A tattoo is a permanent mark on the skin made by piercing the skin with needles and introducing pigment. Tattooing is considered generally safe when doneby an experienced tattooist who sterilizes equipment and follows proper sanitary practices, and if appropriate care is taken during the healing process. However, getting a tattoo involves perforating the skin--one of the body's principal protections against disease. If not done safely, this can cause life-threatening infections. According to the U.S. Centers for Disease Control, human immunodeficiency virus (HIV), hepatitis B virus, and other blood-borne infections may be transmitted if blood-contaminated instruments are not properlysterilized or disinfected. The American Red Cross refuses donations of bloodfrom anyone who has undergone tattooing during the previous year. There is also a risk of an allergic reaction to tattoo pigment. In some cases, large, thick scars (sarcoid-like granulomas) have formed at a tattoo site.

The tattoo (which comes from the Tahitian "tatu"meaning "to mark something")may well have existed since 12,000 years BC, although its purpose varies fromculture to culture. In 1992, a 4000-year-old body of a man with tattoos wasfound in a glacier in Austria. In ancient Egypt, a tattoo was considered a sign of nobility or fertility, and the marks have been found on Egyptian mummies dating from 2000 B.C. Believed by many ancient peoples to provide magical protection against bad luck or disease, tattoos were used to identify rank, social position, or group membership in a variety of cultures including the Greeks, Gauls, Thracians, and ancient Britons and Germans. In Roman times, tattoos were the mark of slaves and criminals, but the dawning of Christianity brought the practice into disreupte and tattooing was forbidden in Europe.

Tattoos have always had an important role in ritual and tradition. In Borneo,women tattooed their symbols on their forearm to indicate a particular skill. If a woman wore a symbol indicating she was a skilled weaver, her marrigeability status rose. Tattoos around the wrist and fingers were believed to wardoff illness.

Tattooing made a comeback in England and Europe in the 19th century, when tattooing became popular among royal families of the late 1800s. In fact, the mother of Winston Churchill, Lady Randolph Churchill, had a tattoo of a snake on her wrist.

Tattooing among the native populations in the Americas was widely practiced;many Indian tribes tattooed their face and/or their body. While some groups simply pricked the skin with black dyes, some tribes used color to fill in skin scratches. Among the tribes of Micronesia, Malaysia and Polynesia, nativespricked their skin with a special pronged implement and tapped in special pigment. Maoris of New Zealand are known for making complex curved designs in the face with a stone instrument. Eskimos and many tribes of the Arctic and subarctic tattooed their bodies by puncturing the skin with a needle, drawing asoot-covered thread underneath the skin.

The first electroc tattoo device was patented in the United States in 1891 and soon this contry became well konwn for tattoo designs. Americzn and European sialors flocked to tattoo parlors in port cities all over the world. At thesame time, tattoos were often used to identify criminals and army deserters;later, prisoners in Siberia and Nazi concentration camps were given tattoos.

During most of the 20th century, tattoos had an unsavory reputation largely associated with motorcycle and street gangs, criminals, and military personnel. In the 1980s and 1990s, however, tattooing became more mainstream, with tattoos sported by musicians such as Cher and sports figures including Dennis Rodman.

Tattoos are applied using a small device that works like a sewing machine. Aneedle bar containing anywhere from one to 14 needles is moved across the skin. The needles penetrate the skin, injecting colored ink. This can produce pain, and a small amount of bleeding. You can expect the site to crust and peelduring the first week.

The current popularity of tattooing and body piercing has also brought on anincrease in potentially hazardous conditions. There are no state or federal regulations regarding tatooing, and neither the procedures nor the pigments used in the process are regulated.

Anyone considering a tattoo should visit a number of tattooists, observing the cleanliness of their establishments and asking about infection control. Look around you. The area must be well-lit. The spray bottle the artist uses onyour skin should be disinfectedbetween customers. Reputable studios take pride in their sterilization practices and equipment. They should be happy to answer your questions. If a tattooist refuses to discuss safety issues, go somewhere else.

Questions to ask might include:

  • Do you have an autoclave (a heat sterilization chamber regulated in the U.S. by the Food and Drug Administration)?This machine is a must. Autoclaving is a process that pressurizes the instruments and kills any virus or bacteria.
  • Will you remove new sterile needles from an autoclave bag in front of me? (If not, leave immediately).
  • Do you require consent forms from customers? This should be filled out prior to tattooing.
  • How often do you use needles? Needles should come in a sterile package, and should be used once, then disposed of in a leakproof, puncture-resistant biohazard container. (A biohazard container is a plasticcontainer, usually red, with a biohazard symbol on the outside.) Needles, once open from their sanitary packages, must not be placed on unsanitized surfaces. The artist should NOT set the needle down on the table.
  • Do you keep a record of the dyes used in each client's tattoo? This can be useful ifthe tattoo is removed at a later date.
  • Do you wash hands and use latex gloves during the procedure? What do you do if you are interrupted, for example, to answer the phone or open a drawer? If telephones or other objects are touched, the gloves should be discarded and new ones used to complete theprocedure.
  • How often do you clean and disinfect the premises, including the bathroom?
  • Do you serve clients who appear to be under the influence of alcohol or drugs?
  • Do you tattoo minors? Many U.S. states prohibit this.
  • What do you do with leftover ink? This should be discarded after each procedure. It should never be returned to the supply bottle.
  • Can I see examples of your finished work? Photos should be openly available.
  • What training have you had? Are you a member of the Allianceof Professional Tattooists? This nonprofit group educates tattooists in infection control practices.

You should also check with city or county health officials to find out what local regulations apply to tattooing, and whether complaints have been made concerning the studio you are considering. Some states and municipal governments (for example, New York City) have outlawed tattooing.

Never tattoo yourself or allow it to be done by a friend or a "scratcher" working out of a kitchen or van. People with hemophilia or pregnant women are not good candidates for tattoos. If you have multiple allergies, ask for a "patch test" with the colors you want before returning for a tattoo. This will help you determine if your body will react to some of the pigments. Don't drinkalcohol or take illegal drugs before your tattoo sessions. Both aspirin andalcohol thin your blood and promote excessive bleeding. Aspirin also decreases blood clotting, which will slow down your healing.

Most shops will give you an aftercare information sheet. There are three things to remember about caring for your new tattoo: moisturize--but not too much--and don't pick the scabs! You should leave on the protective dressing supplied for the first few hours (or overnight). You can then remove the dressing,clean the area gently with soap and water, and apply a thin film of over-the-counter antibiotic ointment. Repeat this process the second and third days.After that, keep the area clean and (if you wish) lightly lubricated with vaseline to ease crusting and lessen itch. You must wait at least two weeks before swimming or exposing the site to direct sunlight. After that, sunscreen should be used to keep the pigments from fading. It is important to keep the site clean and moisturized to allow healing. After healing, you should put a bandage over the site if you visit a tanning salon.

It is important to remember that tattoos are intended to be permanent, and that removing them can be expensive and leave scars or permanent discoloration.Expect to pay $1,000 or more to remove even a fairly small-sized tattoo withlaser surgery--and health insurance won't pay for tattoo removal. Methods toremove tattoos include:

  • Surgical removal-- in which the entire tattoois cut away. The skin is then drawn together and stitched with sutures. Thisis a popular method of tattoo removal, especially when the dyed area is small. The advantage of this method is that the entire tattoo can be removed, butwith larger tattoos, it may be necessary to remove the skin in stages, starting with the center and then removing the sides later. Your doctor will firstinject a local anesthetic to numb the area. This procedure causes slight bleeding, which is easily controlled with electrocautery. In some cases with large tattoos, a skin graft taken from another part of the body may be necessary.
  • Dermabrasion--sanding the skin with an abrasion device. First, yourdoctor will spray a small portion of the tattoo with a solution that freezesthe area. The tattoo is then "sanded" with a rotary abrasive device, causingthe skin to peel. Because some bleeding is likely to occur, a dressing is immediately applied to the area.
  • Salabrasion--a centuries-old techniqueusing a salt solution and abrasion, is sometimes used today, although this method can leave a scar if the solution penetrates too deeply. Your doctor will apply a local anesthetic on and around the tattooed area, followed by a solution of ordinary tap water dipped in table salt. An abrading apparatus suchas the one used with dermabrasion, or a simple block wrapped in gauze, is used to vigorously rub the area. When the skin becomes deep red, your doctor will apply a dressing.
  • Scarification--using an acid solution to remove the tattoo, leaving a scar in its place.
  • Laser removal--a variety oflasers are available for this purpose. Tatoos can be removed using short pulsed lasers including the Q-switched ruby laser, Ng:YAG, Alexandrite and 510 nanometer pulsed dye laser. Your doctor will apply a cream to numb the skin prior to treatment. Pulses of light from the laser are directed onto the skin, breaking up the tattoo pigment. Over the next several weeks the body's cells remove the treated pigmented areas. More then one treatment is usually necessary to remove all of the tattoo. Amateur tatoos can usually be entirely removed, as can black professional tattoos. Multicolored professional tattoos are more difficult to remove, and require several different wavelengths for the different colors. Regardless of which method of tattoo removal is used, some scarring or color variations are likely to remain. Healing time varies depending upon the size and depth of the tattoo, the type of procedure and your own ability to heal. It is important for you to discuss the various procedures, how they are performed, and the probable results.

Besides being a fashion statement, tattooing can have more practical applications, such as covering hemangiomas (pink/red skin lesions also known as portwine stains), color changes in the lips after facial surgery, and masking themottled-skin appearance of vitiligo. Tattooing can also be used to apply "permanent" eyeliner, although the iron oxide sometimes used for this purpose can cause injury if you later undergo magnetic resonance imaging (MRI).

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