Tattooing needs indelible regulation

Tattooing has become increasingly popular in recent years, but we know little about the inks that are punctured into the skin, or about their long-term effects. The risks of tattooing have not been studied much and the regulations that do apply to it are not up-to-date, says ministerial advisor at the MSAH Marilla Lahtinen.

Tattooing has been practiced by many cultures for thousands of years, but Marilla Lahtinen advises caution by anyone thinking of getting a tattoo. She stresses that pregnant women, people with serious chronic illnesses and young people under 18 should avoid getting tattooed, and that anyone else should anyway think before they ink.

"It's good to think about it properly, because if you change your mind about having a tattoo or it results in skin problems, getting rid of a tattoo is a difficult and costly operation. If you do decide to get tattooed, it's important to do it at a reliable place. Someone who's keen to get one doesn't necessarily know much about it, and deciding to do it at, say, a festival may be too impulsive, and you can't be sure of the quality of the tattooing or the standards of hygiene."

The main health risks of tattooing concern the procedure and materials that are used. If the needle used to puncture the skin is not sterilized or the tattooist has dirty hands, there's a danger of infection or of contracting a blood-borne disease. Analyses of the inks used in tattooing have detected highly hazardous chemicals. Though the pigments usually remain in the skin for decades, some of them break down and can spread to other parts of the body.

Not all of the pigments used in tattoo inks are hazardous, but analysis conducted in Denmark of 61 tattoo pigments found that 20 per cent of them contained toxins that can increase the risk developing cancer. They include heavy metals, azo dyes and toxins such as arsenic.

Tattoo pigments do not necessarily carry proper product descriptions, and it can be difficult to determine their composition. In particular, the accountability of online suppliers dealing in tattoo inks remains vague.

"There are restrictions on the use of paints containing things such as heavy metals, and cosmetics are subject to stringent legislation, but the composition of tattoo inks is not regulated in any specific way," says Lahtinen.

Also, there are no formal qualifications or training requirements for tattooists. The only requirement for them to operate is to notify the local health authorities that they are. Legal controls are non-specific. "The law states generally that no one is allowed to cause health hazards," Lahtinen explains. "In addition the Consumer Safety Act shall be followed."

About 10-15 per cent of EU citizens have been tattooed. Considering the prevalence of tattooing the resulting harm to health has been fairly infrequent.

"Allergic reaction, inflammation, non-healing wounds..." Lahtinen lists complications that have been identified. She also points out that the long-term effects remain unknown. "The tattooed area on the skin may be prone to chronic disorders. But it's still impossible to say for sure whether a skin cancer that develops due to having a tattoo."

Widespread enthusiasm for tattoos is still a relatively recent trend, which is why the possible effects of this form of body art may only be apparent in some decades to come. The worst-case scenario, says Lahtinen, would be a new type of epidemic cropping up after 20-30 years.

The spread of tattooing has promoted EU countries to take notice of the potential health hazards. Concerns expressed by member states and the European Parliament in the early 2000s led to a regulatory review in 2003 on the safety of tattoos, an initiative that also covered body piercing.

Though some countries have age restrictions for obtaining tattoos, other regulatory efforts are generally in the form of guidelines. Only recently have issues concerning the composition of the new generations of inks prompted calls for more stringent approaches.

Related to this is the need to overcome the paradoxical EU legal position on tattooing, as the activity takes place for cosmetic reasons - it is often defined as ‘permanent makeup' - but does not fall within the scope of the Cosmetics Regulation. Regulations on the use of inks fall under the jurisdiction of the 2001 general product safety directive and chemicals legislation.

In addition, the European Commission publishes a weekly overview of notifications of hazardous products, collated from national level reporting through the RAPEX network. This has included alerts on the presence of nickel, cadmium, and carcinogenic aniline in tattoo inks.

As concerns about the possible health impact on tattooing becomes more pronounced, countries may now more prepared to use regulations instead of guidelines. In February this year, new rules came into effect in Sweden to regulate the use of certain substances in tattoo ink and impose obligations on manufacturers and importers with respect to safety, labelling and product registration.

In Finland the tattoo industry is self-regulating, and obligations related to the safety of inks are covered generally by compliance with the EU chemicals legislation and general product safety directive, and by the government's 2004 decree on the safety of consumer products and services.

The latter stipulates that a product shall be deemed to represent a risk to health "cause injury, poisoning, illness or pose some other kind of danger to health" due to any "false, misleading or inadequate information supplied in respect of it".

The Finnish Safety and Chemicals Agency (TUKES) monitors product safety issues. The MSAH is now running information on its website on tattooing and its possible hazards, and Finland has voiced support for further regulation in response to a European Commission inquiry. Marilla Lahtinen believes that ingredients prohibited for use in tattoo inks should be listed, as is the case with cosmetics.

But there is also much that consumers can do.

Lahtinen urges people thinking about getting tattooed to take care in their choice of tattooist, and pay attention to good hygiene both at the tattoo studio as well as in tending to the healing process afterwards. If they encounter any problems, they should seek medical advice and inform the tattooist. "It's not a good idea to stay at home wondering about whether you've made a mistake."