As an archaic form of expression that is deeply rooted in culture, tattoos represent a collective artform and means of body ornamentation which has been embellished as a tool for self-expression in the modern world today.
The Word Tattoo: Origin
The history of tattoos harks back thousands of years to the Neolithic period; indeed, the etymology of the word “tattoo” can be traced back to its Tahitian roots – “ta-tau” which means “resultant from tapping”.
The oldest recorded evidence of tattooing is manifest in the form of “Otzi the Iceman” – a frozen mummy from 3000 BC which was discovered in the early 90s.
Researchers postulate that Otzi tattooed himself as a result of acupuncture in an attempt to relieve pain at osteoarthritic (degenerative joint disease) anatomical sites.
Tattoos and Medicine
Tattoos are derived from the inoculation of pigments into the skin which results in a permanent design – this can be for cosmetic and even medical reasons.
Physicians often deliberately arrange for the tattooing of patients for marking radiation ports in radiotherapy indicated for cancer, for pigmentation of an “artificial” nipple in breast-cancer patients who have had a mastectomy and for camouflage therapy in patients suffering from vitiligo (a hypopigmentation skin disorder).
Indeed, we have come a long way from Otzi’s time.
Estimates put tattoo prevalence at roughly 24% of the US population from late childhood to 60 and more than 100 million Europeans have tattoos
Effects of the Tattoo Process in Our Skin
The procedure of tattooing can be broken down into 4 key stages:
Inoculation
Tattoo pigment is placed into the dermis (a specific layer of skin that underlies the epidermis which represents the outermost layer). This tattoo pigment is recognised in the space between the dermis and the epidermis as a “foreign invader” by the body’s immune system.
Remember – the skin acts as an external barrier to germs, toxic compounds and even harmful external substances such as heat and ultraviolet radiation.
Phagocytosis
When the external barrier is bypassed, the white blood cells which function as a second-line defence mechanism rush to eliminate this “foreign substance”. These white blood cells which are known as phagocytes engulf the pigment in a process known as phagocytosis.
Granulation
This inflammatory reaction is later followed by a healing process in which the overlying epidermis flakes away and micro-scarring occurs in the dermis layer. During this scarring process which is characterized by the formation of granulation tissue and collagen genesis, the engulfed pigment remains trapped, so to speak, and remains stable for years.
Collagen genesis
Over decades, the pigment tends to migrate deeper into the dermis – this is evident by the fading of tattoos and the grainy resolution depicted over many decades after the onset.
Are Tattoos Dangerous?
The complications of tattoos can be sub-classified into short-term and long-term complications. Under short-term complications, we are looking at 2 main categories – infections and allergic reactions
Infections
While infections are entirely preventable, they still do occur through 3 pathways:
- Contaminated tattoo ink
- Inadequate disinfection of the skin to be tattooed
- The healing process itself
As outlined earlier, the basis of tattooing is predicated upon causing a local micro-inflammation, resulting in the trapping of tattoo ink pigment within phagocytes and subsequent scar tissue. During this healing process, people may experience burning and itching, causing them to scratch the skin repeatedly, which increases the risk of bacterial infections.
Separately, contaminated tattoo needles or re-used needles may increase the risk of being infected with HIV, hepatitis B and C, as well as Herpes Simplex virus.
This underscores the importance of choosing tattoo parlours which are licensed and regulated, as well as insisting that tattoo hygiene be practised in regard to safety and quality.
Allergies
Allergies (ranging from local skin allergies to full blown anaphylaxis) can be caused by a bevy of chemicals such as dichromate, cobalt, cadmium, mercury and nickel sulphate which are highly prevalent in tattoo inks due to the vibrant colours they impart.
It is advisable to declare any known allergies to the tattoo artist, as well as monitor one’s self closely for signs of allergy shortly after, as well as for up to 48 hours to remedy it quickly.
Tattoos & Cancer
The evidence linking certain types of cancer as squamous cell carcinoma and malignant melanoma association is notably weak, and this observation is likely to be a coincidence (remember that correlation is not causation!).
Factors such as carcinogenic substances in the ink, prolonged ultraviolet radiation and genetics could have confounded this reported association.
Conclusion
Tattoos are generally safe and have their role in society as personal cosmetic adornments and medical adjuncts for specific patient populations.
Although they can be associated with short-term complications such as allergy and infection, these can be avoided most if not all of the time by practicing safe and regulated tattoo artistry.
People who are keen to obtain tattoos should therefore practice due diligence by educating themselves on the topic, identifying safe and regulated tattoo parlours, and monitoring themselves in the acute (48 hours) phase for signs of infection and/or allergy.