With the current state of knowledge, it is impossible to answer this question. Carcinogenic substances, particularly metals, polycyclic aromatic hydrocarbons, and primary aromatic amines, have frequently been found in toxicological analyses of tattoo inks. It is not known whether the intradermal injection of these substances can be compared to their absorption by the respiratory or topical route, and for example whether they can cause DNA damage and mutations. However, it is known that most of the tattoo pigments do not remain in the dermis after injection but are transported to adjacent lymph nodes and potentially to other organs. From in vitro studies, it is known that many substances that are present in tattoo inks have adverse effects on the immune system and basic cell functioning. This emphasizes the urgent need for epidemiological research on the potential carcinogenicity of tattoo inks.
To date, one epidemiological study of tattooing and skin cancer has been published. Although this study did not observe an overall increased risk of early-onset basal cell carcinoma among people with a tattoo compared with people without a tattoo, the study did observe that people with a tattoo had an 80% higher risk of early-onset basal cell carcinoma within the tattooed region of the body compared with another anatomical site. Three epidemiological studies of tattooing and haematological cancers (lymphoma and cancers of the blood and bone marrow) have been published. The first study, conducted in British Columbia, Canada, reported no increased risk of overall non-Hodgkin lymphoma or multiple myeloma associated with tattoos. The second study, conducted in Sweden, found a 20% higher risk of lymphoma among people with a tattoo compared with people without a tattoo. The risk was strongest for certain subtypes of lymphoma, particularly diffuse large B-cell lymphoma and follicular lymphoma. Notably, the highest risk of lymphoma was observed within the first 2 years after the first tattoo was received. The third study, conducted in Utah, USA, observed no increased risk of Hodgkin lymphoma, non-Hodgkin lymphoma, or myeloid neoplasms (e.g. acute myeloid leukaemia, myelodysplastic syndromes, chronic myeloid leukaemia) associated with tattooing. The study did observe an elevated risk of certain cancer subtypes associated with tattooing, particularly rare mature B-cell non-Hodgkin lymphomas, but the sample size was too small to produce statistically precise estimates.
However, these published studies should be interpreted with caution, for several reasons. First, their case–control study design, comparing cancer cases with matched control groups, may be affected by response bias (cancer cases with tattoos could be more likely to volunteer for such a study than those without tattoos), which can lead to overestimation of a real effect. Also, considering that it would take many years after tattooing for a cancer to arise, the retrospective exposure assessment of these studies limits their statistical power to detect such associations, because the tattoo prevalence in the population has increased only recently. Another shortcoming is that all of the published studies have not controlled adequately for confounders or other factors that could mediate a causal relationship. Because the tattooed population has a higher burden of known risk factors for cancer, it is particularly important to carefully control statistical analyses for such confounding factors. For lymphoma specifically, controlling for tattoo-related microbial and viral infections is key to causally link increased tattoo-associated cancer risk to the carcinogenic tattoo pigments rather than the tattoo-related infection triggering a lymphoma. Finally, the incomplete exposure data on tattoo size and tattoo colours of most of the cited studies prevented the authors from calculating firm dose–response relationships (e.g. whether lymphoma risk could increase only above a specific tattoo size).
In summary, these studies give some vague indications that tattooing could be associated with increased risk of some types of haematological cancers, but the outlined methodological shortcomings currently prevent any firm conclusions from being drawn.
Finally, in order to establish causality in epidemiological research, prospective cohorts with larger sample sizes, such as the IARC-initiated studies CRABAT and Tattoo inK, are needed to fully understand the relationships between tattooing and cancer risk. The first prospective risk estimates for these cohorts are expected in 2030.
To find out more about the rationale for studying the potential carcinogenicity of tattoo inks, please consult the Background page.
No. Neither tattooing as a lifestyle behaviour nor specific tattoo inks have yet been evaluated by the IARC Monographs programme. However, several substances classified as carcinogenic (Group 1), probably carcinogenic (Group 2A), or possibly carcinogenic (Group 2B) to humans have been identified in tattoo inks; these classifications were based on studies that did not specifically consider the intradermal exposure scenario as seen with tattooing. Although some of these classified substances, particularly metals, were once used as colour pigments, the carcinogens present in tattoo inks today are generally contaminants due to impure raw materials or contamination during the production process.
Yes. Please consult the Projects page for information on current and closed research projects on tattoos.
Yes, there are. Allergic reactions to tattoos, although rare, have been observed. These can occur even months or years after the tattooing. Some known allergens, such as nickel, are quite common in tattoo inks, although they are regulated to the lowest possible technical level in the recent European Registration, Evaluation, Authorisation and Regulation of Chemicals (REACH) regulation on tattoo and permanent make-up inks. Moreover, not all tattoo allergens have yet been identified, and there is no allergy testing before tattooing. In addition, skin reactions such as granuloma formation may occur, and a potential relationship with a higher risk of sarcoidosis, a rare immunological disease with occasional skin manifestations, is discussed. Further conditions believed to be associated with tattooing, such as uveitis (inflammation of the middle layer of the eye) and pseudolymphoma (a benign condition that resembles lymphoma), have also been reported in the medical literature. However, an inflammatory skin reaction immediately and up to 1 month after the tattooing is in most cases a normal defence mechanism of the body.
In addition, viral infections, such as hepatitis B virus and hepatitis C virus, and bacterial infections can be transmitted under unsterile working conditions, especially through needles. By getting a tattoo in a professional and trustworthy tattoo studio, you can minimize this risk of infections.
Not much is known about the long-term systemic effects of tattoos, especially on different types of cancer, because the longitudinal epidemiological studies needed to investigate these potential relationships have not yet produced results.
Since January 2022, tattoo and permanent make-up inks are regulated under the Registration, Evaluation, Authorisation and Regulation of Chemicals (REACH) framework in Europe. REACH, a binding European tool for consumer safety, provides concentration limits for hazardous chemicals in consumer products. This new regulation led to the banning or restriction of more than 4000 chemical substances under Entry 75 of Annex XVII of Regulation (EC) No. 1907/2006. Although this is a good step towards harmonization of regulation and safety of inks, it remains unclear to what extent tattoo ink manufacturers will be able to produce compliant inks of sufficient quality for artistic tattoo purposes. Chemical analyses of the new inks already placed on the market are urgently needed.
Apart from this European regulation, regulations are non-existent or vague. For example, in the USA, which is the world’s largest manufacturer of ink and has the highest prevalence of tattoos, colour pigments are basically regulated, but tattoo and permanent make-up inks are not subject to pre-market approval.
Currently, no “positive lists” of tattoo inks exist. This means that existing regulations, if there are any, are “negative lists” banning known hazardous substances instead of “positive lists” permitting safe substances. To protect customers, in Europe all substances used in tattoo inks must be declared by the manufacturer and their safety information provided. However, as a general problem, the safety assessment of chemicals is typically based on more traditional exposure routes, such as inhalation, ingestion, or skin absorption, and rarely considers the intradermal exposure scenario as seen with tattooing, because of unavailable data.
No, at least not intentionally. Usually, tattoo artists in Europe will only buy inks that have been approved for the European market and that are deemed to be safe according to their labelling and safety sheets. However, mislabelling of ink bottles and incomplete safety sheets (meaning non-listing of certain substances) were common issues in the past and may persist even with the recent European REACH regulations. The manufacturer is not necessarily to blame; often raw materials are contaminated, which makes production of “clean” inks extremely difficult.
On the non-European market, regulations of ink ingredients are generally very loose. Therefore, inks not intended for use in the European Union should be regarded with caution.
Usually, all ingredients should be listed on the label of the ink bottle in decreasing order or at least provided in the safety sheet. However, because this information is not always complete and mislabelling is common, you cannot be sure about ingredients unless you get the ink tested.
If you buy from a European supplier, the inks should be REACH-compliant. Also, REACH-compliant inks follow specific labelling requirements. They should carry the statement “Mixture for use in tattoos or permanent make-up” and a reference number uniquely identifying the batch. Furthermore, there should be a list of ingredients in decreasing order and, if applicable, special labelling for nickel, chromium (VI), and pH regulators. Sometimes the information can only be shown in the safety sheet or instructions for use if small packaging does not enable the printing of a list of all ingredients at a readable size.
Any ink with the label “not to be used in the EU” is non-compliant, as are most inks purchased before January 2022.
Unfortunately, you have no way of knowing, but the colour of your tattoos may give some indication. If your tattoos are black, they will mainly consist of carbon or iron pigments. Sometimes black inks may be contaminated with combustion products (called polycyclic aromatic hydrocarbons) bound to the carbon pigments themselves. Bright-coloured inks often contain organic industrial dyes (azo or di-azo dyes in red, orange, or yellow inks or phthalocyanine in blue inks). The long-term health effects of these substances are still not well understood. If your inks have earthy or dull colours, they may contain a larger proportion of metals. White ink, which is often also used to lighten up colours, contains titanium dioxide.
In Europe, there is an existing non-binding EU Standard BS EN 17169:2020 "Tattooing – Safe and hygienic practice". In addition to this, several European Union countries have implemented national guidelines. In the USA, hygiene guidelines in tattoo studios are regulated on a state level.
Before getting tattooed, think twice about the design and style, and choose an artist accordingly. You do not want to remove your tattoo just a few months later!
The most important thing is to get tattooed in a professional tattoo studio. Visit some studios before getting your tattoo. Have a look at the hygiene conditions, and talk to the artists personally, which will give you an idea about their expertise and their trustworthiness. You may even ask to see the colours they are using; a trustworthy artist will not hesitate to show them to you.
Regarding the colours to choose, at the current state of knowledge, there is no such thing as a “safe colour”, because the necessary studies on long-term health effects are just starting. However, black inks may be less risky because the list of potential ingredients is much shorter than for coloured inks.
Finally, you should consult a medical doctor or dermatologist if you have known contact allergies or any other immune-associated conditions.
It would be safer to wait. Although studies on the topic are lacking, you should follow the precautionary principle and wait until you finish breastfeeding, to avoid potentially exposing your baby to multiple toxins.
During the tattooing process, the tattoo ink comes into contact with blood and lymphatic fluids, and thus potentially with the placenta and breast milk. During this initial phase, the soluble liquid part of the ink, which contains large amounts of hazardous substances, will become bioavailable and will subsequently be washed out of the body. A study quantifying the peak exposure and the duration of this short-term exposure to toxic materials and their metabolization is currently under way at the German Federal Institute for Risk Assessment. Although the results are still pending, it seems likely that the systemic exposure to hazardous substances directly after tattooing is rather high.
Furthermore, there may be a risk of bacterial and viral infections being transmitted through unsterile material, and these may be transmitted to your baby.
Yes, you should. Some substances in tattoo inks can be photoreactive, which means that they change their chemical properties upon irradiation.
Aesthetically, this process facilitates the fading of a tattoo. Compared with tattoos on sun-exposed body parts, which tend to become blurred quite quickly, tattoos that are unexposed (e.g. covered by clothing) will keep their initial look longer.
In addition, some substances in tattoo inks may potentially release toxic cleavage products into the body upon irradiation. The long-term consequences to human health of these phototoxic tattoo reactions are not yet known.
No, but some removal methods may be safer than others. Most importantly, you should refrain from using chemical scrubs and self-made removal recipes distributed through the Internet. They are likely to lead to severe skin damage without removing the tattoo. Surgical removal of a tattoo may lead to scar formation and risks of infection.
Even the most common way to remove a tattoo, via laser, may be dangerous because of the phototoxic properties of some tattoo pigments. During laser removal, the strong laser irradiation destroys the pigments in the dermis, which may lead to a release of large amounts of toxic cleavage products into the body. Although long-term studies on health effects related to laser tattoo removal are lacking, the total destruction of the pigments in the body (the tattoo removal) is probably more dangerous than their persisting poorly soluble, almost solid state (the undestroyed visible tattoo). In addition, laser removal will not always lead to the desired effect, and some colours may remain visible despite multiple expensive laser sessions. The good news is that laser removal of black tattoos, which are the most common, has the best aesthetic results and is probably the least risky.
You should also be aware that removal of a tattoo will remove only its visible part. The systemic exposure to tattoo pigments that have been transported to other parts of the body will remain unchanged.
The safest way to avoid tattoo removal is to simply not get tattooed. This is one more good reason why you should choose your design wisely and make sure to have a good artist.
In addition to people who are pregnant or breastfeeding, there are other groups who may wish to avoid getting tattooed. People with known contact allergies should exercise caution. Studies of the chemical composition of tattoo inks have found that many inks contain additional ingredients beyond those reported in ingredient lists. Although allergic reactions are rare, they can occur months or years after receiving a tattoo, and this prohibits the ability to do an effective patch test before tattooing. Beyond these recommendations, there is not enough research to make concrete recommendations for other groups. Knowing the risk factors associated with tattooing (see “Are there any known health risks associated with tattooing?”) may help you make an informed decision. Individuals who are predisposed to certain conditions or who have underlying conditions, including those who are immunocompromised, should consult a medical doctor before receiving a tattoo.
