Page 60 - JSOM Fall 2024

Winston Churchill’s Mother and the Inked Operator

Health Risks and Biokinetics of Tattoo Inks

Anna M. Gielas, PhD

ABSTRACT
Tattooing is an ancient art form widely practiced among Spe- some of which are known carcinogens and sensitizers. Besides
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cial Operations Forces (SOF) personnel. The ink injected into color pigments, tattoo inks generally consist of emulsifiers, sol-
skin tissue during tattooing often contains various compounds, vents, preservatives, and impurities. Additionally, some inks
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including impurities and contaminants, which can pose health may contain hazardous contaminants of unknown provenance
risks. This article provides an overview of recent research to with bioactive potential. 6
inform SOF medical personnel about the potential health im-
plications of both new and older tattoos. Acquiring tattoos during deployment exposes servicemem-
bers to risks related to the ink and potentially substandard
Keywords: tattoo; ink pigments; risks; allergies; infection; hygienic conditions of the tattoo instruments and application
inflammation; sarcoidosis; lymphoma procedures. Amateur tattooing involves hand-tapping the ink
into the epidermis and dermis using a sharp tool. Electrically
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operated tattooing devices (tattoo guns) allow the needle to
pierce these two skin layers up to 3,000 times per minute,
hat do many Special Operations Forces (SOF) op- with each needlestick carrying the potential for transmission
erators have in common with Winston Churchill’s of blood-borne pathogens. In fact, unsanitary settings can sig-
Wmother? Tattoos. Lady Randolph Churchill had a nificantly elevate the risk of exposure to viruses, such as HIV
snake tattoo twined around her wrist. In the late 19th and and hepatitis B and C. New tattoos are also associated with
7,8
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early 20th centuries, tattoos were fashionable among royalty bacterial infections, specifically with staphylococci and strep-
in England and wider Europe. However, tattooing is a much tococci. 9–11 Antibiotics are the usual course of treatment; how-
older and surprisingly universal human practice. It has existed ever, a tattoo-related infection should not be underestimated.
for seven millennia and is archaeologically evidenced across Given the global increase in antimicrobial resistance, it may
most continents. 1–3 advance into life-threatening conditions such as sepsis, even
in non-immunosuppressed individuals like SOF personnel.
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Tattooing has always been a risky business. Whether for the The healing process following a new tattoo is characterized by
ancient Egyptians, Lady Churchill, or modern-day operators, susceptibility to infections from other microorganisms, includ-
tattooing has consistently posed risks. In 2016, Winn and col- ing fungi and parasites. 2,7,10 Occasionally, an allergic reaction
leagues discussed several safety and health risks associated may emerge within 1 to 2 days of the tattooing procedure. 6,12
with the intradermal application of ink pigments in a case re- These reactions may be localized to the tattooed region or
port published in this journal. Since then, researchers have manifest as widespread rashes or eczemas. 6,12 Although they
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reported new insights, including observations on the toxicity tend to resolve without treatment, it may take several weeks or
and biokinetics of tattoo pigments. In view of the new and even months for these reactions to subside. Patients with pre-
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growing literature on tattooing and tattoo inks, this article existing dermatoses are more likely to experience an exacerba-
aims to inform SOF medical personnel about the potential tion and other complications of their diseases when receiving
health implications of both newly acquired and older tattoos. a new tattoo. Generally, it is worth noting that the healing
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process following tattoo application differs significantly from
Although tattoo inks are injected into human tissue, they common wound healing due to the presence of cytotoxic ink
are not required to meet the safety standards that apply to particles in the wound, which may result in other, hitherto less
pharmaceuticals and medical devices inserted into the human reported complications. Considering the potential health con-
body. In 2023, the U.S. Food and Drug Administration issued cerns, servicemembers with new tattoos may warrant closer
a guidance document for manufacturers and distributors of attention of SOF medics.
tattoo inks to help identify whether their products are con-
taminated with microorganisms. However, tattoo inks remain In older tattoos, ink-related allergies are the most common
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unregulated in the United States and many other countries complication. 7,8,14 Sensitization to ink particles may take
worldwide. These inks are complex suspensions of chemical several years; thus, allergic reactions typically manifest as
substances, including both inorganic and organic pigments, delayed responses (type IV allergies). 6–8,12,14,15 In cases where
Correspondence to Anna M. Gielas, 81 Stock Street, Flat 0/1, Paisley, PA2 6NQ, United Kingdom or amg203@cantab.ac.uk
Dr. Gielas is affiliated with the Centre for Global Knowledge Studies, University of Cambridge (UK).

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