Tattoo: biases, health risks run skin deep
From cultural relevance to breaking the stigma
In many countries, tattoos are seen as fashion statements and personal expression, especially among the youth. While reflecting social trends that value individuality, they also carry cultural weight, marking honor, rites of passage, and connections to heritage. Designs often symbolize identity and tradition, showing that tattooing is both a matter of style and a way of preserving collective memory.
Nevertheless, in some cultures, tattoos still carry a stigma due to their association with underground circles. The recent landmark ruling in South Korea marks a step toward breaking that perception.
The country has lifted a decades-old restriction on tattooing, passing the Tattooist Act [1] to legalize the practice by nonmedical professionals for the first time in 33 years. Approved by an overwhelming majority in the National Assembly, the law removes tattooing from its long-standing legal gray zone, where thousands of artists had operated without protection despite its popularity. It overturns a 1992 Supreme Court ruling that classified tattooing as a medical procedure limited to licensed doctors.
Under the new system, aspiring tattooists must pass a national exam and obtain a license, while meeting requirements for hygiene training, recordkeeping, and parental consent for minors. Semi-permanent makeup is included in the new definition of tattooing acts, though tattoo removal remains restricted to medical professionals.
Lawmakers described the measure as a way to safeguard public health while granting legitimacy to tattooists, and industry leaders welcomed it as a historic moment that could bring South Korea’s tattoo culture to the global stage. The law will take effect after a two-year preparation period, with transitional provisions for existing practitioners.
Meanwhile, the Ministry of Health and Welfare has indicated that doctors, oriental medicine practitioners, and dentists may still be allowed to perform tattoos without a license under future ordinances.
Tattoo bias in the workplace and other sectors
The workplace [2] remains one of the most visible arenas where tattoo stigma endures, often influencing hiring decisions and career advancement. While tattoos are increasingly accepted, perceptions vary across generations, with some employers still reluctant to hire candidates who “get inked”.
Research suggests that in fields such as finance or corporate services, customers and clients may view tattooed employees as less professional or trustworthy, adding another layer of bias that workers must navigate.
In healthcare, the stigma takes a different form. People with tattoos are often subject to a temporary waiting period before donating blood [3] not because tattoos make them ineligible, but because of the potential risk of blood-borne infections introduced during the tattooing process. Even with modern hygiene practices, unsterilized needles can transmit viruses such as Hepatitis B, Hepatitis C, and HIV.
To safeguard recipients, blood services [4] impose a three-month deferral, allowing time for any potential infections to become detectable. Although all donations are screened, no test is completely foolproof, making the precautionary window essential.
This medical caution, while rooted in safety, contributes to the broader perception of tattoos as a health risk.
Studies, regulations target tattoo ink risks
A new study has found bacterial contamination in about 35% of commercial tattoo and permanent makeup inks sold in the US, raising concerns about infection risks.
The research [5] , published in Applied and Environmental Microbiology by the American Society for Microbiology, reported the presence of both aerobic and anaerobic bacteria in sealed and unopened ink bottles. It is the first study to confirm anaerobic bacteria in tattoo inks.
Corresponding author Seong-Jae “Peter” Kim, a microbiologist with the US Food and Drug Administration’s National Center for Toxicological Research in Arkansas, said the results suggest contaminated inks could be a source of infection once injected into the skin. He noted that product labels claiming sterility did not guarantee the absence of bacteria.
Researchers tested 75 tattoo inks from 14 manufacturers, using oxygen-rich incubators to detect aerobic bacteria and oxygen-free anaerobic chambers to identify anaerobes. About one-third of the products showed contamination, regardless of brand or labeling.
Kim said tattoo-related complications have increased alongside the practice’s rising popularity, with microbial infections only one part of the risk. He added that immunologic complications, such as allergic reactions, and toxic responses remain significant concerns.
While the US study points to microbial risks, regulatory responses are also emerging abroad. In Karnataka, India, Health Minister Dinesh Gundu Rao announced plans to regulate tattoo parlors [6] after the state Food Safety Department found 22 types of metals in tattoo ink samples. The government will also write to the Centre seeking national guidelines and push for tattoo inks to be classified as cosmetic products to ensure tighter oversight.
Rao said the regulations aim to address health risks posed by heavy metals and microbial contamination, which experts warn can enter the body through the skin and cause diseases. The state government is also considering inspections to enforce compliance and prevent unsafe inks from entering the market.
Together, the US findings and Karnataka’s regulatory measures underscore a growing international focus on tattoo ink safety, an issue gaining urgency as tattooing continues to expand in popularity worldwide.
Mixed evidence emerges on tattoos and cancer risk
Along the same vein, researchers from the University of Southern Denmark, working with colleagues from the University of Helsinki, have reported evidence that tattoo ink may increase the risk of skin and lymphoma cancers. The study [7] based on data from more than 5,900 Danish twins, found that tattooed individuals were more frequently diagnosed with these cancers compared to those without tattoos.
The team explained that tattoo ink does not remain confined to the skin but can migrate to the lymph nodes, a vital part of the immune system. Once there, the particles may trigger chronic inflammation, which over time could promote abnormal cell growth. Henrik Frederiksen, a clinical professor at the University of Southern Denmark, said their observations suggest that the immune system may treat ink particles as foreign substances, placing a constant strain on the body’s defenses.
Using twin data allowed researchers to better isolate the impact of tattoos by controlling for shared genetic and environmental factors. Jacob von Bornemann Hjelmborg, professor of biostatistics at the university, noted that this provided a stronger framework to examine whether tattoos themselves influence cancer risk.
The study also found that tattoo size was a significant factor. Individuals with tattoos larger than the palm of a hand had nearly three times the rate of lymphoma compared to those without tattoos, even after adjusting for age and the length of time since the tattoo was applied.
According to assistant professor Signe Bedsted Clemmensen, the findings suggest that the larger the tattoo and the longer it has been in place, the more ink accumulates in the lymph nodes, warranting further investigation into its long-term effects.
While the study did not identify a clear link between specific ink colors and cancer risk, researchers noted that previous studies have associated certain pigments with allergic reactions and other health issues. They emphasized the need for further research at the molecular level to determine how tattoo particles interact with the immune system over decades.
The Danish findings are reinforced by a separate Swedish study published in 2024, which also observed a link between tattoos and lymphoma. Researchers stressed that, given the growing popularity of tattoos, already common among younger generations, it is important to deepen understanding of their possible long-term health risks.
However, another study offers a contrasting perspective, suggesting that individuals with multiple tattoo sessions may face a lower risk of melanoma, or skin cancer.
Led by Jennifer Doherty of the University of Utah and published in the Journal of the National Cancer Institute, the study [8] examined 7,000 participants and reported that those with two or more sessions had reduced rates of both invasive and in situ melanoma. By contrast, people with only one tattoo session were more likely to develop melanoma, particularly in situ, though the reason remains unclear.
The team had initially expected tattoos to increase cancer risk due to ink-related carcinogens, pigment breakdown, and possible inflammation. Instead, the results showed a mixed pattern, with melanoma risk decreasing as the number of tattoo sessions increased.
Researchers suggested this could be linked to greater sun protection practices among tattooed individuals, a physical barrier effect of ink against ultraviolet radiation, or immune responses triggered by tattooing.
Experts cautioned that the findings do not mean tattoos prevent cancer and urged continued sun protection. They also noted that earlier research has associated tattoos with higher risks of certain blood cancers, underscoring the need for further study on how tattooing may influence cancer risk.
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Sources:
[1] https://www.nbcnews.com/world/asia/south-korea-passes-landmark-bill-legalize-tattoo-artists-rcna233838
[2] https://www.semanticscholar.org/paper/e35723676669f39d9957a59a40e53bcde09fc074
[3] ( https://www.medanta.org/patient-education-blog/mythbuster-can-you-donate-blood-with-a-tattoo )
[4] (https://www.redcross.org/local/pennsylvania/southeastern-pennsylvania/about-us/news-and-events/news/national-tattoo-day.html)
[5] (https://scitechdaily.com/safety-warning-35-of-tattoo-inks-tested-positive-for-harmful-bacteria/)
[6] (https://www.hindustantimes.com/cities/bengaluru-news/karnataka-plans-tattoo-parlour-regulations-after-tests-find-22-types-of-metals-in-ink-101740798533405.html )
[7] (https://scitechdaily.com/concerning-new-research-links-tattoo-ink-to-increased-cancer-risk/)
[8] ( https://attheu.utah.edu/science-technology/melanoma-less-common-in-individuals-with-several-tattoos/ )
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