Materials Used in Body Art 2 · nowadays in the different forms of body art. 2.2 Piercings 2.2.1 Materials A diversity of materials has been used over the centu-ries. Natural materials

C. de Cuyper, M. L. Pérez-Cotapos S. (eds.), Dermatologic Complications with Body Art, 13DOI: 10.1007/978-3-642-03292-9_2, © Springer-Verlag Berlin Heidelberg 2010

2.1 Introduction

Body art has become increasingly popular in the last decades resulting in the raising occurrence of compli-cations and adverse reactions, some of them related to the procedures, other side effects caused by the sub-stances used. In order to identify the causative agent it is essential to know the exact composition and nature of the materials applied. Although a lot of research has been done in this fi eld, there is still a lack of uniform worldwide regulation on the procedures and materials.

This chapter will give an overview of materials used nowadays in the different forms of body art.

2.2 Piercings

2.2.1 Materials

A diversity of materials has been used over the centu-ries. Natural materials such as wood, ivory and bones

Materials Used in Body Art

Christa De Cuyper and Davy D’hollander

C. de Cuyper (�) Department of Dermatology , AZ Sint-Jan, Ruddershove 10 , 8000 , Brugge , Belgium e-mail: [email protected]

2

Core Messages

Body art is increasingly popular, resulting in ›the raising occurrence of complications and adverse reactions, some of them related to the substances used. To identify the causative agent, it is essential to know the exact compo-sition and nature of the materials applied. Nickel allergy is the most common complica- ›tion of body piercing and can easily be avoided by the use of ornaments made of high-grade stainless steel or inert plastic material. Tattoo compounds in comparison to cosmet- ›ics are in general not offi cially controlled. Moreover, the origins as well as the chemical and toxicological specifi cations of these colour-ing agents are hardly known by the producers, the performers and by the consumers. From the medical perspective, uniform world- ›wide regulation would certainly offer opportu-nities to reduce the risks and complications involved in the use of chemical components that might be potentially hazardous and may threaten the health of the tattooed individual with special concern for heavy metals and car-cinogenic aromatic amines. Recent studies have demonstrated that sunlight ›exposure and laser treatment of tattoos can induce decomposition products with carcino-

genic properties. The clinical implications of these fi ndings have not yet been identifi ed. Recommendations on the hygienic conditions ›of piercing and of the application of tattoos and permanent make up (PMU) are available. Respecting these guidelines could minimise the risk of transmission of infectious diseases. The occurrence of contact allergy to tempo- ›rary (henna) tattoos is linked to the presence of PPD in high concentration.

14 C. de Cuyper and D. D’hollander

have always been popular in tribal, religious and ritual-ethnic piercings (Fig. 2.1 ). Large ranges of metals (copper, silver, gold, iron) have been recovered in excavations.

Earrings like most jewellery were often made of sil-ver and gold, pearls and precious stones, but in recent times many cheap jewels are just made of plated nickel. Most common materials used nowadays for piercing or embedding are stainless steel, titanium, niobium, gold, glass and plastics (Figs. 2.2 and 2.3 ; Table 2.1 ). Different qualities of stainless steel are produced. To check if number 316 grade steel corresponds to the require-ments, International Organization for Standardization (ISO) [1] and American Society for Testing and Materials (ASTM) [2] standards can be used.

Stainless steel is specifi ed with letters and numbers, letter L corresponding with low carbon (higher corro-sion resistance) and VM signifying vacuum arc re-melted (a technique used to improve homogeneity, with better crystalline structure and mechanical properties); number 316 grade steel corresponds with this composi-tion (Fe, <0.03% C, 16–18.5% Cr, 10–14% Ni, 2–3% Mo, <2% Mn, <1% Si, <0.045% P, <0.03% S). To

control one can check the “mill sheets” delivered by the producer if they correspond to these standards [3] .

Polytetrafl uorethylene (PTFE) an inert thermoplastic polymer with non-stick properties and Biofl ex/bioplast a Tygon-like material are also suitable for initial piercings, and piercings taking a long time to heal [4] . Individuals allergic for nickel can use the dimethylglyoxime nickel

Fig. 2.1 Traditional golden piercing

Fig. 2.2 Modern stainless steel piercing

Fig. 2.3 Modern glass jewel

2 Materials Used in Body Art 15

spot test to check nickel-releasing objects and jewels (Fig. 2.4 ). The test kit consists in a bottle with dimethyl-glyoxime. A drop of the product must be applied on a cotton tip. The suspected metallic item must be rubbed with this moistened cotton tip. If a pink–red colour is produced the item contains nickel.

2.2.2 Sterilisation of Instruments

A sterile and hygienic work method while placing a piercing or changing jewellery is imperative to avoid infections. We have explained below how to work.

All instruments and the jewellery used for placing piercings are sterilised in the following manner:

After each use and before the fi rst use, instruments are placed in a disinfection tray for 20 min to remove tissue residue and lower the bacteria count with 99% (Fig. 2.5 ).

Instruments are rinsed and placed in an ultrasonic cleaner. They are treated during 60 min with implod-ing air bubbles to ensure thorough cleaning to a molec-ular level (Fig. 2.6 ).

The instruments are rinsed and laid out to dry (Fig. 2.7 ).

When they are completely dry they are wrapped in sterilisation foil (Fig. 2.8 ).

After wrapping, the instruments are placed in the vacuum autoclave to sterilise them. The use of a vac-uum is needed because the equipment is wrapped (Fig. 2.9 ).

Table 2.1 Piercings

316 L stainless steel a 316 LVM stainless steel a 15–17 stainless steel a Titanium Ti6A14V (90% titanium, 6% aluminium, 4%

vanadium) a Niobium Gold 18 kt PTFE (polytetrafl uorethyleen or Tefl on) Biofl ex/bioplast b

a To check if number 316 grade steel corresponds to the require-ments, ISO ( http://www.iso.org/iso/home.htm ) and ASTM ( http://www.astm.org/ ) standards can be used Stainless steel is specifi ed with letters and numbers, L corre-sponding with low carbon (higher corrosion resistance) and VM signifying vacuum arc re-melted (a technique used to improve homogeneity, with better crystalline structure and mechanical properties); number 316 grade steel corresponds with this com-position (Fe, <0.03% C, 16–18.5% Cr, 10–14% Ni, 2–3% Mo, <2% Mn, <1% Si, <0.045% P, <0.03% S). To control one can check the “mill sheets” delivered by the producer if they corre-spond to these standards Information and sources: http://www.bmezine.com/pierce/arti-cles/surgste.html b A Tygon-like material ( http://www.tygon.com )

Fig. 2.4 Nickel spot test

Fig. 2.5 Disinfection

Fig. 2.6 Ultrasonic cleaner


After sterilising, the equipment is stored in closed cabinets and drawers till use. Equipment that is not used within a month is re-sterilised.

To avoid cross-contamination with disposable mate-rial, gauzes, corcks, rubber bands, cotton tips and toothpicks are sterilised in bulk and set-up is done on a

sterile fi eld. Needles are bought sterilised and used only once.

When coming in for a piercing, we fi rst wash our hands (Fig. 2.10 ).

We remove the equipment from its wrapping and put it on a sterile fi eld (Figs. 2.11 and 2.12 ).

Fig. 2.7 Drying

Fig. 2.8 Wrapping

Fig. 2.9 Sterilisation in the autoclave

Fig. 2.10 Washing hands

Fig. 2.11 Set-up 1

Fig. 2.12 Set-up 2


After the piercing procedure, the equipment is dis-posed in the disinfection tray to be re-sterilised. Needles are disposed of in a sharp container (Fig. 2.13 ).

2.2.3 Legislation

Non-occupational contact with nickel, primarily through nickel-plated clothing fasteners and cheap jewellery, more in particular ear piercings, is responsible for sensi-tisation especially in females (5–15% vs. 0.5–1% in males) [5– 7] . Because the high incidence of nickel allergy has a strong association with nickel contact, efforts have been done in the last decade to reduce sensitisation by regulating the nickel content in products with intimate and prolonged skin contact. The European Union “Nickel Directive” [8] was amended by the European Commission in 2004 and supported by the Nickel Institute.

The amended Nickel Directive prohibits “the use of Nickel (CAS No 7440-0-20 EINECS No 2311114) and its compounds:

1. In all post-assemblies that are inserted into pierced ears and other pierced parts of the human body unless the rate of nickel release from such post-assemblies is <0.2 µg/cm 2 /week (migration limit);

2. In products intended to come into direct and pro-longed contact with the skin such as:

Earrings • Necklaces, bracelets and chains, anklets and • fi nger rings

Wristwatch cases, watch straps and tighteners • Rivet buttons, tighteners, rivets, zippers and metal • marks, when these are used in garments

If the rate of nickel release from the parts of these products coming into direct and prolonged contact with the skin is >0.5 µg/cm²/week

3. In products listed in point 2 where these have a non-nickel coating unless such coating is suffi cient to ensure that the rate of nickel release from those parts of such products coming into direct and pro-longed contact with the skin will not exceed 0.5 µg/cm²/week for a period of at least 2 years of normal use of the product.

Furthermore, products which are the subject of points 1, 2 and 3 above, may not be placed on the market unless they conform to the requirements set out in those points.” [8]

The member companies of the Nickel Institute sup-port communication, education of manufacturers and retailers of consumer products that will be in contact with the skin, jurisdiction to implement measures that will be protective of consumers, and research. They also try to extend their efforts towards other continents in particular Australia and North America [9] . The impact of the EU Nickel Directive on the occurrence of nickel contact allergy has been observed in Europe during the last years and appears to be substantial as was illustrated by the study of Liden [10] . However, cheap materials are still used worldwide and even in Europe on the street, they are often of unknown origin and do not correspond to the requirements of the Nickel Directive. There are no specifi c FDA regulations cor-responding to the European Nickel Directive.

2.3 Permanent Tattoos and Permanent Make-Up (PMU)

2.3.1 Introduction

Tattoo compounds in comparison to cosmetics are in general not offi cially controlled. Moreover, the origin as well as the chemical and toxicological specifi cations of these colouring agents are hardly known by the produc-ers, the performers, or even by the professionals involved in these procedures, and certainly not by the consumers.

Fig. 2.13 Needle container


Drawing and writing inks, such as Indian ink, Pelican ink and printer inks, are very popular in amateur tattoos, although the producers do not recommend their prod-ucts for these purposes. Considering the safety of the consumer, heavy metals such as mercury, cadmium and lead have been banned for cosmetic purposes by the Food, Drug and Cosmetic Act (FDCA) in 1976 and have disappeared in tattoo inks since. It is rare to fi nd these elements in the tattoo inks nowadays; they have been replaced in the last decades by organic molecules mostly azo dyes. However, azo pigments are manufactured for the production of car paints and textile dyes and not pri-marily as cosmetics or for the injection use in humans.

2.3.2 Legislation

Tattoo inks and the pigments in these inks are consid-ered as cosmetics and colour additives and should be safe. Although some colourants are approved for use in cosmetics none is approved for injection into the skin. The FDA does not strictly regulate and control these materials or the practice of tattooing, and in the USA these matters have been covered by local laws and juris-dictions mainly intended to regulate the body art estab-lishments. In recent years, toxicological research has been done on specifi c pigments [11, 12] . More details about the USA approach can be found in Chap. 1.

The council of Europe has dealt with the safety issue of tattooing and PMU for years and adopted in 2003 the CoE Resolution on the regulation of tattooing/PMU products. Although tattoo inks are implanted intrader-mally it would have been reasonable to treat these products like medicine, concerning their sterility and composition. However, a more realistic approach has been chosen and the cosmetic approach submitting tat-too and PMU colourants to the requirements and safety assessments of cosmetics has been proposed (the sixth amendment of the Cosmetic Directive 76/768) [13] . Recently, resolution Res AP(2008)1 on requirements and criteria for the safety of tattoos and PMU (super-seding resolution ResAP(2003)2 on tattoos and PMU) was adopted by the Council of Europe and recommends that the governments of the member states take into account the principles set out in the appendix of the resolution [14] . This resolution not only “follows a negative list approach by listing the substances which must not be used in tattooing products and PMU, based

on current knowledge in this fi eld,” but also recom-mends “to regulate the use of substances in tattoos and PMU by taking steps towards establishing – on the basis of safety assessments carried out by competent bodies and harmonised at European level – an exhaus-tive list of substances proved safe for this use under certain conditions (positive list).” This resolution has already been implemented in the Dutch law. The reso-lution includes specifi cations about the content of the tattoo/PMU products, the labelling, the conditions of application and the obligation to inform the public and the consumer about the health risks of tattoos and PMU and tattooing practice. It proposes two test methods, one developed by the Dutch Food and Consumer Product Safety Authority and the other provided by the Swiss Federal Offi ce of Public Health.

See resolution ResAP (2008)1 on requirements and criteria for the safety of tattoos and PMU [14].

The aim is that, according to this EU resolution, tat-tooing/PMU products are subject to regulation, to be implemented by the member states, which means that for every ready-to-use product that is on the market under the EU Cosmetics Directive, there should be a dossier to be held at the address mentioned in the prod-uct label. Any country can ask the “dossier-owning-country” to consult the content of this dossier. All the products must be labelled and provided with an ingre-dient-list that can be consulted by the consumer. Products that do not comply with the regulations cannot be sold lawfully and must be removed from the market. Competent surveillance authorities are empowered by law to remove the product judged to pose a threat to the health of the consumer. Obligations are on the EU-based manufacturer of a ready-to-use-product and also on the EU-based juridical subject that for the fi rst time imports this product into the EU, to be used or to be sold on the common market. Also professionals are obliged by law to check that only ready-to-use products complying with the regulation are used on their clients. This means that responsibilities are applicable to the producers, the authorities and professionals [15] .

From the medical perspective, this approach certainly offers opportunities to reduce the risks and complications involved in the use of chemical components that might be potentially hazardous and may threaten the health of the tattooed individual with special concern for heavy metals and carcinogenic aromatic amines; recommenda-tions on the conditions of the application of tattoos and PMU should also minimise the risk of transmission of


infectious diseases. It remains an open question whether an effi cient enforcement can be installed and surveil-lance authorities will be able to perform controls and will take their responsibilities to make safety assess-ments [16] . We still have to deal with current practices not respecting these guidelines and also with the conse-quences of procedures and products used in the past. Better knowledge about substances used in the practice of body art can be helpful to identify clinical problems occurring in medical practice.

2.3.3 Composition of Tattoo/PMU Products

Products used for tattooing and PMU are a mixture of chemicals that absorb visible light, the actual colou-rants , and a large spectrum of auxiliary ingredients (Table 2.2 ).

The colourants can be divided in two subgroups: the pigments and the dyes . Chemically, the pigments can be metallic salts (oxides, sulphides, selenides) or organic molecules of different origin. The dyes are mostly organic molecules.

Ink is defi ned as a “solution” of a colourant in a liquid. Tattoo ink however is a suspension of pigment particles in a solution of water, glycerine and alcohol (mostly ethanol or isopropanol). Pigments are tiny coloured (black, white or fl uorescent), solid particles, insoluble in, and normally not affected by, the medium in which they are incorporated. Pigments will change the appearance of an object by the selective absorption and/or scattering of light. The structure of a pigment will not alter during the colouring process. The size

of the microcrystalline particles will defi ne the colour of the end product. The tattoo is the result of the pigment in the skin after healing. To prepare tattoo ink, pure pig-ment powder or a pre-dispersed paste can be used; the latter is a mixture of pure pigment powder and acrylo-nitrile butadienestyrene (ABS)-plastic processed to microparticles and wetted to obtain a paste, which is much easier to handle; the amount of plastic can be adapted to obtain different shades. In order to make a stable suspension the polar properties of the pigments can be modifi ed by using additives ; this process is called wetting . In PMU also dyes are used. In contrast to pig-ments, dyes are soluble either in water or in some organic non-polar solvent. The dyes consist of a stabi-liser (mostly barium sulphate) with a coloured surface (e.g. acid azo dye). For the traditional tattooing pur-poses, mostly pigments are used because they offer a high light stability and are chemically resistant, espe-cially the metallic salts. They remain unchanged in con-trast to the “stabilised” dyes, which are preferentially used in the PMU products. Dyes have a tendency to fade over time, an advantage in the indication of PMU (semi-permanent), while pigments will persist unaffected and permanent, as is the objective in ornamental tattoos. Many tattooists make their own blends of pigments and dyes to obtain their favourite results (Fig. 2.14 ).

2.3.3.1 Evolution of Colourants

In ancient times, materials used for tattooing consisted in minerals, plant extracts, soot, carbon and ochre; the same products are still used nowadays in ethnic tattoos. According to Wikipedia, Indian ink, also called Chinese ink since it may have been fi rst developed in either China or India, has been used since at least the fourth century b.c. [17] . In India, the carbon black from which the Indian ink is produced is obtained by burning bones, tar, pitch and other substances. Other sources mentioned are lamp-black, carbon black, bone black, pine sooth and petro-leum. Carbon black has been used for centuries in printing inks and paint. Over the past 50 years, it is applied in the rubber industry, particularly for the manufacture of tyres. Since the eighteenth century, tattooing was “imported” and became popular in Europe; mostly soot and carbon-based ink such as India ink and metallic components were used in that time. Colourants mentioned in the literature used for traditional tattooing include mineral pigments and metallic oxides/hydroxides/sulphides/aluminates

Table 2.2 Components of tattoo inks

Colourant Pigment: eg.Carbon [CI 77266] Dye

Auxillary ingredients Vehicle: water (H2O)

Solvent Additives

Wetting agents: Glycerine, Ethyleenglycol

Preservatives : eg.Witch hazel Stabiliser Thickeners : Glycerine pH regulators

Impurities from the production process

–


such as chrome (trivalent chromic oxide, hydrated chro-mium sesquioxide) for green, cobalt and indigo for blue, cadmium sulphide for yellow and mercury sulphide or cinnabar for red. Iron oxide is used for ochre, red and brown, manganese for purple. Titanium dioxide, zinc oxide and barium sulphate are applied or added to obtain light colours (Table 2.3 ). Soot derivatives and carbon pig-ments (graphite) are still used nowadays for black inks. In recent years, an important shift has taken place in the use

of colourants. The most important change seems to be that the heavy metals, mercury (cinnabar) and cadmium responsible for allergic reactions in red and yellow tattoos have disappeared today and have been replaced by syn-thetic molecules [11, 18– 20] . During the revival of tattoo-ing in the 1980s, complex organic colourants gained popularity; nowadays, 80% of the pigments are synthetic organic molecules mostly azo pigments and polycyclic compounds [21] .

Fig. 2.14 Large variety of tat too inks

Table 2.3 Colourants

Colours Metals Organic Other –

Black – Charcoal, carbon – Brown Ferric oxide, cadmium sulphide – – – White Lead carbonate, Zinc oxide, titanium

dioxide – – –

Violet – Azo dyes Manganese – Purple/lilac – – Manganese oxide Rare allergic reactions Flesh Ferric oxide – – – Green Chromium oxide (Casalic green), Chlorinated

copper (phtalo-cyanine)

– Allergies for hexavalent chromium

Hydrous chromium oxides (Guignets green), chromium sesquioxide (Viridian)

Red Mercury sulphide (cinnabar), cadmium selenide

Azo dyes Sienna, brazilin, carmine cochinilla red, santalin

Allergic reactions to mercury Phototoxic reactions

Yellow Cadmium sulphide Azo dyes – Phototoxic reactions Blue Cobalt Copper

(phtalo-cyanine)

Indigo Granulomatous reactions


In the category of organic pigments, we fi nd azo dyes (orange, brown, yellow, red) and other polycyclic amines, dioxazine, phthalocyanine, quinacridone and arylide. Organic pigments listed in tattoo inks include Pigment Yellow 14, 55, 74, 83, 87, 97, Pigment Orange 13, 16, 36, Pigment Red 5, 9, 22, 112, 122, 146, 170, 266, Pigment Violet 19, 23, Pigment Green 7, 36, PB15 and Pigment Brown 25 [11] . In many tattoo inks, titani-umdioxide is used as a lightener. Natural pigments being used nowadays are colourant extractions from trees, fl owers and roots such as curcumine (Curcuma), brazilin (Brazil wood = natural red 24) and santalin (red sandalwood = natural red 22/23) (Table 2.3 ). An excel-lent and extensive overview of the “chemicals used in tattooing and PMU products” in Western Europe has been made by Baeumler, Vasold, Lundsgaard and Talberg for the Workshop on “technical scientifi c and regulatory issues on the safety of tattoos, body piercing and related practices” organised in 2003 for the European Commission in order to identify the chemical nature of the colourants that are being used for these purposes these days [18] . They also investigated whether the colourants in question were permitted in the related fi eld of cosmetic products or not. The colou-rant used in cosmetics is strictly regulated and safety assessments have been carried out by the EU Scientifi c Committee on Cosmetics since 1997. Summarising this survey, it appears that several colours reported, of which many new organic pigments, to be used by fi rms per-forming PMU in Norway, Denmark and Finland, were not allowed at all in any kind of cosmetics. The same applied to the colours reported by the German delega-tion that were used in tattoo and PMU studios in 2001 and by the Danish authorities that were used for tradi-tional tattooing. The inorganic salts of mercury, cad-mium and cobalt seem to be abandoned. Some of the azo-type colourants used in PMU contained aromatic amines as impurities, classifi ed as carcinogens. By direct contact with the market operators, 40 organic and 12 traditional inorganic colourants have been identifi ed. The impression was that the colourants being used were ordinary industrial pigments and dyes that can be easily obtained. Out of the 40 organic colourants identifi ed, 24 (60%) were azo compounds and of these 9 contained an amine that has been classifi ed carcinogenic. Results from the study revealed that of the 52 organic colou-rants identifi ed in the marketplace 17% contained a car-cinogenic aromatic amine as did the 63 samples investigated by the Dutch authorities . In these studies, it was shown that in particular 3,3 ¢ -dichlorobenzidine

seems to be the molecule that can possibly be released from the azo-colourants used for tattooing and PMU [18, 22] . Another issue is the fact that colourants in cos-metics, being medium size or large molecules pass through the skin in a small degree only and will have another impact on the underlying tissues than a chemi-cal administered intradermally by the procedure of tat-tooing. Many of the colours used are allowed only in rinse-off products and others are not allowed in any kind of cosmetics.

Concerning the purity of the materials, the European Community expert team concluded that there are many pigment producers, producing industrial pigments with limited information about purity and impurity profi les. They normally know that these industrial pigments are not suffi ciently pure to use in food or cosmetics, and in most cases, one can presume that the producer himself will dissuade the use for cosmetics, foodstuff, medi-cine and also for tattoo colours; as the person manufac-turing tattoo colours usually needs very little pigment compared to, e.g., the paint industry, the pigments will very rarely be bought directly from the producer but mostly be obtained in second or third line . Fortunately, however, there are a range of pigment producers and products meeting the approved demands to purity within cosmetics, foodstuff and medicine.

The chemical identity of the molecules used in tattoo/PMU inks is illustrated in (Tables 2.4 – 2.9 ) and more can be found in Appendix I of the 2003 document [18] .

A personal survey was done by D’hollander in 2006 , concerning tattoo inks used in Belgium in body art parlours, checking the colour index (CI) numbers from the list of ingredients supplied by Mario Barth’s Intenze, Starbrite, Diabolo Novum, Diabolo Classic, Micky Sharpz Traditional, Micky Sharpz Easyfl ow and Millennium Mom’s (Table 2.10).

Currently used colourants that can be obtained from suppliers on the Internet are labelled with a CI number. The different CI numbers correspond to different chem-ical categories (Tables 2.4 – 2.9 ); the same CI number is

Table 2.4 Mineral Pigments

Mineral pigments

Iron oxides FeO, Fe 2 O

3 , Fe

3 O

4

Heavy metals HgS, CdSe, CdS, CdZnS, PbCrO

4 , Cr

2 O

3 , PbS,

[Cu 2 (CO

3 )(OH)

2 ], PbCO

3

Other TiO 2 , ZnO, BaSO

4 , C

CI number 77000–77999


used for different qualities of purity. Three different categories of purity exist according to cosmetics, food and medicine and are subject to EU regulations, respec-tively, EU directive 76/768/EOF (cosmetics), EU direc-tive 95/45/EC (food) and EU directive 78/25/EC (medicine). The results of this survey are summarised in Table 2.10 . This survey also illustrates that a great deal of the colourants that can be purchased in an easy way do not respond to the requirements of cosmetics.

Timko et al. performed an in vitro quantitative chemical analysis of tattoo pigments with the objective to test the accuracy and completeness of information supplied by tattoo ink manufacturers and to perform an elemental assay of tattoo pigments. They examined 30 tattoo inks by using scanning electron microscopy with energy-dispersive X-ray analysis [20] . As a result of this study, the most commonly identifi ed elements were aluminium (87%), oxygen (73%), titanium (67%) and carbon (67% of the pigments). The relative contri-bution of elements to the tattoo ink compositions was highly variable between different compounds. Overall, the manufacturer-supplied data sheets were consistent with the elemental analysis, but there were important exceptions. The study showed that individual tattoo inks are complex compounds whose composition may include organic dyes, metals and solvents.

Table 2.6 Azo compounds

Azo compounds

Light stable

NHO

N

Cheap and easy to produce

Used in food, plastics, diesel, clothing…

Insoluble in water, but often soluble in alcohol or solvents

Azo compounds are fragile and under infl uence of high energetic radiation and heat aromatic amines can be created

Mono azo are indicated by CI numbers 11000–19999

Diazo are indicated by CI numbers 20000–29999

Triazo are indicated by numbers 30000–36999

Polyazo are indicated by CI numbers 37000–39999

Azo compounds are mostly yellow, orange, red, magenta or purple

Table 2.5 Organic pigments

Organic pigments

Azo compounds Diazo compounds Cu-phthalocyanine Dioxazine Arylide Quinacridone

Table 2.7 Phtalo-cyanine compounds

Phtalo-cyanine compounds

Very stable and safe

N

N

N

N

NN

N

N

N

N

N

N

CuCu N

N N

N

CICI

CI

CI

CI

CI

CICI CI

CI

CI

CI

CI

CI

CI

Only blue and green

Insoluble in water and most solvents

CI numbers 74100–74299

Table 2.8 Dioxazine compounds

Dioxazine compounds

Very heat and light resistant

C1

C1

O

O

N

N

N

N Mostly violet and magenta colours


Table 2.9 Natural pigments

Natural pigments

CI number 75000–76999 H

O O

OH

OCH3

OCH3

OCH3

O O

OH

OH

HO

HO

H3CO

H3CO

HO

OH

RO

OH

O

H

HO

OH

Colourants from trees, fl owers, roots, …

Curcumine (Curcuma), brazilin (Brazil wood), santalin (red sandal wood)

Table 2.10 Survey 2006 by D’Hollander. Summary of results

Colour index (CI) Conventional name Chemical class Allowed in all kind of cosmetics

CI 11680 Pigment Yellow1 Azo No (not in those used close to mucous membranes)

CI 11741 Pigment Yellow 74 Azo No CI 11767 Pigment Yellow 97 Azo No CI 12466 Pigment Red 269 Azo No CI 12470 Pigment Orange 22 Azo No CI 12475 Pigment Red 170 Azo No CI 12477 Pigment Red 210 Azo No CI 12485 Pigment Red 146 Azo No CI 12490 Pigment Red 5 Azo No CI 12510 Pigment Brown 25 Azo No CI 13980 Pigment Yellow 151 Azo No CI 21095 Pigment Yellow 14 Azo No CI 21108 Pigment Yellow 83 Azo No (only rinse-offs) CI 22095 Oxamine Red B1 Azo No CI 51319 Pigment Violet 19 Oxazin No (only rinse-offs) CI 71105 Pigment Orange 43 Anthraquinone No (not in those used close to

mucous membranes) CI 73900 Pigment Violet 23 Quinoacridine No (only rinse-offs) CI 73915 Pigment Red 122 Quinoacridine No (only rinse-offs) CI 74160 Pigment Blue 15 Phthalocyanine Yes CI 74260 Pigment Green 7 Phthalocyanine Yes CI 74265 Pigment Green 36 Phthalocyanine No CI 74280 Heliogen Green B Phthalocyanine No CI 77266 Pigment Black 6 and 7 (graphite) Pure carbon Yes CI 77491 Pigment Brown 6 and 7 Pigment

Red 101 and 102 Iron III oxide Yes

CI 77492 Pigment Brown 6 and 7 PigmentYellow 42 and 43

Hydrated ferric oxide Yes

CI 77891 Pigment White 6 Titanium dioxide Yes

Currently used colourants that can be obtained from several suppliers on the Internet are listed here. Each colourant corresponds to a colour index (CI) number. The same CI number is used for different qualities of purity. Three different categories of purity exist, cosmetics, food and medicine and are subject to EU regulations, respectively, EU directive 76/768/EOF (cosmetics), EU directive 95/45/EC (food), EU directive 78/25/EC (medicine) CI numbers from the list of ingredients of suppliers (Mario Barth’s Intenze, Starbrite, Diabolo Novum, Diabolo Classic, Micky Sharpz Traditional, Micky Sharpz Easyfl ow, Millenium Mom’s, survey March 2006 by Davy D’hollander).

The infl uence of laser light on tattoo pigments such as titanium dioxide and iron oxide, inducing oxi-dative–reductive changes resulting in darkening

is discussed in this article. The authors consider the identifi cation of ink constituents as a fi rst, but not fi nal, step in the improvement of laser treatment. They


suggest that further investigation could result in listing inks that are “permanent” but “laser removable” (Figs. 2.15 – 2.17 ). The relationship between the pres-ence of titanium dioxide and poor response to laser therapy is also observed by other authors [23] . It appears that titanium dioxide is used as a brightening agent in many tattoo inks to obtain a lighter colour; titanium dioxide however has a risk for paradoxical darkening when treated with laser. [20] (Fig. 2.18 ). Blue and brown inks containing iron also seem to be more popu-lar for cosmetic purposes than the conventional black inks [23– 25] . Correct labelling and registration cer-tainly could help in directing laser treatment. This aspect however requires the cooperation from the tattoo

artist, to keep client records and to register the products used and when asked for to inform the client or his phy-sician about the materials that have been used including manufacturer and stock numbers.

2.3.3.2 New Developments

Up to 20% of the tattooed individuals regret their deci-sion and many of them seek advice for tattoo removal [26] . The problems arising with laser-resistant tattoos and darkening as a result of laser treatment occurring in tat-toos in general, but in particular in PMU has been subject for new developments. The concept of easy removable tattoo inks has been a challenge for the tattoo industry and for researchers involved in lasertherapy [27– 31] .

Fig. 2.15 Multicolour tattoo

Fig. 2.17 Red disappearing with QS NdYag 532; yellow and purple appear to be diffi cult to treat colours

Fig. 2.18 Red tattoos have high risk for paradoxical darkening

Fig. 2.16 Black pigment fading easily with QS NdYag 1064


Information obtained from the Internet states that Freedom 2 is developing through the particle encapsula-tion (P2) and enhancement platform (P2E) a new micro-bead version of tattoo inks. The removable tattoo ink consists of nanosize pigment particles enclosed in poly-mer-coated beads of about 1-µm diameter. These micro-beads are stored in the dermal macrophage. The polymer beads contain a dopant that absorbs light of a specifi c wavelength and explode when they are treated with cor-responding laser light independent of the colour inside the bead. The liberated pigment particles are small enough to be eliminated from the skin. In fact, an “Infi nitink” tattoo is permanent but removable because of its construction. According to the information, the sci-entists have perfected the dissolution of the pigment so that when treated with laser the tattoo will be gone with fewer treatments. Black will be available by the end of 2008; the full colour line is expected in the future [32– 34] .

2.3.3.3 Other ingredients

To obtain a stable tattoo/PMU ink, additives and a carrier medium are needed. Additives with a thicken-ing effect and surface-active chemicals needed to change the polar properties of the pigments are used in order obtain a homogenous solution. These additives can help to make the ink stick to the tattooing needle. Because organic material and water are subject to bac-terial and fungal contamination, preservatives like benzoic acid are often added to the tattooing/PMU products. Other substances, even local anaesthetics, have also been mixed in [18] . The carrier usually con-sists of water, alcohol and glycerine. Common sol-vents that function as carriers are ethanol or isopropanol. These substances in concentrations up to 15% are added by some producers to assure sterility. Popular carrier components include hamamelis extract, propylene glycol and glycerol. Listerine is often used for thinning of traditional tattoo inks. Also vodka is used by tattooists to thin tattoo inks. Unsafe substances recovered from tattoo inks are methanol, ethylene gly-col, aldehydes (glutaraldehyde), detergents and benzo-ates. Listerine, a popular mouthwash, not only contains thymol, eucalyptol, menthol and methyl-salicylate as active ingredients but also benzoic acid, sodium ben-zoate fl avouring components, water, alcohol and poloxamer that are frequently used as an additive.

In summary, the majority of tattoo and PMU prod-ucts are a mixture not only containing labelled colou-rants but also a large variety of known and unknown molecules. The local tattooist makes his preferred blends by mixing different complex pigments and by adding thinners and additives. In this context, it is understandable whenever an allergic reaction occurs, the allergologist is confronted with the almost impos-sible task to identify the cause of this event (see Chap. 6). To minimise the public health risks, one should expect strict regulation concerning materials used to implant into the human body and draw a parallel between tattoo inks and medicine. The best solution would be that only safe products (colourant and auxiliary products as well) within the limits of toxicological knowledge could be legally sold. However, since this is not realistic in the body art branch a more pragmatic “cosmetic” approach has been chosen, limiting the restrictions to molecules approved for food and cosmetics. Even in that aspect it seems that the implementation of the Resolution Res AP (2008) 1 of the Council of Europe is not respected yet and there is still a long way to go.

Besides the toxicological aspects, the sterility of the products is another point of concern. Many of the body art practitioners have only elementary knowledge about sterility, although excellent guidelines exist and are easily accessible on the Internet. The ideal scenario of single-use ink caps and disposable material is wishful thinking.

2.3.4 Risks and Complications

Several complications arising after tattooing can be attributed to the technique but in particular to the materials used [35– 37] . Infection can be caused by bacterial or fungal contamination of the inks or tattoo devices. The procedure itself, disrupting the integrity of the skin implicates a risk for transfusion-transmitted infections [38, 39] . Not only the consumer but also the practitioner is at risk and should take appropriate mea-sures. As mentioned before, the majority of body art practitioners have only elementary knowledge about sterility and hygienic measures are often neglected.

Allergic and toxic reactions can not only be due to additives, to the chemical composition of the colourant, but also due to impurities from the production process of the pigment itself.


Allergy to pigments and dyes manifesting as imme-diate and delayed-type reactions have been described and are addressed in Chap. 6.

Carcinogenic potential is of major concern . As mentioned earlier, the survey done by Baeumler et al. for the Workshop on “technical scientifi c and regula-tory issues on the safety of tattoos, body piercing and related practices” organised in 2003 for the European Commission has revealed that tattoo inks can contain aromatic amines with carcinogenic potential. The fol-lowing molecules have been identifi ed: solvent red 1 containing o-anisidine , Pigment Red 7 containing 4-chloro-o-toluidine , Pigment Yellow 87 and Pigment Orange 16 that contain 3,3-dichlorobenzidine , while the Dutch study detected o-toluidine in one sample and 2,4-diaminotoluene in three samples [13, 18] . In these studies, it was shown that in particular 3,3 ¢ -dichlo-robenzidine seems to be the molecule that can possibly be released from the azo-colourants used for tattooing and PMU practices.

The introduction of the principle of selective photo-thermolysis has changed completely the therapeutic modalities of tattoo removal [24] . Good knowledge about the physical properties of the devices used and the absorption spectrum of the pigments treated can infl uence the clinical outcome of the treatment [20, 28, 30, 31] . The effect of laser irradiation of tattoo inks in vitro was also investigated at Regensburg University, Germany [37, 40– 42] . Laser-induced decomposition products were found in a laboratory setting and toxic and even carcinogenic compounds have been identi-fi ed. This research was extended to experimentally tat-tooed skin. In a study, Engel et al. [43] investigated the pigment concentration in pig skin and human skin experimentally tattooed with an azo pigment, Pigment Red 22(PR 22). Although many azo pigments such as PR22 are not allowed for use in cosmetics because they may release carcinogenic decomposition products, these azo compounds are commonly used in tattoo inks. The study determined the concentration of tattoo pigment in the skin ranging from 0.60 to 9.42 mg/cm 2 . Extrapolation gives an indication that in fact very high quantities of carcinogenic products are injected into the skin, while in the meantime the same molecules are even not allowed in cosmetics in Europe because their absorption could cause health problems in humans. Photodecomposition of tattoo pigments was demon-strated by Cui. Pigment Yellow 74, a pigment used in commercial tattoo inks, was irradiated with a Xenon

lamp simulating solar exposure and decomposition products that could potentially have toxic properties identifi ed [11] . The effect of natural sunlight on tattoo pigments was also studied by Engel et al. [44] and the presence of primary decomposition products with car-cinogenic properties was also demonstrated. From these data, one could conclude that a tattooed individ-ual has a risk to be exposed to a carcinogenic product in the ink as such and through the natural exposition to sunlight. When treated with laser there is even an increased risk because carcinogenic decomposition products are released due to the treatment [37, 40– 42] . Until now, the malignancies reported in tattooed indi-viduals have been considered as coincidental, but large epidemiologic studies are needed to prove a relation-ship between tattooing and cancer [45– 48] . It is unclear whether considerable change in the composition of tat-too products in the last decades, switching more and more to organic azo compounds, will lead to an increase in malignancies. To our knowledge it has not been demonstrated yet that people with extensive tattoos covering large body areas had a higher incidence of malignancies. Fortunately, after the initial healing period following the tattooing procedure the colourants are stored (safely?) in the fi broblasts and remain there unchanged for years. The relation between tattoo pig-ments and skin cancer is discussed by Kluger [49] . It is questionable if the exposure to the carcinogens released from tattoos could have an infl uence that could be comparable to, for example, the exposure to tobacco smoke on the lungs or to sunlight on the skin, an inter-esting subject for epidemiologists. One could suppose that this impact will only be noticed after many years taking into account the time needed for inducing malig-nant transformation. Considering the high number of tattooed individuals one can estimate that millions of people on the globe are living with a self-infl icted risk factor that could have important consequences for pub-lic health. The fact that about 10% of them seeks medi-cal advice for removal and will be exposed to laser therapy could even mean that an extra element should be taken into account. More research concerning the chemical analysis of tattoo pigments and decomposi-tion products as well as an assessment of the infl uence and risks of laser treatment of tattoos is needed. Careful observation and recording of adverse events in tattooed individuals can offer important information leading to a better knowledge and estimation of the possible side effects of tattooing.


2.4 Temporary Tattoos

The natural source of henna is the plant Lawsonia inermis , which is part of the family Lythraceae. The name is derived from Isaac Lawson, assistant of the famous botanist Linnaeus. The active component is lawsone = 2-hydroxy-1, 4-naphthoquinone [35].

Henna has been used as medicine for centuries to treat skin diseases such as leprosy and smallpox. In the Orient, extracts of dried leaves were made to dye hair, nails and skin. The product used is a thick mixture of the dried and powdered plant with water or oil. The paste or liquid is applied with a stick, brush or cotton swab or directly from a syringe, or cone-shaped container onto the skin; it can dry for 20–30 min and/or be covered with an occlu-sive dressing or plastic sheet to enhance penetration in the skin; the staining is temporary and lasts a few weeks. This ritual originally observed as touristic attraction is nowadays considered as exotic and popular in youngsters during holidays around the Mediterranean Sea. Although natural henna has a very low allergic potential an increase of reports of allergic reactions to temporary henna tattoos (THT) was observed in the last decades due to the use of new mixtures (se e Chaps. 3, 6). Natural henna gives a red colour and is known as “red henna.” Coffee, black tea, a variety of plant extracts, limejuice and even urine of ani-mals have been used since ages to obtain darker colours. More recently, the addition of other colouring agents cre-ates a larger variety of colours. Ingredients added by the artists include paraphenylenediamine (PPD) and indigo blue to obtain “black and blue henna.” The extremely high concentration of PPD up to 15% in these paintings and the use of occlusion may be responsible for subse-quent sensitisation. The incorporation of PPD in cosmetic products in the EU is restricted to a maximum concentra-tion of 6% and to a maximum 10% for diaminotoluenes by the Cosmetics Directive of the EU. However, this con-centration exceeds in many of the street side THT and is not controlled anyway. The consequence of PPD sensiti-sation is the risk of cross-sensitisation and allergic reac-tions to other para-derivatives as sulphonamides. Side effects are described in Chaps. 3 and 6.

2.5 Conclusion

The increasing popularity of body adornment through piercing and tattooing in its different forms has raised many questions about the safety of the techniques and

the materials used. Many efforts have been done yet to identify the risk factors and to develop preventive mea-sures aimed at protecting public health. Regulation of the composition of the products, harmonisation of the methods for the analytical determination of possible harmful substances and recommendations to ensure that procedures are carried out under appropriate hygienic conditions offer a big step forward to promot-ing consumers health.

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Documents

Materials Used in Body Art 2 · nowadays in the different forms of body art. 2.2 Piercings 2.2.1 Materials A diversity of materials has been used over the centu-ries. Natural materials