Tattoo Pigments: Popular Fashion Accessories or Health Hazards?¶

Tattoos—ancient forms of body art/body modification (and selfexpression—for some) have recently become popular fashion accessories worldwide (1). However, despite their ornamental and psychological attributes tattoos may carry considerable health hazards (e.g., risk of infection) (2). It is with interest that I read the two articles (3, 4) published in this issue providing some (in vitro) evidence that the tattoos colorants industrial pigments, which have never been intended (and produced) by the chemical industry to be used in humans for ornamental purposes (but rather to stain consumer goods) may indeed contain hazardous (e.g., toxic and/or carcinogenic) compounds. Most tattoos are applied for the sake of fashion (1). Almost 50 percent of all tattoos are being done on women (5). In recent years body tattooing in unconventional (more subtle) sites (e.g. lumbar area, lower abdomen, breast, buttocks) has gained increasing popularity among young women including in pregnancy worldwide (6, 7). Indeed, in his practice of obstetric anesthesia the author of this correspondence encountered a parturient with multicolor tattoos covering her mid-lumbar area in whom an uneventful administration of epidural labor analgesia (one attempt at L2-3 interspace with an 18 GA Tuohy needle) was complicated by postpartum tenderness and burning in the lumbar area where the epidural catheter had been sited (7). A pigment-containing tissue core from a tattoo seemed a possible cause of deeper lumbar tissues irritation (possibly the first reported case of an in vivo evidence of tattoo pigment toxicity?). The current literature is silent on neurological complications of a hollow needle insertion through a tattoo for labor analgesia. Since hollow needles entrap tissue fragments (along with the tattoo’s pigment) in their bore as they pass to deeper structures (8), the possibility of lumbar tissue irritation/infection, and/or neurological long-term sequela exists.