Introduction 

Tattoos have become engraved throughout history as a means to put elaborate artwork onto a person’s skin. In the past, soot and soil were used to tattoo, whereas nowadays tattoo colourants are used, chemical particles that are injected into the human skin. Tattoo ink is made from varying chemicals, with the base colours (red, blue, green) made from dichromate salts, cobalt, cadmium and mercury. The brown, white, black, violet colours are created from iron oxide, titanium dioxide, carbon and manganese.

The tattoo ink itself is not considered a pharmaceutical or cosmetic substance. Despite this, when injected into the skin, the body is exposed to some chemicals, which may affect skin tissue or lymph nodes which are close to the tattoo site. This article will look into how tattoo infections within professional practices can occur and what signs and symptoms to look for.^1,2

Understanding tattoo infections 

Tattoo infections have four main sources:

• Tattooists can be a potential carrier of pathogens
• Insufficient hygiene practices during the tattoo procedure
• Contaminated tattoo ink entering the body
• Insufficient aftercare

The contaminated tattoo ink can impact several people, as the contamination may happen before the tattooing process or during ink production. Infections are usually bacterial, fungal, or viral, triggered because of non-sterile equipment, the tattooist being ill, or poor aftercare.³

The most common microbial type is bacterial, like Mycobacterium Bovis, and these can be categorised into groups according to their bacterial type. Viral infections, such as HIV and hepatitis B, with symptoms appearing as early as 20 days or as late as 3 months after the tattoo was done.

In some cases, fungal infections may arise, but their detection is not as common, and there is limited research on the specific fungi responsible for these infections. Additionally, parasitic infections can also happen alongside patients who are already living with HIV, due to their compromised immune systems.

Other risk factors for a tattoo infection include: allergic reactions, pre-existing skin conditions like psoriasis and eczema, and a weakened immune system.^1,2,4

Early signs of a tattoo infection

Signs of infection do not always show up right away, they can develop within a few days, or even months after. Signs of a tattoo infection can include:²

• Plaque elevation (swollen)
• Dermatitis (red rashes, dry skin, and itchiness)
• Non-allergic inflammatory reaction (sneezing, and/or an itchy nose)
• Neuro-Sensitive reaction to touch (sensitivity when the area is touched)
• Pimples or other manifestations
• Redness and swelling beyond normal healing
• Warmth around the tattooed area
• Pus or unusual discharge (yellow, green, or foul-smelling)

People with weakened immune systems may be at a higher risk of developing infections. In turn, this should be discussed with the tattooist before the procedure to implement the right precautionary measures. In rare cases, the infected tattoo may lead to tetanus or other more serious conditions. Extreme cases also include tissue necrosis, where the tissue dies, and this may require surgery to remove it and the use of steroids. When the infection worsens, antibiotics may no longer be sufficient in the treatment plan, therefore, it is vital to discuss with a medical professional any symptoms that you may have.^3,4,5,6,7

Treatment

Treatment plans vary depending on the stage of the infection, therefore, it is important to look out for the symptoms as early as possible to prevent complications and have a better recovery rate.

• Mild infection: there is redness, swelling, or minor pain, usually over-the-counter antibiotic ointments can help alongside proper wound care, keeping the area dry and gently cleansing
• Moderate infection: there is pus or increased swelling, a prescription may be required for oral or topical antibiotics and scratching the area should be avoided
• Severe infection: characterised by systemic infection signs (e.g fever and chills), which may require stronger antibiotics or, in some cases, abscess draining or further medical evaluations to prevent complications

The first line of treatment is typically antibiotics alongside proper hygiene management, and medical attention should be sought if the symptoms worsen or new symptoms appear. In some cases, dermatome shaving has been used as a treatment method, involving the removal of the outer layer of skin containing the tattoo, and this procedure is performed by either a plastic surgeon or a dermatologist.^8,9,10

Preventing tattoo infections 

The first step in preventing tattoo infections is to choose a reputable and licensed tattoo artist who follows strict hygiene protocols. Strict hygiene protocols include the sterilisation of equipment and fresh needles, as well as keeping the studio or tattoo area clean. Physicians should also make the patients aware of any potential complications after tattooing and give proper instructions on aftercare.

The following measures can be implemented by the tattoo artist to lessen the chances of infection:

• Sterile needles - using disposable individual packaging by the manufacturers
• Surround the needle with a single-use disposable cartridge system to prevent cross-contamination 
• The tattoo machine needs to be covered with a barrier film
• A tattooist must wear a fresh pair of gloves each time
• The machines are designed to be disinfectant-friendly, so they should be fixed immediately if there are any holes, cracks or rough surfaces

Proper aftercare protocols should be followed after getting a tattoo, including keeping it covered for the first few hours, washing your hands before touching it, and gently cleaning (mild soap and lukewarm water) before patting it dry. A thin layer of fragrance-free moisturiser should be applied once or twice a day. Activities that should be avoided include picking at the tattoo or soaking in any form of swimming pool or water. 

Infection signs of redness, pus, and swelling should be monitored if any occur, and proper medical attention should be sought. The maintenance of a healthy immune system, which includes eating well, staying hydrated, and avoiding excessive alcohol and smoking, can support proper healing and reduce the chance of complications. Excessive consumption of unhealthy foods, such as fast foods, can trigger an inflammatory response due to their harmful ingredients.^4,11

FAQs

How do you know your tattoo is infected?

Indicators of a tattoo infection include persistent redness surrounding the tattoo that either spreads or does not fade, yellow discharge, and continuous pain.

Can your body reject a tattoo years later?

Yes, it can look red, hot, and swollen for longer than a few days. Rash or bumpy skin around your tattoo

How do you treat a skin infection from a tattoo?

Antibiotics typically clear up an infection related to tattoos. If untreated, there can be complications from a skin infection, including a more severe infection or, in rare cases, sepsis in certain individuals.

Summary

Tattoos have a long history as a form of body art, using soot and soil in the past and chemical colourants today. Tattoo inks consist of various chemicals, with basic colours made from dichromate salts, cobalt, cadmium, and mercury, while others use iron oxide and titanium dioxide. Tattoo ink is not classified as a pharmaceutical or cosmetic product. However, when injected, it can expose the body to chemicals that may affect skin tissue and nearby lymph nodes. Tattoo infections can come from four main sources: tattooists as potential carriers, poor hygiene during the procedure, contaminated ink, and inadequate aftercare. Infections, typically bacterial, fungal, or viral, often result from non-sterile equipment or poor aftercare.

Symptoms can appear from days to months after getting a tattoo and include swelling, redness, warmth, and pus. Treatment varies by infection severity, from over-the-counter ointments for mild cases to stronger antibiotics for severe infections. Medical attention is necessary for worsening symptoms. Choosing a licensed tattoo artist who follows hygiene protocols is vital in preventing infections. Aftercare includes keeping the tattoo covered, washing hands, and using mild soap. Monitoring for infection signs and maintaining good health can aid healing.