Tattoos have long been a form of self-expression, cultural identity, and art. Beyond aesthetics however, the process of tattooing involves a complex interaction between ink, skin, and the body’s immune system. As the popularity of tattoos continues to rise, so do concerns about their long-term effects on skin health and overall well-being.
The process of tattooing
Tattooing is the process of embedding ink into the dermis, the second layer of the skin, using a needle that punctures the epidermis at a high frequency. The tattoo machine, equipped with a group of needles, moves rapidly to deposit ink particles under the skin. Unlike surface-level ink applications, such as henna, tattoo ink becomes permanent as the immune system encases the ink particles in fibroblast cells (cells that help form connective tissue), preventing them from dispersing. Diya Shaji, a professional tattoo artist from Bangalore, explains that a professional tattoo machine moves the needle anywhere between 50 to 3,000 times per minute. The ink is deposited about 1.5 to 2 millimetres deep, which ensures its permanence, as it sits in a stable layer of the skin.
Tattoo ink composition varies, with pigments derived from carbon, heavy metals, and synthetic dyes. The human body recognises tattoo ink as a foreign substance, triggering an immune response. Macrophages, a type of immune cell, attempt to remove the ink particles, which is why some fading occurs over time. However, since ink particles are too large for complete removal, they become trapped in the skin.
What is the body’s response to tattooing?
Nicolas Kluger, assistant professor of dermatology at Helsinki University Hospital, Finland, and a leading global expert in tattooing and body modifications explains that the body’s response to tattoo ink is both immediate and long-term. As soon as the tattoo machine needle breaks the skin, capillaries react with an inflammatory response. The skin becomes red, sensitive, and raised, and this reaction can last from a few hours to a couple of days. Over time, macrophages try to remove the pigment, but not all of the ink is eliminated. Instead, it becomes entrapped in the macrophages, fibroblast cells, or remains between the collagen in the dermis. While studies have not proven any direct association between tattoos and cancer, concerns remain about ink composition, particularly in regions where regulations are lax. Dr. Kluger points out that recognised safe manufacturers exist, but some inks contain carcinogenic heavy metals, making careful selection crucial.
Complications can also arise post a tattooing session. Healing problems, local infections, and bacterial or viral issues such as staphylococcus or even hepatitis can occur if sterilisation protocols are not strictly followed. Allergic reactions are another concern. Dr. Kluger says these reactions can manifest as painful, swollen lumps appearing in red, pink, or violet shades. Black ink reactions, on the other hand, are more likely to be granulomatous and could indicate underlying sarcoidosis (a disorder where the immune system overreacts and causes inflammation in various organs). Individuals with pre-existing skin conditions like psoriasis, vitiligo, or lichen planus must be cautious, as getting a tattoo when such diseases are active can trigger flare-ups, he says.
Scarring and keloid formation can also be potential concerns, particularly for individuals with dark or highly pigmented skin tones. Improper tattooing techniques can lead to hypertrophic scarring, which can be difficult to manage. Tattoo removal methods, including laser treatments such as Q-switched, picosecond, or CO2 lasers, may not always provide complete removal, sometimes leaving behind a ghost image of the tattoo. Dr. Kluger warns that the risk of hypertrophic, achromic scarring is significantly higher if the removal process is not handled correctly, particularly on dark skin tones.
Safety regulations
Tattoo safety regulations vary worldwide. The European Union recently banned certain hazardous ink components, while the United States’ Food and Drug Administration (FDA) monitors tattoo pigments. In India, tattoo regulations with regard to hygiene and safety protocols remain lax, and ink quality control is not standardised, leading to practices varying widely among tattoo parlors, increasing the risk of infections and other complications. Dr. Kluger advises that prospective clients should ensure their tattoo artist uses certified, high-quality ink and follows strict hygiene protocols.
Divya Shaji emphasises the importance of professional ethics in the industry, noting that good tattoo artists prioritise safety through single-use needles, sterile gloves, and high-quality ink. She explains that an experienced artist not only ensures the hygiene and safety of the procedure but also advises clients on tattoo placement, aftercare, and longevity. “Tattoos are a lifelong commitment, and choosing the right design and placement is crucial,” she says.
Advances in tattoo technology
Advancements in tattoo technology aim to make the process safer. Researchers are developing biodegradable tattoo inks that fade naturally over time. Additionally, modern laser removal techniques are becoming more effective, offering hope for those seeking to erase their ink. Being aware of, and understanding the science behind tattooing allows individuals to make informed choices about body modifications.
Tattoos, when done safely, can be a beautiful form of self-expression, but they require responsibility. As tattoo culture evolves, so does our understanding of the ink’s interaction with the body, paving the way for safer, more informed decisions.
(Dr. Monisha Madhumita is a consultant dermatologist at Saveetha Medical College, Chennai and member of the International Alliance for Global Health Dermatology, London, UK. mail.monisha.m@gmail.com )
Published – February 28, 2025 05:00 am IST
