Tattoos

For today’s urban vixen, tattooing is also a way to communicate her allure, sensuality or possibly her devotion to someone she cares about. A tattoo is a form of art and decoration where the canvas is your skin. Skin art allows men and women to express their individuality and uniqueness.

Tattooing has been around for thousands of years, and it is sure to last for thousands more. It is believed to date back to ancient Africa, specifically in Egypt, to a time roughly 2000 years before the pyramids were built. In Latin America, the Mayans were also known to have tattoos, as were the Aztecs and Incas. The Polynesians spread the practice of tattooing throughout Southeast Asia, and then sent it around the world when they tattooed the sailors they encountered. In addition to body art, tattoos are used for cosmetic and reconstructive purposes – from permanent make-up (eyeliner and lip liner, for example), to camouflage for unsightly scars and replacement of the areolae in mastectomy patients.

The term tattoo literally means to puncture the skin. Tattoos are applied to the body by puncturing the skin’s outer layer and inserting colors into the dermal layer of the skin. You should think of tattoos as permanent, although over time some of the colors may fade.

There are many different ways in which you can obtain a tattoo, but whether old-fashion or modern techniques are used, the skin is punctured with a sharp instrument. Originally, tattooing required one or more needles fixed to a stick and driven into the skin by slightly tapping. The Polynesian taping sound- Tau Tau – is what led to the original name--tattoo. Currently, tattooing is usually performed with an electric-powered needle or gun.

Since tattoos are permanent and there are risks associated with tattooing, it is important to carefully and knowledgeably select a tattoo artist and shop or parlor. Since several tattoo inks can cause allergic reactions or scarring, you should also discuss your decision to get a tattoo with your dermatologist. Please see below for the essentials for tips to ensure a safe tattoo experience.

Tips for a Safe Tattoo Experience

  1. Select a licensed tattoo shop or parlor and an experienced tattoo artist or operator
  2. Check with your local health department to see if there have been any past claims against the shop or parlor
  3. Avoid “scratchers”, which are people who operate out of their homes without proper tools or licensing
  4. 4. Avoid tattoo parties where several friends will get tattoos from a scratcher at the same time. Ask yourself if the savings is really worth jeopardizing your health.
  5. Make sure the tattoo artist is clean (check his or her nails) and sober and has been vaccinated for Hepatitis. (If he or she takes meticulous care of himself or herself, then he or she will most likely take good care of you and your new tattoo.)
  6. Make sure that the shop or parlor is clean and orderly when you enter and you should see an autoclave for sterilizing instruments and there should be a supply of unused disposable needles, tubing and razors.
  7. The operator must use sterilized or new and disposable instruments when performing your tattoo.
  8. Look over the artist's other work and consider bringing your own artwork with you to the parlor for your tattoo.
  9. Don’t let your friends tattoo you, or try doing it yourself unless you have training. These tattoos are often unsightly and difficult to remove. You may also have a higher chance of developing an infection.

Overall, tattooing is a relatively simple and quick process. You will be seated in the tattoo chair, which is often a dentist-style chair that will be either in an open location or a private room. You will remove any clothing that covers the area to be tattooed. It is helpful to wear loose clothing if you will need to put it back on when your work is finished. The tattoo artist should wash his or her hands before beginning the procedure and latex or vinyl gloves must be worn. The area of your body you have chosen for your tattoo will be cleaned, usually with rubbing alcohol, and hair on the tattoo site will be removed with a disposable razor. Make sure your artist uses a new razor, and throws it away once it has been used.

As for the actual tattoo process, most tattoo studios will first use a machine called a thermal-fax to create a stencil. The thermal-fax saves hours of tracing time by the artist as your tattoo design is inserted into the machine and it transfers onto a piece of thermal paper. The thermal paper will then be used to transfer the stencil onto your skin. Some artists will use soap or water to moisten your skin, and some will use stick deodorant to aid in making the transfer better and darker. When the paper is pulled away from your skin, you will be left with a purple-colored likeness of your future tattoo on your skin. The remainder of the procedure will be performed with a tattoo machine.

Tattooing machines operate somewhat like sewing machines. A needle bar moves up and down, penetrating your epidermis and dermis (the upper and middle layers of the skin). The needle is operated by a foot pedal. Inks are placed in small cups called “ink caps”, needles and tubes removed from their sterile pouches and placed in the machine. Clean, distilled water is poured into a cup to be used to change from one color ink to another. When the artist begins your tattoo, he or she places ointment over your transfer design to keep the transfer from accidentally rubbing off and to allow the needle to slide along the skin more smoothly. A small single needle is used to create the outline of your tattoo, and a row of needles are used for shading and filling in the tattoo. The length of time it will take to complete your tattoo depends on your skin and complexity of the design.

Tattoos can be painful, but the level of pain will be determined by the size and location of the tattoo. Areas closest to the bone tend to be more painful than fleshier areas, but your personal pain threshold will be the greatest determinant of the discomfort you experience. After the tattoo is finished, it must be properly cared for. Remember to follow the post procedure instructions that your tattoo artist has given you so that the area will heal quickly and without unwanted side effects. A bandage will be applied to your tattoo, which should be left on at least overnight. When you uncover you new work, you will most likely be advised to gently wash it with an anti-bacterial or anti-microbial soap while taking a bath or shower. The area is usually patted dry and a thin coat of antibiotic ointment, such as Bacitracin or Polysporin will be applied to aid in the healing process. While your tattoo is healing, avoid swimming in either public pools or the ocean and avoid soaking in a hot tub. Keep your hands off your new tattoo and do not pick the area; some skin will flake off naturally and a scab will form, but resist pulling it. If the area becomes dry, moisturizing creams or lotions can hydrate the area. Lastly, it is important to protect your tattoo from the sun. Initially, you will want to keep it covered when you are outdoors. After it heals, it will still be important to protect the area so use SPF 30 sunblock to prevent fading.

Skin Reactions
As demonstrated in the chart above, pigments in tattoo dyes have the potential for causing a number of skin reactions. Some of the reactions are immediate and others may be delayed for a number of years. The most common reactions are eczematous, lichenoid, or granulomatous. Additionally, photosensitive or phototoxic reactions may occur and keloidal scars may form. Sarcoidosis, which is a common disorder in women of color, may appear within tattoos.

Eczematous hypersensitivity reactions are localized, scaly, red patches at the tattoo site that are itchy. Swelling of the skin may also occur. These reactions are treated with topical steroid creams or ointments. Additionally, anti-itching creams or antihistamines may also be recommended by your doctor for relief of itching. Depending on the severity of the reaction, it may resolve spontaneously or ultimately require removal of the tattoo.

Lichenoid reactions present as small, skin-colored, flat-topped bumps in the area of the tattoo. Treatment is not usually necessary. Granulomatous reactions are round, firm collections of reactive tissue that form beneath your skin. These bumps are larger and much more noticeable than lichenoid bumps. Granulomatous reactions are the most common type of allergic reaction to a specific ink. They are difficult to treat and often cause redness, swelling and bumpiness of the skin. Your dermatologist will attempt to treat this allergic reaction with prescription topical steroids or injected steroids as the first line of treatment. However, if this doesn’t work, tattoo removal may be necessary.

Keloids, which are large, raised scars that sometimes form after tattooing, occur commonly in people with brown skin. They are actually an abnormal healing reaction of the skin caused by the puncturing of the tattoo needles. Since there are no easy treatments for keloidal scars, it is inadvisable to get a tattoo if you know you are prone to keloids. Keloids can sometimes be flattened with a series of steroid injections by your dermatologist.

Finally, in some tattoos, photosensitive or phototoxic reactions can be a problem. A photosensitive reaction is an allergic reaction due to a combination of the tattoo ink and the sunlight, which produces an itchy, scaly and red rash. In contrast, a phototoxic reaction, also due to a reaction between the ink and the sun, will results in blistering of the tattoo area or a sunburn-like reaction. Although reactions can be caused by a number of dyes, they are most commonly linked to yellow pigments. For this reason, it is important to protect your tattoo from the sun.

Because tattoos inject foreign matter into your body, it is important to discuss any allergies with your dermatologist and tattoo artist beforehand. Allergies need not mean avoiding tattooing altogether, as organic and other pigments may be available to you.

Tattoo Ink
It is important to realize that when you get a tattoo, you are inserting something foreign, the tattoo ink, into your body. It is a good idea to know exactly what goes into most tattoo inks. Ink starts as a pigment that your artist will mix. Most tattoo pigments are derived from metals, and these metals may cause some people to have an allergic skin reaction. Fortunately, several pigments have non-metallic alternatives for those who are concerned about allergic reactions. Please refer to the chart below, which details the most common ink colors and their ingredients. It will also show you which colors are most likely to cause reactions.

Color

Base

Reaction

Red

Red pigments are derived from mercury, also listed as mercury sulfide, cinnabar, vermillion and red cinnabar. The metal cadmium red may is also be used.

Non-metallic red pigments that can be used for tattoos include carmine and scarlet lake or sandalwood and brazil wood, which are organic red pigments.

Mercury pigments are most commonly associated with skin reactions. These reactions may occur years after you get your tattoo. Often the metal alone doesn’t cause a problem, but it is when the pigment is exposed to cross reactants that a reaction can occur. Chemicals like the preservative thimerasol (used as a preservative in contact lens solutions and eye drops), mercurochrome, and some vaccines, may cause a reaction in your tattoo. If you think you have a thimerasol allergy, you may want to explore non-metallic pigments. Also, some organic compounds have been known to cause phototoxic reactions when exposed to sunlight.

Black

Black and grey pigments are usually carbon products. Other sources include black ink and logwood.

Sensitivity to carbon pigment is rare, since it is not derived from a metal. However, black henna tattoos have been known to cause allergic reactions due to contaminants in the black henna.

Yellow

Yellow pigment is most often derived from cadmium sulfide.

Yellow is known to be a common cause of skin reactions. Usually eczematous, these reactions are localized to the tattoo, but sometimes generalized reactions occur. Cadmium may also be associated with phototoxic reactions when exposed to light.

Blue

Both deep and light blue dyes are derived from a variety of cobalt salts.

Blue pigments commonly cause granulomatous reactions as well as allergic skin reactions localized to the tattoo. In some cases, eye inflammation has been reported.

Green

Green dyes are derived from chromium and chromium oxide. They are listed under a variety of names such as chrome green, casalic green and guignet’s green.

Chromium sesquioxide, or veridan, another type of chromium salt, and copper salt derivatives are often used to make shades such as emerald green.

Chromium is a common cause of eczematous skin reactions, both localized to the tattoo, as well as on other parts of the body. Most allergic reactions do not appear immediately; rather they occur several years after the tattooing. Intense itching may be the first sign of a reaction.

Purple/Violet

Purple pigment is obtained from the metal manganese

Manganese may cause the formation of granulomatous reactions in skin.

Brown

Brown dyes are created using venetian Red, a ferric oxide derivative, or from cadmium salts.

Both brown dye derivatives have been known to cause phototoxic reactions when exposed to sunlight.

White

White pigments are made from titanium or zinc oxide or from the use of lead carbonates.

Mild skin reactions may occur from the metallic derivatives.

Other

Colors such as neon or "hot" colors often contain flourescene and metal compounds.

Many people are allergic to fluoroscene.

Tattoo Removal
Even when tattoos are well though out, problems may arise later and you may eventually want to remove the pigment from your skin. In fact, it is estimated that of the 10% of the U.S. population with tattoos, almost half will eventually have them covered or removed. Whether you no longer want your ex’s name on your arm, or you have developed an unwanted reaction, there are a number of options available for removal of your tattoo.

Your first option to conceal your tattoo is to use make-up to cover it. Covermark and Dermablend are two brands that tend to work particularly well, and offer more complete and waterproof coverage. Your second option is to consider having the tattoo covered by another piece of tattoo art. Talk to your artist about this possibility if you are not sure you want the tattoo completely removed.

If you have decided to have your tattoo removed, there are three options: laser removal, excision and dermabrasion. These options involve the actual removal of the skin that contains the tattoo. Of the three options, laser removal is the most effective and preferred, but it is not without possible side effects. Scar formation is a possible side effect, as is incomplete removal of the tattoo.

Bottom Line

Tattooing is a unique and beautiful form of art and decoration for your skin. The decision to have a tattoo is a serious one that requires consultation with your dermatologist and tattoo artist. Once you understand the procedure, as well as the side effects, you will be able to make the correct decision for you and ultimately enjoy your tattoo for many years to come.

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