Despite sterile techniques, today CDC and the New England Journal of Medicine report small outbreaks of tattoo infections traced back to bacteria in the ink.
Tattoos become much less appealing when they're infected. It's like when my friend Mitch got his eyebrow pierced in high school, which was obviously an attempt to look tough, but it ended up getting a huge, unsightly scab. Because he kept picking at the scab in his sleep, it simply refused to heal. For about six months he had to carry a handkerchief with him because it would ooze blood. He rarely noticed the oozing until it had dripped down into his eye, so he had to rely on the averted gazes of the others in order to presume that he needed some cleanup.
Ultimately, that made Mitch look unkempt and the opposite of tough: susceptible to injury. It didn't help that the embarrassment often made him cry. But getting a tattoo infection shouldn't be looked at as a sign of weakness. It turns out it might not even be a sign that the tattoo parlor you went too was jacked-up, skeezed-out, or otherwise illegitimate.
The New England Journal of Medicine reports today that in recent months there have been outbreaks of a specific type of tattoo-related infection. The bacteria, nontuberculous mycobacterium (a relative of TB), has been traced to infected ink. Inks may pick up bacteria when they are diluted with tap water, or when needles are handled in non-sterile ways, and that's what they originally thought was happening. But it turns out that the bacteria has been found even in sealed ink containers, suggesting that tattoo ink production facilities may not always be the bastions of sterility we once presumed.
The FDA counts tattoo ink as a "cosmetic" and so requires that it be manufactured in a regulated environment. But it doesn't have the authority "to require premarketing submission of safety data from manufacturers, distributors, or marketers of cosmetic products." Most of their power is on the retroactive end -- to investigate, recall, and shut down. So the FDA's call right now is one for public awareness. People who get infected tattoos should go to MedWatch to report it so they can trace the contaminants back to their sources.
Infections with nontuberculous mycobacterium isn't particularly aggressive or dangerous, but it can be difficult to diagnose and treat. It usually presents as red papules (pictured to the right). Because it can be difficult to distinguish from an allergic reaction or other type of infection, and sometimes requires a skin biopsy to make the right diagnosis, people can get stuck living with it for months. Macrolide antibiotics have generally been effective, though, according to the NEJM.
To avoid infection, the recommendation is that we go to tattoo parlors that are not only adhere to standards of sterility, but also "who can confirm that their inks have undergone a process that eliminates harmful microbial contraminants." There's not a specific stamp or seal that you can look for to prove that, though. Yet. So a quick way to think about it might be that if you walk into the establishment and the propriety of the term "parlor" feels ominously ironic, and they refuse to tell you where they got their ink or if it's clean, move on.
If you go through with it anyway, because maybe this tattoo just couldn't wait (sometimes sentimental appeal is time-sensitive -- it's only spring break once), and you do get an infection, report it so the outbreak can be traced and quelled.
In the long term, though, better regulating the sterile production of tattoo ink on the front end may be in order. It takes dedication and vigilance to keep society's cool looking their uninfected coolest. In the case of my friend Mitch, the solution came when his mother finally made him start wearing her cooking mitts while he slept so he couldn't pick at his eyebrow scab. And you know what? It eventually healed.