Sociocultural & Health Considerations of Tattoos
Many of our patients have tattoos. Sometimes they’re visible, sometimes hidden. All of them have a story.
The current statistics are interesting. An American Academy of Pediatrics report from 2017 quoted a Pew Research Center study that said up to 38 percent of young people ages 18 to 29 have at least one tattoo. According to research group Dalia in 2018, 32 percent of American respondents between ages 14 and 29 were tattooed, 45 percent of those between 30 and 49, and 28 percent over age 50.
Medically, tattoos are known to be possible routes of infection for several types of bacteria and viruses, including mycobacteria, warts, HSV, and hepatitis. According to the Journal of AIDS and Clinical Research in 2017, tattoo needles are a potential mode of transmission of HIV, though there were no proven cases in the United States up to that date (except for two cases in 1988 with shared needles in a prison, where tattoos can have specifically codified meanings for their wearers). The CDC (cdc.gov/hiv/basics/transmission) emphasizes that “there are no known cases in the United States of anyone getting HIV this way. However, it is possible to get HIV from a reused or not properly sterilized tattoo or piercing needle or other equipment, or from contaminated ink.”
Contact dermatitis and other reactions to tattoo pigments have also been documented, in addition to exacerbation of preexisting dermatologic conditions. Even temporary henna tattoos bear certain risks, including cases of hemolysis from red henna in G-6PD deficient individuals, and PPD sensitization from black henna. Disorders such as keloid scars and sarcoidosis can occur in tattoos. Although tattoo inks do not cause melanoma, tattoo artists should not tattoo over moles, and cancers can occur within tattoos.
Archaeological data shows that at least 5200 years ago, the Iceman found in the Alps died with tatoos, the oldest human example of these skin markings. Ancient people all over the world, in Egypt, Greece, Polynesia, Peru, Greenland, and New Zealand, have been found to demonstrate mummified remains, as well as artistic depictions on pottery, of people with tattoos.
Tattoos’ significance has been thought to vary historically between cultures, according to Smithsonian.com in 2007. Body locations varied from face, to extremities, to trunk, to genitalia. Women in Egypt are thought to have received abdominal and thigh tattoos as protection in childbirth. The Scythians’ upper class had tattoos of mythical animals. The Romans actually referred to one group from the ancient northern British isles as “Picti,” meaning “the painted people.” In their own Greco-Roman civilizations, tattoos, then called “stigmata,” were used to mark slaves or criminals, as was also done in ancient China. Religious and ethnic groups also used tattoos to distinguish themselves as members, sometimes coercively in cases of forced conversions. Some religious groups forbid tattooing as a desecration of the body as an image of the divine.
in 1769, Captain James Cook went to Tahiti and witnessed the extensive culture of tattoos, locally called “tattau, “ meaning “to strike.” Europeans took up the practice, partly as symbols of protection during these dangerous voyages at sea.
In modern times, during the Holocaust, Nazis forcibly tattooed serial numbers on Jews and other prisoners in concentration camps in a concerted attempt to erase their sense of humanity and individuality. Holocaust survivors had to then live with the imprinted skin and memories of their traumatic assaults and incarceration.
Tattoo artists in some US states can complete a 3-year apprenticeship with the Alliance of Professional Tattooists, and are expected to certify completion of blood-borne and other infectious pathogens education before receiving state licensure. Clients should seek these safety assurances, which vary widely depending on local regulation. According to payscale.com, entry level tattoo artists may earn $20,000 per year, increasing significantly with experience, perhaps up to $200,000.
Tattoos are designed and worn by many people now, often as a means of unique and creative self-expression. Tattoos are also used to mark important life events, commemorate significant people, as well as permanent makeup, or to recapture a modicum of control and normalcy after surgical procedures, such as areolar tattoos after breast cancer reconstructive surgery.
Let us now enter the creative world of body art through individuals’ stories and photographs.
About the author
Dr. Randi Rubenzik is a board-certified Dermatologist who graduated from the University of Arizona College of Medicine in Tucson in 1996. She completed her Dermatology residency there in 2000, after an internship in Internal Medicine at Northwestern University. She graduated with a B.A. in English from Stanford University in 1990, and has remained passionate about literature and the liberal arts ever since.