Tattoos can induce blood infections

A recent medicine clinic Review article describes the characteristics of systemic bacterial infections associated with tattoos. These side effects can be avoided by maintaining strict hygiene when getting a tattoo.

Study: Systemic infections associated with tattoos or permanent makeup: a systematic review. Image Credit: daniel catrihual /


The practice of tattooing has been documented in ancient literature since the Neolithic period. Around the 18e century, tattoos were introduced into western culture. According to recent estimates, more than 20 million Americans and 100 million Europeans are tattooed.

Tattooing is a painful process that involves the introduction of artificial pigments under the skin. If not done hygienically, tattoos can induce various health complications including immune and inflammatory reactions, infections and chronic skin defects such as dermatoses. Between 2% and 27% of individuals experience some sort of discomfort after getting a tattoo, with 0.5-6% developing skin infections.

In the current systematic review, scientists review and analyze studies related to tattoo adversity to identify causative pathogens associated with serious or fatal systemic infections.

study design

The scientists searched the PubMed database for articles that were published between 2009 and 2019. All studies describing tattoo-related systemic infections in humans were included in the final analysis. The pathogens identified in these studies were compared against a literature search without year restriction.

Tattoo-related systemic infection has been defined as any pathogen invading the skin with or without spread to other organs.

Important observations

The final analysis included a total of 17 studies. Contrary to the historical literature, none of the selected studies reported the development of tuberculosis, syphilis or systemic viral infections after tattooing.

Several sporadic cases of Mycobacterium leprae, which is the bacterium responsible for leprosy, have been identified in India. Additionally, several cases of enlarged lymph nodes due to non-tuberculous mycobacteria, which do not cause tuberculosis or leprosy, have been identified.

The most commonly identified nontuberculous mycobacteria included Mycobacterium chelonae, Mycobacterium abscessus, and Mycobacterium haemophilum. The majority of Mycobacterium haemophilum-induced systemic infections have been identified in women after eyebrow tattooing, 50% of which ultimately required parotidectomy, which is the partial or complete removal of the parotid gland.

Several studies reporting septic shock associated with cellulitis or necrotizing fasciitis have been identified. Septic shock was primarily associated with pyogenic bacteria and occurred within two weeks of tattooing. The death occurred in a person with Vibrio vulnificus-related septic shock.

Only one study reporting staphylococcal toxic shock syndrome was identified. This infection has been observed after traditional Samoan tattoos or after tattooing in unsanitary conditions.

Infectious endocarditis has been identified mainly in young men. The condition was associated with fever, as well as pulmonary or systemic embolisms, without local symptoms. In 50% of cases, valvular abnormalities were present as a known risk factor.

Massive embolization was detected in two cases, while leaflet perforation and perivalvular abscess were reported in two cases. A single case of toxic shock syndrome has been identified.

Several studies reporting dermatophytosis were identified during the study period; however, none reported systemic infection.

Significance of the study

The current study reports that systemic infections can develop after tattooing. However, tattoo-related death is a rare occurrence, with only one death reported in the last ten years.

Historical evidence has widely reported viral infections after tattooing. Specifically, several reports mention tattoo-related outbreaks of the human immunodeficiency virus (HIV) and hepatitis B or C virus infections.

It is important to note that a shift in causative pathogens has been observed in recent times. In fact, nontuberculous mycobacteria have been identified as emerging bacteria causing systemic infections.

A centralized reporting system should be developed to understand the epidemiology of the phenomena. Additionally, proper hygienic conditions should be maintained during tattooing.

Journal reference:

  • Rello, J., Tejada, S., Campogiani, L., et al. (2022). Systemic infections associated with tattoos or permanent makeup: a systematic review. medicine clinic. doi:10.1016/j.medcle.2021.01.026.

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