The business of tattooing it is a practice that consists in the execution of a sign, or a drawing, permanent on the skin (il tattoo) by injecting inks, consisting of dyes or pigments and other ingredients, into the dermis, the deepest layer of the skin.

The practice of tattooing is also very common in Italy and is considered invasive, being a procedure that involves the penetration of ink through a needle into a fabric. The data relating to its diffusion in the Italian population are available on the website of the Istituto Superiore di Sanità (

When deciding to undergo a tattoo, it is of fundamental importance to contact a qualified tattoo artist, in possession of the certificate of attendance of a specific regional training course and who operates in compliance with the health and hygiene requirements provided for by the "Guidelines of the Ministry of Healthcare for the "execution of tattoo and piercing procedures in safe conditions" (Circulars of the Ministry of Health no. 2.9 / 156 of 5.02.1998 and no. 2.8 / 633 of 16.07.1998). the procedure is carried out in a center authorized to carry out tattooing activities by the competent authority in the area. The regulation on safety conditions in Italy varies from region to region and in Europe varies from state to state.

Tattoo inks available on the market must be sterile and non-toxic and are subject to compliance checks with respect to the European Resolution of 20 February 2008, also adopted by the Italian Ministry of Health, which sets out the requirements and criteria for the safety of tattoos and permanent make-up. (ResAP1: the Resolution of the Council of Europe on the requirements and criteria for the safety of tattoos and permanent make-up).

The tattoo artist must make sure that the client is of age; in the case of minors, the consent and presence of a parent or guardian is mandatory.

The following types of tattoo can be distinguished:

  • artistic tattoo, with only decorative function
  • tattoo for medical purposes, used to cover pathological conditions of the skin and restore the appearance of healthy skin or as a complement to reconstructive surgery: for example, in breast reconstructions to define the areola of the nipple: the penetration of the needles is less deep than in the tattoo artistic and the pigments are specifically selected
  • permanent makeup or PMU (Permanent Make Up), that is a particular tattoo application used to simulate make-up: for example, the tattoo of the eyelid (blepharo pigmentation), of the browbone and the contour of the lips. Also in this case the penetration of the needles is less deep compared to the artistic tattoo and the pigments are specific
  • post traumatic tattoo, attributable to the consequences of a trauma or an accident: pigmented substances remain trapped under the skin and give rise to small spots or lines of blue or black color

There are also so-called "temporary tattoos". They are made by applying the pigment (for example henna, a dye of natural origin) on the surface of the skin without the use of needles. In practice they constitute a real painting.The design has a short duration and tends to disappear over time not only due to discoloration due to light and washing but also to the replacement of skin cells.

Effects on health

The tattoo is a procedure that does not require anesthesia, it can cause a slight bleeding and cause more or less severe pain depending on the part of the body involved and the size of the tattoo.

Electric-powered tattoo machines puncture the skin (causing a small lesion) at a rate that can vary from 50 to 3,000 times per minute to introduce tiny droplets of ink into the dermis.

Because of these injuries, the danger of bacterial infections is high (with the relative appearance of related diseases) especially if the instrumentation used has not been cleaned and sterilized. The chances of contagion decrease with the use of tools disposable, or disposable. This consideration is also valid for ink containers since repeated use of the same bottle can cause bacterial and fungal contamination.

Other sources of infection can be microorganisms coming from the skin of the person receiving the tattoo or from the tattoo artist.

Infection-related disorders (symptoms) include:

  • swelling and redness of the skin in the tattooed area
  • development of heat and, in some cases, even pain

Generally, they resolve without leaving skin alterations; in some cases, other symptoms may occur, such as headache and fever.

The effects obviously depend on the bacteria and microorganisms that caused the infection, some can cause heart and kidney disease.

In the case of instruments that are not sterilized after each use and contaminated with infected blood, there is also the risk of falling ill with tetanus, hepatitis B and C or contracting the virus responsible for AIDS (HIV).

The safety of chemical substances potentially contained in inks is regulated by the ResAP Resolution of 2008 which provides a list of substances whose use is prohibited in the formulation of tattoos and permanent make-up; the use of substances with carcinogenic, mutagenic or toxic properties for reproduction (the so-called CMR) is never allowed. However, some inks, particularly those purchased through unofficial resellers, may contain chemicals that are not allowed, toxic or carcinogenic (for example, aromatic amines) as components of the dyes. They can cause long-term health effects. Furthermore, some metals may be present, in the form of impurities (lead, chromium, mercury), in higher quantities than indicated in the Resolution. Among these, nickel should be contained at the lowest possible levels since it frequently causes allergies in the population.

Tattoos can also cause:

  • sensitization and reactions to theLergic, the substances used by tattoo artists (pigments or metals) can cause allergic sensitization of the organism with short or long-term effects. Allergic reactions can manifest themselves with skin rashes and itching, even years later, due to some dyes (especially red, green, yellow)
  • inflammatory reactions, swelling or thickening of the skin (keloids) or the underlying tissue
  • nerve injuries, with consequent alteration of sensitivity or local motor skills

In the event that one of the cases described above occurs, it is necessary to contact a dermatologist or your family doctor; the tattoo artist does not have the health skills necessary to recommend treatments.

Also, although rarely, tattoos or permanent makeup can cause swelling or burns during MRI investigations, and in some cases, metal-based pigments can invalidate images from exams such as X-rays and MRIs.

Tattoos in safety: instructions for use

The technical preparation of the tattoo artist and the hygienic-sanitary conditions in which the tattoo is carried out are fundamental requirements to be evaluated before deciding to undergo it.

Before carrying out the tattoo, the tattoo artist must inform the client about the type of operations he will perform, the risks associated with their execution as well as the precautions to be observed after the treatment, by providing a form containing all the information. At the same time he must deliver, and then acquire, the form of informed consent that the customer must sign, after having understood the information received, to express his will to undergo the treatment.

Some guidelines should be followed:

  • consult your doctor before undergoing a tattoo, to find out if in your case it is contraindicated or not recommended
  • always contact a tattoo artist in possession of the suitability hygienic-sanitary and authorized to operate in an authorized premises
  • acquire all the information on the risks and on the materials and products used to be able to sign, with full awareness, the informed consent
  • ensure that there is an adequate level of hygiene of the staff and the work environment and that gloves, mask and disposable gown are used
  • check that the tattoo artist cleans his hands thoroughly before and after the execution of the tattoo
  • make sure the needles are new, sterile and disposable and the tattoo machine is covered with a special protective sheath. Any non-disposable instruments must be sterilized
  • request information on the composition of the inks which must be sterile, non-toxic and used in disposable pigment containers / capsules
  • remember that the unused part of the pigment must be discarded together with the container and cannot be used for other people
  • avoid choosing anatomical parts in which moles are present or in which healing is particularly difficult
  • make sure that the area of ​​the skin intended for the tattoo is intact, healthy and properly disinfected
  • check that creams and soaps are used with a disposable applicator or via dispenser
  • constantly check the tattoo during the healing and cicatrization process following the indications provided for the period following its execution (after-care)
  • do not expose the tattoo to direct sun or sunlamps without putting on total protection in the period following the execution of the tattoo, and until its complete recovery
  • do not swim in the sea or in the pool and avoid sauna and steam room before complete recovery
  • contact your doctor or dermatologist immediately in the event that problems arise after the execution of the tattoo

Cases in which the tattoo is not recommended or contraindicated

In some situations, having a tattoo can be contraindicated or not recommended. They include:

  • pregnant women
  • people suffering from allergies / photosensitivity, epilepsy, infectious, autoimmune or respiratory and cardiovascular diseases
  • individuals suffering from skin diseases, of inflammatory processes in progress or that have moles or other pigmented areas in the area to be tattooed
  • people who suffer from diseases, or take drugs, which alter normal re-epithelialization of the skin
  • individuals who suffer from bleeding / scarring disorders or who have a tendency to bleed (for example, patients with diabetes, haemophilia, Mediterranean anemia, etc.) or who are being treated with chemotherapy drugs
  • areas that have undergone plastic surgery or radiation therapy over the last year
  • scars formed less than a year ago
  • tattooed areas for less than six weeks
  • areas where a tattoo has been removed by laser

Avoid DIY tattoo

The tattoo performed on oneself or carried out by non-professional people (relatives, friends, etc.) and in unsuitable environments must be absolutely avoided. In fact, in the absence of adequate procedures, products and equipment, the risk of contracting infections or reporting other complications is very high.

Tattoo removal

The tattoo is an indelible mark that remains on the skin for a lifetime. Therefore, it is essential that the decision to get a tattoo is a conscious choice.

In the event of repentance, the removal of the tattoo, which involves the elimination of the pigment introduced into the dermis, is a treatment that only a doctor can perform and is not without risks. There are various methods to get rid of tattoos, but the most used today is the laser. It is good to know that even when done with the latest laser technologies, the removal can be time-consuming and expensive and the results are not always what you want.

Monochromatic tattoos and natural pigments can be removed more easily than polychromatic ones and artificial pigments but the success of the operation also depends on the size, depth and location of the tattoo: in fact some parts of the body are more difficult to treat (e.g. face, backs of hands and feet, genital areas) and permanent scars may remain.

Other methods, mainly used in the past, are:

  • dermabrasion, which removes the superficial layers of the skin up to the pigment contained in the dermis with small rotating burs
  • surgical excision, especially used in case of allergic reaction because with this procedure no pigment residue remains. Mainly small tattoos are removed
  • use of chemicals (deep chemical peel), the substances used are capable of causing inflammation and death (necrosis) of the cells of the various layers of the skin up to the dermis, where the pigments are located. Scars can remain and in any case, due to the toxicity of the products used, the probability of undesirable effects is high. Therefore it is rarely used nowadays

Laser tattoo removal can also cause complications. Examples include pigmentation changes, crusting and blistering. Damage such as transient erythema and bleeding can also occur, affecting the small blood vessels and capillaries, induced by the energy peaks of the laser.

Similarly to the execution of the tattoo, its removal can also give rise to hypersensitivity reactions. In this case it is not only the original pigment that can trigger a reaction, but also its degradation products. Local allergic reactions, following removal with the laser, they were observed mainly with the red pigment (presence of mercury), green (presence of chromium) and blue (presence of cobalt).

Further links

Tattoos, the first Italian data processed by the "Istituto Superiore di Sanità

Draisci R, D’Ilio S, Fidente RM, Deodati S, Ferrari M, Guderzo S (Ed.). Tattoos: safety of use and control criteria. Rome: Higher Institute of Health; 2019 (ISTISAN reports 19/2)

Renzoni A, Pirrera A, Novello F et al. The tattooed population in Italy: a national survey on demography, characteristics and perception of health risks. Annals of the "Istituto Superiore di Sanità". 2018; 54: 126-136

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