Background: Millions of people are tattooed. However, the frequency of health problems is unknown. Methods: We performed an Internet survey in German-speaking countries. Results: The provenance of tattooed participants (n = 3,411) was evenly distributed in Germany. The participants had many (28%; >4) and large tattoos (36%; ≧900 cm2). After tattooing, the people described skin problems (67.5%) or systemic reactions (6.6%). Four weeks after tattooing, 9% still had health problems. Six percent reported persistent health problems due to the tattoo, of which females (7.3%) were more frequently concerned than males (4.2%). Colored tattoos provoked more short-term skin (p = 0.003) or systemic (p = 0.0001) reactions than black tattoos. Also the size of tattoos and the age at the time of tattooing play a significant role in many health problems. Conclusions: Our results show that millions of people in the Western world supposedly have transient or persisting health problems after tattooing. Owing to the large number and size of the tattoos, tattooists inject several grams of tattoo colorants into the skin, which partly spread in the human body and stay for a lifetime. The latter might cause additional health problems in the long term.

Drews DR, Allison CK, Probst JR: Behavioral and self-concept differences in tattooed and nontattooed college students. Psychol Rep 2000;86:475–481.
Laumann AE, Derick AJ: Tattoos and body piercings in the United States: a national data set. J Am Acad Dermatol 2006;55:413–421.
Marcoux D: Appearance, cosmetics, and body art in adolescents. Dermatol Clin 2000;18:667–673.
Long GE, Rickman LS: Infectious complications of tattoos. Clin Infect Dis 1994;18:610–619.
Stirn A, Brähler E, Hinz A: Prevalence, sociodemography, mental health and gender differences of tattooing and body piercing (in German). Psychother Psychosom Med Psychol 2006;56:445–449.
Timko AL, Miller CH, Johnson FB, Ross E: In vitro quantitative chemical analysis of tattoo pigments. Arch Dermatol 2001;137:143–147.
Bäumler W, Eibler ET, Hohenleutner U, Sens B, Sauer J, Landthaler M: Q-switch laser and tattoo pigments: first results of the chemical and photophysical analysis of 41 compounds. Lasers Surg Med 2000;26:13–21.
Papameletiou D, Zenie A, Schwela D, Bäumler W: Risks and health effects from tattoos, body piercing and related practices. 2003.
Prinz BM, Vavricka SR, Graf P, Burg G, Dummer R: Efficacy of laser treatment of tattoos using lasers emitting wavelengths of 532 nm, 755 nm and 1,064 nm. Br J Dermatol 2004;150:245–251.
European Commission Enterprise Directorate General Pharmaceuticals and Cosmetics: The Rules Governing Cosmetic Products in the European Union, vol 1: Cosmetics Legislation. Luxembourg, Office for Official Publications of the European Communities, 1999.
Haley RW, Fischer RP: Commercial tattooing as a potentially important source of hepatitis C infection: clinical epidemiology of 626 consecutive patients unaware of their hepatitis C serologic status. Medicine (Baltimore) 2001;80:134–151.
Entz AT, Ruffolo VP, Chinveschakitvanich V, Soskolne V, van Griensven GJ: HIV-1 prevalence, HIV-1 subtypes and risk factors among fishermen in the Gulf of Thailand and the Andaman Sea. AIDS 2000;14:1027–1034.
Stemper ME, Brady JM, Qutaishat SS, Borlaug G, Reed J, Reed KD, Shukla SK: Shift in Staphylococcus aureus clone linked to an infected tattoo. Emerg Infect Dis 2006;12:1444–1446.
Centers for Disease Control and Prevention (CDC): Methicillin-resistant Staphylococcus aureus skin infections among tattoo recipients: Ohio, Kentucky, and Vermont, 2004–2005. MMWR Morb Mortal Wkly Rep 2006;55:677–679.
Kluger N, Muller C, Gral N: Atypical mycobacteria infection following tattooing: review of an outbreak in 8 patients in a French tattoo parlor. Arch Dermatol 2008;144:941–942.
Bachmeyer C, Blum L, Petitjean B, Kemiche F, Pertuiset E: Granulomatous tattoo reaction in a patient treated with etanercept. J Eur Acad Dermatol Venereol 2007;21:550–552.
Balfour E, Olhoffer I, Leffell D, Handerson T: Massive pseudoepitheliomatous hyperplasia: an unusual reaction to a tattoo. Am J Dermatopathol 2003;25:338–340.
Doumat F, Kaise W, Barbaud A, Schmutz JL: Basal cell carcinoma in a tattoo. Dermatology 2004;208:181–182.
Gutermuth J, Hein R, Fend F, Ring J, Jakob T: Cutaneous pseudolymphoma arising after tattoo placement. J Eur Acad Dermatol Venereol 2007;21:566–567.
Jacob CI: Tattoo-associated dermatoses: a case report and review of the literature. Dermatol Surg 2002;28:962–965.
Morales-Callaghan AM Jr, Aguilar-Bernier M Jr, Martinez-Garcia G, Miranda-Romero A: Sarcoid granuloma on black tattoo. J Am Acad Dermatol 2006;55:S71–S73.
Paradisi A, Capizzi R, de Simone C, Fossati B, Proietti I, Amerio PL: Malignant melanoma in a tattoo: case report and review of the literature. Melanoma Res 2006;16:375–376.
Stinco G, de Francesco V, Frattasio A, Quinkenstein E, Patrone P: Malignant melanoma in a tattoo. Dermatology 2003;206:345–346.
Antony FC, Harland CC: Red ink tattoo reactions: successful treatment with the Q-switched 532-nm Nd:YAG laser. Br J Dermatol 2003;149:94–98.
Ortiz A, Yamauchi PS: Rapidly growing squamous cell carcinoma from permanent makeup tattoo. J Am Acad Dermatol 2009;60:1073–1074.
Bethell C, Fiorillo J, Lansky D, Hendryx M, Knickman J: Online consumer surveys as a methodology for assessing the quality of the United States health care system. J Med Internet Res 2004;6:e2.
Maurer M, Ortonne JP, Zuberbier T: Chronic urticaria: an Internet survey of health behaviours, symptom patterns and treatment needs in European adult patients. Br J Dermatol 2009;160:633–641.
Balter KA, Balter O, Fondell E, Lagerros YT: Web-based and mailed questionnaires: a comparison of response rates and compliance. Epidemiology 2005;16:577–579.
Engel E, Santarelli F, Vasold R, Maisch T, Ulrich H, Prantl L, König B, Landthaler M, Bäumler W: Modern tattoos cause high concentrations of hazardous pigments in skin. Contact Dermatitis 2008;58:228–233.
Cui Y, Spann AP, Couch LH, Gopee NV, Evans FE, Churchwell MI, Williams LD, Doerge DR, Howard PC: Photodecomposition of Pigment Yellow 74, a pigment used in tattoo inks. Photochem Photobiol 2004;80:175–184.
Engel E, Spannberger A, Vasold R, König B, Landthaler M, Bäumler W: Photochemical cleavage of a tattoo pigment by UVB radiation or natural sunlight. J Dtsch Dermatol Ges 2007;5:583–589.
Federal Institute for Risk Assessment (BfR): Tattoos and permanent make-up are not without risk. BfR Press Release 2004;3.
US Food and Drug Administration (FDA): Tattoos and permanent makeup, rev. 2008.∼dms/cos-204.html.
Regensburger J, Lehner K, Maisch T, Vasold R, Santarelli F, Engel E, Gollmer A, König B, Landthaler M, Bäumler W: Tattoo inks contain polycyclic aromatic hydrocarbons that additionally generate deleterious singlet oxygen. Exp Dermatol 2009, in press.
Zwad J, Jakob A, Gross C, Rompel R: Treatment modalities for allergic reactions in pigmented tattoos. J Dtsch Dermatol Ges 2007;5:8–13.
Baugh SD, Yang Z, Leung DK, Wilson DM, Breslow R: Cyclodextrin dimers as cleavable carriers of photodynamic sensitizers. J Am Chem Soc 2001;123:12488–12494.
Zunt JR, Tapia K, Thiede H, Lee R, Hagan H: HTLV-2 infection in injection drug users in King County, Washington. Scand J Infect Dis 2006;38:654–663.
Nishioka Sde A, Gyorkos TW, Joseph L, Collet JP, Maclean JD: Tattooing and risk for transfusion-transmitted diseases: the role of the type, number and design of the tattoos, and the conditions in which they were performed. Epidemiol Infect 2002;128:63–71.
Kircik L, Armus S, van den Broek H: Malignant melanoma in a tattoo. Int J Dermatol 1993;32:297–298.
Kirsch N: Malignant melanoma developing in a tattoo. Int J Dermatol 1972;11:16–20.
Lee YT, Craig JR: Melanoma in a tattoo of the breast. J Surg Oncol 1984;25:100–101.
Wolfort FC, Hoopes JE, Filtzer HS, Cochran TC: Superficial melanoma in a tattoo. Br J Plast Surg 1974;27:303–304.
Engel E, Vasold R, Santarelli F, Maisch T, Gopee NV, Howard PC, Landthaler M, Baumler W: Tattooing of skin results in transportation and light-induced decomposition of tattoo pigments: a first quantification in vivo using a mouse model. Exp Dermatol DOI: 10.1111/j.1600-0625.2009. 00925.x.
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