Yesterday, The New England Journal of Medicine published the article "Tattoo Ink-Related Infections --Awareness, Diagnosis, Reporting, and Prevention." The article is based on investigations by The Food and Drug Administration (FDA) into an outbreak of tattoo-related skin infections cased by a family of bacteria called nontuberculous Mycobacteria (NTM) that has been found in a recent outbreak of illnesses linked to contaminated tattoo inks. Coordinating their investigation with state and local health departments and the Centers for Disease Control and Prevention (CDC), they discovered 22 confirmed cases of this infection primarily in New York as well as Washington, Iowa, and Colorado. It was found that the inks were contaminated before distribution and is believed to have occurred during the production process. The inks in which the bacteria were found have been recalled.
You can find all the details in the following reports:
* FDA: Tattoo Inks Pose Health Risks
* CDC: The Hidden Dangers of Getting Inked
* CDC: Tattoo-Associated Nontuberculous Mycobacterial Skin Infections -- Multiple States, 2011-2012
Here are some key aspects of the reports I think are worth highlighting:
First, the FDA is quick to note that no matter how diligently tattooists follow hygienic procedures, infections can still incur because the bacteria were found in non-opened bottles of ink and contamination is not often visible.
Fourteen of the confirmed NTM infections, specifically Mycobacterium chelonae, came from Upstate Tattoo Company in Rochester, NY. YNN.com reports that one of the tattooists bought ink at an Arizona tattoo convention and used it on clients and the co-owner of the shop. A second supply was then ordered and that batch had the bacteria. The ink allegedly is "Catfish Carl's Realistic Wash." While the CDC does not specifically name the inks recalled, on the FDA's Enforcement report for May 23rd, 2012, it does list a recall of three different Catfish Carl's Realistic Washes. Ynn.com says that Upstate Tattoo is considering legal action against the ink manufacturer.
[Update: Upstate Tattoo Co. has been given a clean bill of health by the Monroe County Health Department, which stated the shop followed all hygienic procedures.]
The infection was first identified by a dermatolgist who contacted The Monroe County Health Department when a patient's rash persisted for a long time after receiving a tattoo at Upstate. The rash was located in the specific area where the grey wash was used, not throughout the entire tattoo. This sparked the investigation.
The CDC blog says that, after it was notified about these NY cases, it issued a public health alert and found two clusters of tattoo-associated NTM skin infections in Washington state, one in Iowa, and one in Colorado. Contamination was found in inks produced by other manufacturers, which they do not identify, and could have come from unsanitary manufacturing processes or the use of contaminated ingredients. It adds the following key fact:
[...] All were related to inks likely contaminated by non-sterile water either during the manufacturing process or during dilution by the tattoo artist just prior to tattooing a client.
Non-sterile water includes filtered or distilled water as well as tap and regular bottled water.
NTM infections look like allergic reactions and can be hard to diagnose and treat. Different types of antibiotics are often prescribed. [Ointments won't treat the problem.] If not properly treated, the FDA says that Mycobacterium chelonae can cause lung disease, joint infection, eye problems and other organ infections.According to the FDA's Office of Cosmetics and Colors, Dr. Linda Katz, if you experience tattoo-related complications, notify your tattooist and the FDA through its MedWatch program.