What Is the Main idea?

Tattooing involves pricking the body and introducing ink into the skin. In a small number of cases, bacterial infection can occur, requiring a course of antibiotic treatment. Here, we discuss what we need to be aware of when considering getting a tattoo, especially regarding infections. As reported in the open access article “Tattoo-Associated Cutaneous Mycobacterium mageritense Infection: A Case Report and Brief Review of the Literature” published in Case Reports in Dermatology, there are also chances of getting an atypical infection due to mycobacteria which is harder to identify, as we describe here in the blog post.

What Else Can You Learn?

The sources, symptoms, and general treatment for bacterial infections occurring around a tattoo are explained here. Further, important points to note for the prevention of infections when getting a tattoo are detailed.

Tattoos and Bacterial Infections

Tattooing is a process that involves pricking the body thousands of times to inject ink into a deeper tissue layer of the skin. This is almost equivalent to minor surgery and, ideally, has to be performed under proper, sterile conditions. In one study, the authors report that in 2.1% of cases there can be tattoo-related skin issues which include inflammation, allergic reaction or infection. In rare cases, the infection can be severe.

One of the functions of the skin is to prevent microorganisms from infecting the body. However, with tattooing, when done under non-ideal conditions, there is the possibility of microorganisms infecting the skin. It can be due to bacteria, viruses, or fungi. The most common infections are due to bacteria and specifically, bacteria that cause pus formation like Staphylococcus and Streptococcus. In the recent past, there have been reports of infections around tattoos due to mycobacteria, which is a family of slow-growing, immobile bacteria with thicker cell walls.

Symptoms and Sources of Infection

The main symptoms on the skin are different kinds of lesions around the tattooed area – like rashes, inflammation, pus-filled bumps, or raised red spots, usually in a cluster. There is also the possibility of having fever, aches, pains, or swelling of the infected area. For mycobacterial infections, itchy and painful bumps can also be present.

Where do these infections come from? There are multiple sources. At the parlor, the tattoo artists and the other people present can pass on an infection. If the instruments are not sterilized properly, including between every use, infections can occur. The environment in the parlor, including the furniture, could hold infectious bacteria. Finally, an important source of infection is the ink and water (used to dilute the ink). Tattoo ink usually comes in a bottle and is used for multiple customers. There is usually no expiry date on it, making it an unregulated part of the tattoo process.

In the case of a common bacterial infection, the symptoms might show up immediately within hours or a few days of tattooing. However, there are some bacteria like mycobacteria that have a long incubation time so that the infection shows up only after weeks or months.

Fighting the Infection

In people with higher immunity and depending on the bacteria, the body can be naturally resistant to the infection. However, with other bacterial strains or a lowered immunity level of the person, the resistance to infection can be low and the symptoms as described above will show up. In these cases, visiting a doctor and identifying the infection is a must. Antibiotics are the first line of treatment. Firstly, the doctor will take a swab from the site of infection to identify the microorganisms. Simultaneously, they will also check for which antibiotics can work against the infection and which do not. Identifying these antibiotics is equally important to start with proper treatment and for faster recovery.

For mycobacteria, it is a little harder to identify with regular tests. Therefore, when common bacteria are not identified, the tests should include testing for atypical bacteria. Unfortunately, in these cases, the infection can take longer to be properly identified as they grow slowly. Most often, a combination of medication and prolonged durations of treatment are required to get rid of these infections.

Report of Tattoo-Related Mycobacterial Infection

As reported in a case study, a 25-year-old man had red, pus-filled rashes 4 weeks after getting a tattoo. The rash was located near the grey-inked area of the tattoo. After 2 months, when the topical anti-bacterial creams did not work, the doctors tested the infection for typical and atypical bacteria. It took 2 weeks to identify it as mycobacteria and further 2 weeks to know the exact kind. Further, they found that this species of mycobacteria is resistant to the common antibiotic clarithromycin. After further tests and consulting with an infectious disease specialist, a combination antibiotic treatment was recommended for 3 months. Improvements were observed within 5 weeks. The doctors were also able to narrow down the cause of infection to the water used to dilute the black ink to obtain the grey color ink. This was the first of this species of mycobacterial infection seen after tattooing in Australia.

Things to Note

While in most cases tattooing does not cause a problem, there is a small risk factor involved, as described above. For those who are immunocompromised, this needs to be especially considered before getting a tattoo. It is also extremely important to get the tattoo done at a reputed parlor that follows all safety and hygiene protocols. Further, one can look for a licensed parlor and check if the tattooist has passed a tattoo hygiene course, if they are available, and if it is applicable in the country of the parlor. After the tattooing is done, proper after-care instructions as given by the tattooist must be followed. The tattooist should communicate well and clear any doubts during this period of after-care.

If there is an infection, it is important to immediately check with a doctor. If the first line of medications does not work, then checking for atypical infection must be done. At this point, consulting with an infectious disease specialist is recommended.

Finally, it will be good to consider bringing in more regulation to the tattoo industry. While the standards in the tattoo industry have generally increased and there are a lot of guidelines recommended, there is no strict vigilance. This is probably because the risk of death is extremely low. However, a guideline of reporting by doctors and tattoo parlors about the breakout of infections needs to be present and followed. This will help to quickly take action on the further spread of infection and also potentially identify new aggressive strains of bacteria that might come from the tattoo industry. For now, the patients with the tattoo can also play an active role in reporting it to authorities to ensure the safety of all.

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