. Identification and hazard prediction of tattoo pigments by means of pyrolysis-gas chromatography/mass spectrometry. Arch. Toxicol. 2016;90(7):1639–1650.
66. Schreiver I., Hesse B., SeimC. et al. Synchrotron-based ν-XRF mapping and μ-FTIR microscopy enable to look into the fate and efects of tattoo pigments in human skin. Sci. Rep. 2017;7(1):11395.
67. Bauer E.M., Scibetta E.V., Cecchetti D. et al. Treatments of a phthalocyanine-based green ink for tattoo removal purposes: generation of toxic fragments and potentially harmful morphologies. Arch. Toxicol. 2020. URL: https://doi.org/10.1007/s00204-020-02790-7.
68. Greve B., Chytry R., Raulin C. Contact dermatitis from red tattoo pigment (quinacridone) with secondary spread. Contact Dermatitis. 2003;49(5):265–6.
69. Hutton Carlsen K., Serup J. Patients with tattoo reactions have reduced quality of life and suffer from itch. Skin Research and Technology. 2014;21(1): 101–107.
70. European Chemicals Agency (ECHA). Committee for Risk Assessment (RAC) Committee for Socio-economic Analysis (SEAC) — Opinion on an Annex XV dossier proposing restrictions on substances used in tattoo inks and permanent make-up. URL: https://echa.europa.eu/documents/10162/dc3d6ea4-df3f-f53d-eff0-540ff3a-5b1a0. Accessed May 27, 2024.
71. Karadagli S.S., Cansever I., Armagan G. et al. Are Some Metals in Tattoo Inks Harmful to Health? An Analytical Approach. Chem. Res. Toxicol. 2023;36(1):104–111.
72. Kiszla B.M., Elmets C.A., Mayo T.T. Quantitative analysis of restricted metals and metalloids in tattoo inks: A systematic review and meta-analysis. Chemosphere. 2023;313;137291.
73. Karbowska B., Rębiś T., Zembrzuska J. et al. Thallium in color tattoo inks: risk associated with tattooing. Med. Pr. 2020. 24;71(4):405–411.
74. Serup J., Carlsen K.H., Dommershausen N. et al. Identification of pigments related to allergic tattoo reactions in 104 human skin biopsies. Contact Dermatitis. 2020;82(2):73–82.
75. De Cuyper C. Permanent makeup: indications and complications. Clin. Dermatol. 2008;26:30–4.
76. Petersen H., Lewe D. Chemical purity and toxicology of pigments used in tattoo inks. Curr. Probl. Dermatol. 2015;48:136–41.
77. Engel E., Santarelli F., Vasold R. et al. Modern tattoos cause high concentrations of hazardous pigments in skin. Contact Dermat. 2008;58:228–233.
78. Giulbudagian M., Battisini B., Bäumler W. et al. Lessons learned in a decade: Medical-toxicological view of tattooing. J. Eur. Acad. Dermatol. Venereol. 2024 May 6. DOI: 10.1111/jdv.20072
79. Ferguson J.E., Andrew S.M., Jones C.J. et al. The q-switched neodymium: Yag laser and tattoos: a microscopic analysis of laser-tattoo interactions. Br. J. Dermatol. 1997;137:405–410.
80. Baranska A., Shawket A., Jouve M. et al. Unveiling skin macrophage dynamics explains both tattoo persistence and strenuous removal. J. Exp. Med. 2018;215(4):1115–1133.
81. Baumler W. Absorption, distribution, metabolism and excretion of tattoo colorants and ingredients in mouse and man: the known and the unknown. Curr. Probl. Dermatol. 2015;48:176–84.
82. Kluger N., Koljonen V. The surgeon, the tattoo and the black lymph node. J. Plast. Reconstr. Aesthet. Surg. 2013;66(4):561–562.
83. Lehner K., Santarelli F., Vasold R. et al. Black tattoos entail substantial uptake of genotoxicpolycyclic aromatic hydrocarbons (PAH) in human skin and regional lymph nodes. PLoS One. 2014;9(3):e92787.
84. Sokolovskaya E., Shariff Y. Calcifications in axillary lymph nodes on negative mammograms: tattoo pigment mimicking axillary lymph node calcifications. Breast J. 2015;21(6):678–679.
85. Kreyling W.G., Holzwarth U., Haberl N. et al. Quantitative biokinetics of titanium dioxide nanoparticles after intravenous injection in rats: part 1. Nanotoxicology. 2017;11(4):434–442.
86. Umbreit T.H., Francke-Carroll S., Weaver J.L. et al. Tissue distribution and histopathological effects of titanium dioxide nanoparticles after intravenous or subcutaneous injection in mice. J. Appl. Toxicol. 2012;32(5):350–357.
87. Xu J., Shi H., Ruth M. et al. Acute toxicity of intravenously administered titanium dioxide nanoparticles in mice. PLoS One. 2013;8(8):e70618.
88. Sonavane G., Tomoda K., Makino K. Biodistribution of colloidal gold nanoparticles after intravenous administration: effect of particle size. Colloids Surf B Biointerfaces. 2008;66(2):274–280.
89. Sepehri M., Sejersen T., Qvortrup K. et al. Tattoo pigments are observed in the Kupffer cells of the liver indicating blood-borne distribution of tattoo ink. Dermatology. 2017;233(1):86–93.
90. Bolt H.M., Hengstler J.G. Tattoo toxicology, an upcoming complex scientific issue. Arch. Toxicol. 2020;94(7):2273–2274.
91. Hering H., Sung A.Y., Röder N. et al. Laser irradiation of organic tattoo pigments releases carcinogens with 3,3’-Dichlorobenzidine inducing DNA Strand breaks in human skin cells. J. Invest. Dermatol. 2018;138(12):2687–2690.
92. Karpienko K., Sadura F., Januszewicz K. et al. Raman spectroscopy in the measurement of tattoo inks — opportunities and challenges. 2nd International Conference on Tattoo Safety. Abstracts. 2021:17.
93. Baumler W., Weiß K.T. Laser assisted tattoo removal — state of the art and new developments. Photochem. Photobiol. Sci. 2019;18(2):349–3520.
94. Vasold R., Naarmann N., Ulrich H. et al. Tattoo pigments are cleaved by laser light — the chemical analysis in vitro provide evidence for hazardous compounds. Photochem. Photobiol. 2004;80(2):185– 190.
95. Klügl I., Hiller K.-A., Landthaler M. et al. Incidence of health problems associated with tattooed skin: a nation-wide survey in German-speaking countries. Dermatology. 2010. 221(1): 43-50.
96. Kluger N. Acute complications of tattooing presenting in the ED. Am. J. Emerg. Med. 2012;30(9):2055–63.
97. Laumann A.E., Derick A.J. Tattoos and body piercings in the United States: a national data set. J. Am. Acad. Dermatol. 2006;55(3):413–21.
98. Drage L.A., Ecker P.M., Orenstein R. et al. An outbreak of Mycobacterium chelonae infections in tattoos. J. Am. Acad. Dermatol. 2010;62:501–506.
99. Anderson L.L., Cardone J.S., McCollough M.L. et al. Tattoo pigment mimicking metastatic malignant melanoma. Dermatol. Surg. 1996;22:92–94.
100. Shinohara M.M., Nguyen J., Gardner J. et al. The histopathologic spectrum of decorative tattoo complications. J. Cutan. Pathol. 2012;39:1110–1118.
101. Ackerman A.B., Chongchitnant N., Sanchez J. et al. Histologic Diagnosis of Inflammatory Skin Diseases. An Algorithmic Method Based on Pattern Analysis. 2nd ed. Baltimore, MD: William and Wilkins; 1997.
102. Thum C.K., Biswas A. Inflammatory complications related to tattooing: a histopathological approach based on pattern analysis. Am. J. Dermatopathol. 2015;37:54–66.
103. Lebhar J., Jacobs J., Rundle C. et al. Skin cancers arising within tattoos: A systematic review. JAAD International. 2024;16:133–143.
104. Swigost A., Farah R.S, Canova E. et al. Multiple squamous neoplasms arising in a red tattoo after laser tattoo removal. Dermatol. Surg. 2020;46(7):970–973.
105. Schreiver I., Luch A.Tattooing: overriding the skin barrier and the journey into the unknown. Arch Toxicol. 2020;94:647–648.
106. Schreiver I., Hesse B., Seim C. et al. Distribution of nickel and chromium containing particles from tattoo needle wear in humans and its possible impact on allergic reactions. Part Fibre Toxicol. 2019;16:1–10.
Review
For citations:
Sarmanaev S.Kh., Simonenko V.B. Toxicological aspects of tattoos. Clinical Medicine (Russian Journal). 2025;103(7):513-520. (In Russ.) https://doi.org/10.30629/0023-2149-2025-103-7-513-520
Views:
15
Email this article 