Tattooing in the '90s: ancient art requires care and caution - includes related article about health risks

FDA Consumer, Oct, 1993 by Marilynn Larkin

Tattooing, a technique of marking the skin with colors, has been practiced since antiquity. Now this ancient art form appears to be enjoying a renaissance. Movie and television stars have begun sporting small tattoos on unobtrusive parts of the body, and others are following their lead.

Tattooing also has cosmetic medical applications, including covering "port wine stains," coloring skin of people with vitiligo (a disorder that gives the skin a "mottled" appearance because areas have become depigmented), and obscuring color defects in the lips after facial surgery. It is also promoted for "permanent" eyeliner; however, there are safety concerns about this procedure (see "Permanent Eyeliner," which accompanies "Hair Dye Dilemmas" in the April 1993 FDA Consumer).

Although there are no firm statistics, an unpublished 1990 random survey of 10,000 U.S. households revealed that 3 percent of the population as a whole, and 5 percent of men, had tattoos. Brisk sales of tattoo inks also suggest that the number of people receiving tattoos is increasing rapidly, according to a letter in the Jan. 16, 1992, New England Journal of Medicine.

Today's tattoos are applied in one of two ways. "Permanent" tattoos are applied by tattooists using a machine that pierces the skin with needles. "Temporary" tattoos can be applied by anyone by pressing a color-permeated design against the skin with a moistened wad of cotton.

Permanent tattooing is generally safe when done by an experienced tattooist who sterilizes the equipment and follows appropriate sanitation procedures, according to Kris Sperry, M.D., co-founder with tattooist Mick Michieli-Beasley of the Alliance of Professional Tattooists (APT), a nonprofit organization that educates tattooists in proper infection control practices. However, medical complications may occur if the tattooist is careless about cleanliness, or if the person receiving the tattoo doesn't care for the tattooed area properly in the first week or so after it is applied.

Tattooing is illegal in some cities and states, largely because, historically, tattoo parlors often operated without a concern for health and safety, Beasley says. In New York City, for example, tattooing was banned in the mid-1960s after an outbreak of hepatitis B was traced to unsterilized equipment in tattoo parlors. To improve safety, APT organizes seminars for tattooists throughout the country to instruct them in cleanliness and sterilization techniques.

Selecting a Tattooist

The first step when getting a permanent tattoo is to select a good tattooist, according to Beasley. "Tattooing in unsanitary conditions can set the stage for infection of the customer or the tattooist," says Beasley, who is also co-owner of a tattoo parlor.

"|Scratchers' who work out of their kitchen or the back of a van should be scrupulously avoided," adds Sperry, a forensic pathologist in Atlanta, Ga., who has several tattoos. "A tattooist who is genuinely concerned with both his and his customer's health will not risk his livelihood and reputation by failing to follow appropriate health measures."

Beasley and Sperry decided to form APT after meeting with Cathy Backinger, Ph.D., a public health analyst in the Food and Drug Administration's Office of Training and Assistance. In 1988, Backinger developed a resource curriculum for personal service workers--people other than health-care workers whose work puts them in close personal contact with clients, and who may be exposed to a client's blood or risk transmitting blood from client to client. These include people who perform ear piercing, electrolysis, acupuncture, and tattooing.

"Our primary concern was prevention of the transmission of blood-borne pathogens such as human immunodeficiency virus and hepatitis B," Backinger explains. "The curriculum is designed to help state health departments set up courses to educate personal service workers in the techniques of infection control." The curriculum was distributed in 1989 to all state health departments, but not all states have used it as yet, Backinger says.

To help ensure that tattooists were appropriately trained, Beasley and Sperry worked with Backinger to customize the curriculum for tattooists that is presented by APT at national tattoo conventions.

"Our APT guidelines are often more rigorous than those imposed by local health departments," Beasley notes. "Thus, the fact that a tattoo parlor is operating and has not been closed down by the health department does not necessarily mean that the tattooists are following stringent health practices."

Tattooists who complete the course receive a certificate. When selecting a tattooist, a consumer can ask whether the tattooist has taken the infection control course and ask to see the certificate.

According to the APT guidelines, these practices should be followed:

* The tattooist should have an autoclave (a heat sterilization machine regulated by FDA) on the premises.

* Consent forms (which the customer must fill out) should be handled before tattooing.