An investigation into skin lesions that two people developed after getting tattoos has concluded that both were infected with a bacteria not previously linked to the practice.
The infections involved Mycobacterium haemophilum, which usually only strikes individuals whose immune system are compromised. In this instance, however, the patients, both from Seattle, developed rashing despite the fact that both had normal immune systems, a report on the investigation found.
“Two people developed chronic skin infections after receiving tattoos at the same parlor,” explained study lead author Dr. Meagan K. Kay from the U.S. Centers for Disease Control and Prevention. “The patrons were thought to have been exposed through use of tap water during rinsing and diluting of inks.”
Kay, an epidemic intelligence service officer with the CDC, and her team report their findings in the September issue of the CDC’s journal Emerging Infectious Diseases.
The authors pointed out that tattooing is not considered a sterile procedure, is not regulated at the federal level and can be risky. And while the specific inks and colorings (pigments) commonly used to apply tattoos are regulated by the U.S. Food and Drug Administration, the rules usually apply only when cosmetics or color additives are involved.
The latest concern about associated infection risk arose in 2009 when a 44-year-old man and a 35-year-old man sought care for skin infections that had developed at the site of tattoos acquired at a facility in the Seattle region.
Lesion cultures and lab testing revealed that M. haemophilum was the culprit in the case of the first patient. Skin evaluations and patient interviews led the researchers to conclude that the second man most probably also suffered from the same sort of bacterial infection, although they technically classified his situation as a “suspected case.”
A follow-up investigation of the tattoo parlor revealed that municipal water had been used to dilute the ink during the tattooing process.
Water is considered to be a source for M. haemophilum. And though the facility was cleared of any safety violations, and no M. haemophilum bacteria was found in analyzed water samples, the tattoo operators were told to use sterile water for all future tattoo applications.
“It is important to remember that tattooing is not a sterile procedure and infections can occur after tattoo receipt,” Kay said. “Measures should be taken by tattoo artists to prevent infections, including proper training, use of sterile equipment, and maintaining a clean facility. Use of tap water during any part of the tattoo procedure should be avoided,” she explained.
“Those who suspect an infection in their tattoo should consult with their doctors,” she added. “Common infections can present as increased redness, warmth, swelling, pain and discharge.”
Myrna L. Armstrong, professor emeritus at the school of nursing at Texas Tech University’s Health Sciences Center in Lubbock, said the investigation serves to highlight the general risks of getting a tattoo.
“This is an invasive procedure. And there’s basically no regulation in force. Or very sporadic regulation. So as someone who’s been looking into tattoos and body piercing for more than 20 years, I would say that it’s really not very surprising that this can happen,” Armstrong said.
“So while I’m not being negative to the industry, I do think that the customer does need to be aware of the situation he or she is getting into,” she added. “Shop around, review people’s techniques, and make sure [you] really want to have this done.”