Toxins in tattoo inks and health impacts
Tattoos have been an integral part of human culture for millennia, serving as art, symbols of identity, and expressions of personal beliefs. However, in recent years, concerns about heavy metal toxicity related to tattoo inks have grown, sparking interest in understanding the potential health risks associated with getting inked. In this article, we delve into tattoos and explore the presence of heavy metals in tattoo inks, their possible effects on human health, and the safety measures to consider.
Tattoos have a rich historical background and have become increasingly popular in modern times. According to recent statistics in Australia, about 19% of the population has at least one tattoo, with females accounting for almost 24% of tattooed individuals. The age of first tattooing is also shifting, with 36% of people getting their first tattoo at the age of 26 or older, and 20% in their mid-30s or older. Tattoos are most popular in Victoria, followed by NSW and QLD .
Health Impact of Tattoos
While there is some research suggesting no direct link between tattoos and skin cancer, concerns about the health effects of tattoo inks, especially heavy metals, remain . It is well established that exposure to small amounts of heavy metals over an extended period may lead to chronic and acute toxic effects.
Heavy Metal Content in Tattoo Ink
In the tattooing process, the needle is loaded with ink and injected into the skin, past the epidermis and into the dermis, where the ink is deposited. Some blood vessels are broken in this process, providing a pathway for the ink and any associated metals to enter directly into the bloodstream. Once in the dermis, tattoo inks expose the body to small amounts of these metals for an extended period of time, leading to potential allergic responses and chronic and acute toxic effects.
From a chemical point of view, colorants are classified as either pigments or dyes; however, the chemical structures of pigment and dye molecules are frequently the same. In contrast to dyes, pigments are generally tiny particles incorporated in a chemical medium . Pigments may be inorganic or organic, coloured, white or black materials.
A persistent tattoo in skin requires the use of water-insoluble colorants in the form of pigments. In the past, tattooists used inorganic pigments that contained heavy metals such as mercury, chromium or cadmium, resulting in the typical colours yellow (cadmium sulphide), mercury sulphide (red), or chromium oxide (green). Two important inorganic pigments are still in use: Carbon Black for black tattoos and titanium dioxide to reduce the colour strength of coloured pigments (ie white) and increase brightness.
Nowadays, coloured tattoo colorants mainly consist of organic pigments like azo or polycyclic pigments, which are usually obtained from the chemical industry . These pigments comprise two features perfect for use in tattoos: the pigments exhibit brilliant colours, and they are insoluble in aqueous tissue. The organic pigments still contain metals (Al, Ca, Cd, etc.) and may be combines to create different tones or give brightness to the colours  .
There are also other chemicals, such as preservatives, stabilizers, pH regulators, thickeners and fragrances including hydrocarbons and phthalates, which have carcinogenic properties and exhibit a detrimental effect on the hormonal balance and the bodies’ normal function  .
Although they are injected into the human body, tattoo colorants have no pharmaceutical requirements.
Furthermore, the tattoo laser removal process (which is also increasing in popularity together with tattooing) degrades and injects most of the inks from the skin directly into the bloodstream allowing for even higher exposure to the metals contained in the inks during the removal process.
Despite increasing evidence regarding the carcinogenic properties and cutaneous complications of tattoo inks, there are limited regulations governing the permanent makeup and tattoo industries within Australia. It’s important to understand that labelling laws did not apply to tattoo ink as the inks are intended for use by professional tattooists and are therefore regarded as workplace chemicals.
A 2016 report (updated in 2018) from the Australian Government’s Department of Health, National Industrial Chemical’s Notification and Assessment Scheme (NICNAS), which investigated several tattoo inks being used in Australia and interviewed various tattoo professionals revealed that out of 49 inks, only four complied with the European standards.
Alarmingly the presence of polycyclic aromatic hydrocarbons (PAHs) in the inks, was also found, even though it is carcinogenic in nature. Other constituents of the inks sampled include antimony, arsenic, lead, mercury selenium, strontium, zinc copper, barium, amines, mercury and several colourants. (If you are interested in this report download by clicking here.)
In January, 2022, in response to this growing evidence, the European Union restricted 4000 substances in tattoo inks and implemented stricter labelling and safety information.
Evidence of Heavy Metals in Tattoo Dyes
Currently, tattoo inks contain mostly organic pigments, although metals are still present, either as chromophores, shading additives, or as contaminants . It should be noted that micropigmentation inks in permanent makeup are still made up of inorganic pigments because of their greater stability against light and heat, their better setting capacity and their larger size, which make their removal difficult .
Two Italian studies   on the concentrations of metals in tattoo inks available in the Italian market – the first analysed 13 tattoo inks of various colours identified the following elements in order of abundance: Cr, Ni, Cd, Co and Hg . The second, analysed 56 tattoo inks finding the main components were Al, Ba, Cu, Fe and Sr. Concentrations of toxic metals such as Cd, Mn, Pb, Sb and V exceeded 1 μg/g. Among the allergenic metals, Cr was the highest, followed by Ni and Co .
The Danish Environmental Protection Agency  carried out the detection of metals and other elements and the results indicated the presence of Ni in all inks, concentrations of Al were found in many tattoo inks and the presence of increased levels of Ti was also noted.
The analysis of metal content in 226 tattoo inks available in the US market was carried out. In order of prevalence, the elements found were Ti, Fe, Cr, Cu, Zr, Mn, Br, Ni, Nb, Sr, Zn, Ba, Mo, Pb, V, W. Titanium was observed in high concentrations in almost 91% of the samples  also levels of Cr, Cu and Pb were found  above the limits established in the Resolution ResAP (2008) of the European Council .
The distributions of metals found in various tattoo inks sorted by colour are shown in the chart. Average concentration of each element (ppm) in ink samples by colour. Titanium was excluded as it was found in very high concentrations for nearly every colour. 
- Bright green inks were found to contain high concentrations of chromium, manganese, iron, copper, bromine, and barium, as well as traces of lead.
- Yellow inks contain similarly substantial amounts of chromium, iron, nickel, and barium, and traces of lead.
- Blue Inks show high concentrations of copper and bromine.
- Red and brown inks both showed considerable amounts of chromium, iron, nickel and barium.
- Purple was the only colour that showed high concentrations of tungsten, it also had extremely high concentrations of iron and substantial amounts of chromium.
- White and orange inks seemed to contain the fewest metals and these occurred at lower concentrations.
Transport of Tattoo Colorants
Tattoo colorants are a rather complex mixture of various compounds that exhibit different chemical and physical structures. The colorants contain pigment particles of different sizes and molecules, and many of the molecules are in the form of monomers, dimers, or polymers with different solubilities, which influences the extent and the route of transport inside the dermis and to other organs.
In addition to transport, some constituents of the colorants can be metabolized in skin or in the organs to which the compounds were transported. Thus, tattooing of colorants into skin entails a complex reaction of the skin that triggers the immune system and launches manifold transport processes.
After injection into skin, some of the tattoo pigment particles are encapsulated in the dermis. Small particles, admixtures, impurities, as well as educts and products of the pigment molecules may leave the skin directly or can be transported to other anatomical locations in the body via the blood vessel and lymphatic systems. Here they might be stored in or leave the human body via the urinary system or intestines.
An interesting study by the German Federation Institute for Risk Assessment  ascertained the pigments travel to the lymph nodes through visual evidence – the lymph nodes were stained by the pigment. The nano-particles now used behave differently to previously studied microparticles – the longer-term effects are unknown, although the German study believed that they cause chronic enlargement of the lymph nodes and ongoing toxic exposure.
Organs such as liver, spleen and kidney could be destinations of constituents of tattoo colorants, depending on the route of transport via the lymphatic or blood vessel systems. A Danish animal study identified black and red pigments in the liver, specifically in Kupffer cells, of mice that were tattooed on the backs, providing further proof of pigment distribution through blood.
It is assumed that especially large particles, which cannot pass the lymph nodes, stay in the dermis. A major mechanism for the disintegration of the particles is the light-induced decomposition of pigment molecules that may continuously occur whenever tattooed skin is exposed to light sources . Other mechanisms, like enzymatic activities or the recurring activation of macrophages, might contribute to pigment particle transport. However, the contribution of other mechanisms is unknown.
The translocation of tattoo particles from skin to lymph nodes is shown above. Upon injection of tattoo inks, particles can be either passively transported via blood and lymph fluids or phagocytized by immune cells and subsequently deposited in regional lymph nodes. After healing, particles are present in the dermis and in the sinusoids of the draining lymph nodes. 
Quantity of Pigments
Approximately 2.5mg of pigments is deposited inside the skin per square centimetre of tattoo. An upper arm tattoo of 400 cm2, will give a body load of 1g of particles. Highly tattooed people could carry up to 40 g of pigment within their body. The size, colour and density of the tattoo will determine the amount of possible harmful substances as well as the portion of hazardous decomposition products that chronically affect skin, lymph nodes and organs .
Understanding Health Risks
- Tattoo Colours
Tattoo inks come in various types, including those derived from organic and inorganic compounds. Certain ink colours, especially red, yellow, green, and blue, often contain heavy metal compounds, including lead, cadmium, mercury, and chromium.
- Absorption and Distribution
Heavy metals in tattoo inks can be absorbed through the compromised skin barrier during tattooing. Once absorbed, they may distribute to various organs through the bloodstream.
- Allergies and Skin Contact Dermatitis
Some metals are known to trigger allergic reactions. Zinc, Nickel, Thallium  and Tungsten are known to cause skin irritations including rash, bumps, redness, skin colour changes, itchiness etc as a result of Tattoos.
- Laser Tattoo Removal and Heavy Metal Release
Laser tattoo removal involves breaking down tattoo pigments into smaller particles, which may release heavy metals into the bloodstream and surrounding tissues. A 2019 study in Lasers in Surgery and Medicine found that laser irradiation of tattoo pigments released heavy metals, including nickel and chromium, into the surrounding tissue .
- Proof of Heavy Metal Absorption in Post-Mortem Studies
Post-mortem analyses of people with tattoos have revealed heavy metal deposits in various organs and tissues, suggesting systemic absorption. A 2019 study published in the Archives of Toxicology detected measurable levels of heavy metals, such as lead and mercury, in multiple organs, including the liver and kidneys, of individuals with tattoos. 
- Safer Tattoo Ink Alternatives
There is emerging research explores the development of organic and vegan tattoo inks that minimize heavy metal content and potential health risks.
- Tattoo Ink Regulations
Despite increasing evidence of heavy metal risks in tattoo inks, regulations for the tattoo industry in Australia and New Zealand are limited and insufficient. It is essential to raise awareness and advocate for stricter regulations to safeguard public health and well-being.
- Pregnancy & Breastfeeding
Tattoos, especially those containing heavy metals, can pose risks during pregnancy and breastfeeding. The presence of metals and other chemicals in some inks may prevent the administration of an epidural anaesthetic during childbirth. Moreover, new tattoos during pregnancy or breastfeeding may increase the mother’s exposure to toxic metals, potentially affecting the foetus or baby .
Tattoos remain a beloved art form, but the presence of heavy metal tints in tattoo inks raises legitimate health concerns. Evidence suggests heavy metal absorption during tattoo application and release during removal. As the tattoo industry advances, cooperation between researchers, health authorities, and tattoo artists is crucial to establish evidence-based guidelines that prioritize consumer safety.
There is a need to foster awareness of heavy metals and chemicals within pigments used in tattoos. Informed decision-making, safer tattoo ink alternatives, and proactive regulation may assist in mitigating potential health risks.
If you would like to check for the presence of heavy metals and mineral imbalances, I recommend a Hair Tissue Mineral Analysis.
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