Teen tattoos: Easy to get, easier to regret

My friend's daughter, Becky (not her real name), is a radiant, outgoing high school senior who is planning to go to nursing school like her mom. Over the years I've watched her grow into a strikingly beautiful young woman with a flair for style and fashion. So when she recently traded in her braces for nasal piercings and a tattoo, I was taken aback.

But perhaps it should have come as no surprise. Tattoos have gone mainstream. Recent data suggest that more than one-third of adults in the U.S. under the age of 35 and about one-quarter of those ages 18 to 50 now sport at least one tattoo.

State and local authorities oversee tattoo practices, which vary across the country. There is no standard regulation for training or licensing, no requirements for inspection, record-keeping, informed consent, or oversight for compliance and complications.

Although most states including New York have laws prohibiting minors from getting tattoos, Becky, at 17, was easily able to get her tattoo at a New York City studio, no questions asked. The New York City Department of Health and Mental Hygiene does not license tattoo parlors, but it does license tattooists after they pass a three-hour infection control course that costs $25. While this seems surprisingly limited to me, the potential for infection is not. Blood spatter can contaminate tattoo inks, which are often sold in bulk containers, and taint tattooing equipment, which may be difficult to sterilize. Sterile, single-use inks are available, but are not universally used.

Sloppy infection control practices have been linked to outbreaks of community-associated methicillin-resistant Staphylococcus aureus (MRSA) skin infections among tattoo recipients. And tattoos are estimated to account for more than twice as many hepatitis C infections when compared to injection drug use. Other infections, including HIV, can also be contracted through tattooing.

Perhaps equally worrisome is the fact that the Food and Drug Administration does not traditionally regulate the tattoo industry. Tattoo inks frequently consist of azo pigments that not only contain multiple impurities but also are manufactured for use as printing inks and for automobile paint. Many azo pigments are illegal in cosmetics in Europe because they can break down into cancer-causing compounds, which may be absorbed into the skin. Alarmingly, in tattooing, hundreds of milligrams are injected directly into the skin. The FDA's Arkansas-based National Center for Toxicological Research is now investigating tattoo inks to evaluate their chemical composition, how they metabolize in the body, the short-term and long-term safety of pigments used, and how the body responds to their interaction with light (including laser removal).

The risk of infection and a possible link to cancer may not be enough to deter them, but young women who are thinking of getting a tattoo should seriously reconsider. While most are pleased with their tattoos when they get them, feelings may well change over time. According to a July Archives of Dermatology report, more women than men decide to get tattoos removed later on. Reasons for tattoo remorse include embarrassment, negative comments, and fashion concerns.

Now tattoo removal has become trendy. In a March episode of "How I Met Your Mother," Britney Spears made her TV comeback working for a tattoo-removing dermatologist. Around the same time, entertainment blogs reported that Spears herself had a tattoo removed.

If you are thinking about getting a tattoo or about removing one, there are certain considerations you should bear in mind:

• Use only the services of a licensed tattooist who follows proper infection-control procedures.
• Don't do it yourself. A recent study showed that 26 percent of people who get tattoos either do it themselves or have it done somewhere other than in a studio. Teens, in particular those under age 18, have been cited using homemade tattoo guns or injection or sewing needles and risk major injury, scarring, and infection.
• Be aware that you are at risk of keloid formation (scars that grow beyond normal boundaries) if you have a tendency to develop this type of scar from other skin-traumatizing procedures, such as ear piercing.
• There is a risk of allergic reaction to shades of ink.  This may be particularly troublesome because the pigments can be difficult to remove. Allergic reactions may even occur in tattoos you've had for years.
• After you seek medical attention, contact the FDA's Center for Food Safety and Applied Nutrition (CFSAN) Adverse Events Reporting System (CAERS) if you have an adverse reaction. Call (301) 436-2405.
• Think about what will happen if you regret your decision. Although laser technology is improving, the removal of a tattoo is a painstaking process, typically requiring several treatments at a considerable expense. Complete removal without scarring may not be possible.
• Don't purchase do-it-yourself tattoo removal products. These acid-based products are not FDA-approved and can cause dangerous skin reactions.
• Consult your family physician or dermatologist—not a tattoo parlor—if you want a tattoo removed. The American Society for Laser Medicine and Surgery can help direct you to a doctor experienced in tattoo removal.
• Know that you may not be able to donate blood for 12 months under FDA rules.

CR's Take: Speak to your teenagers. They may be thinking of getting a tattoo or may already have one. It's time for this conversation.

—Orly Avitzur, M.D., medical adviser to Consumers Union

Read more from Dr. Avitzur, and tell us what you think about teens and tattoos. Would you allow your son or daughter to get a tattoo? Why or why not?

Comments

[missy]

well i personaly love tattoos in my family only a couple have tattoos my parents hated the idea of me ever getting one its true its so easy to get tattoos now in days. i live in chicago and at age of 14 i had already 4 tattos my parnts fliped out when they found out. but i love them. and next week im goin to go get my 5th and 6th done i also love pircings. my little sister shes bearly 12 goin on 13 is finnally going 2 get one done 2 hope the OG'z dont flip out.!!!

[laser hair removal upland]

For me it not a good idea having a tatoo,although tatoo is a fashion or what so ever,and you have this you just make your skin looks dirty. Anyway thank to your blog,keep posting.

by: sphin

[pam]

I am currently looking for a concealing product to cover up a
tattoo on the inside of a wrist. Something that would last a few hours and not be too messy. Any help would be appreciated.

[Tenk]

Tattoos have become so prevalent that i feel i'm 'edgier' because of my un-inked skin.