Tattoos and Lymphedema

Introduction

There are special situations when tattoos are recommended as being medically necessary. The use of tattooing to create a replacement nipple during breast reconstrudtion is considered to be medically necessary.

In contrast, there are times when tattoos, and body piercing, are not recommended because they are medically risky. When a candidate for tattooing has lymphedema, or is at risk of developing lymphedema, this procedure creates a risk for those with, or at risk for, lymphedema. However when a tattoo in “at risk tissues” is optional, the many risks should be carefully considered before going ahead with the procedure.

Risks of Tattoo Ink Carriers

Tattoo ink consists of pigment (coloring material) and a carrier (usually alcohol). The carrier may be a single substance or a mixture. The purpose of the carrier is to keep the pigment evenly distributed in a fluid matrix, to inhibit the growth of pathogens, to prevent clumping of pigment, and to aid in application to the skin. [1]

• Among the safest and most commonly used ingredients to make the liquid carrier are ethyl alcohol (ethanol), purified water, propylene glycol, or glycerin.
• Among the most toxic and hazardous substances that are also used for carriers include denatured alcohols, other alcohols (methyl alcohol or methanol and isopropyl alcohol or rubbing alcohol), ethylene glycol (antifreeze), or aldehydes, such as formaldehyde and glutaraldehyde

Risks Related to Tattoo Inks

Premixed inks are considered to be as safe, or safer, than inks mixed by the tattooist; however, even with quality pigments and recommended carriers there are still potential health hazards associated with tattoo inks. These hazards include:

Alcohol makes skin more permeable. This means that when alcohol is used in the ink or to disinfect the skin's surface, it allows more chemicals to cross into the bloodstream than it ordinarily would.

Additional adverse effects include allergic reactions, scarring, and extreme sensitivity to sunlight.

FDA Warnings for Healthy Consumers

The U.S. Food and Drug administration lists the following risk warnings concerning tattoos. [2]

• Infection. Even with the use of a new needle, tattooing equipment is still difficult to sterilize. When equipment is not sterile is used, there is an increased the risk of transmitting bloodborne disease such as hepatitis or HIV. Because of these infection risks, the American Association of Blood Banks requires a one-year wait between getting a tattoo and donating blood.
• Allergic reactions. Although allergic reactions to tattoo pigments are rare; however when they do occur, they may be particularly troublesome because the pigments can be hard to remove. Occasionally, people can develop an allergic reaction to tattoos they have had for years.
•  MRI complications. There have been reports of people with tattoos or permanent makeup who experienced swelling or burning in the affected areas when they underwent magnetic resonance imaging (MRI).
• Removal problems. The most common problem with tattoos is costumer dissatisfaction. Despite advances in laser technology, removing a tattoo is a painstaking process, usually involving several treatments and considerable expense.

Warnings from the CDC

In the spring of 2006, the Centers for Disease Control and Prevention (CDC) issued warnings about the transmission of diseases and infections due to a lack of appropriate sanitation in tattoo facilities.

Diseases transmitted by instruments contaminated with blood include HIV (also known as AIDS) and the viral forms of hepatitis (B and C). Infections transmitted due to breaks in the skin include MRSA which is very serious and difficult to treat.[3] [3]

Tattoos for the Lymphedema Patients

When considering a tattoo, particularly in tissues with lymphedema, or at risk of developing it, the client should seriously consider the above concerns plus these additional warnings:

• Anything that involves a needle stick into an affected limb is an invitation to infection. This risk is even greater when having a procedure performed that involves multiple needle sticks and in which the sterility of the equipment cannot be guaranteed.
• Tattooing puts added stress on the lymphatic system because 90% of the dye goes into the lymph nodes and stays there.
• The swelling of lymphedema distorts the tattooed image. The resulting image may be very unsatisfactory.
• The laser treatments required to remove a tattoo could be harmful to tissues that are already damaged by lymphedema and can be very expensive.

References

[1] Tattoo Ink Chemistry, About Chemistry website, 2004.

[2] U. S. Food and Drug Administration Tattoos and Permanent Makeup June 23, 2008.

[3] Health and Safety of Tattoo Artists, Body Piercers, and Their Clients. www.cdc.gov/Features/BodyArt 2008

© LymphNotes.com 2009.This information does not replace the advice of a qualified health care professional.

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Category: Living With Lymphedema Updated: 2010-02-24