Blackout Tattoos: Are they a good idea? What are the risks and benefits?

Tattoos are enjoying a renaissance and the moment. Blackout tattoos have developed as part of the broader trend within the tattoo genre. They are also a popular way to cover old tattoos.

In this article, we talk about what a blackout tattoo is and the possible risks from having such a tattoo done on a large section of your body. We also discuss what your options are if you change your mind and would like to have your blackout tattoo removed.

What is a blackout tattoo? 

A blackout tattoo is pretty much as it sounds. It is a solid block of black over large areas of the body, such as the chest, arms or legs. Blackout tattoos have become popular over recent years because they are a super-convenient way of covering up or hiding old tattoos. They also look tough, so guys are more attracted to them than girls.

What are some of the possible consequences of having a blackout tattoo?

Well, firstly, you will probably look pretty cool for a while. That's a good consequence. However, other than that one possible advantage, what are the disadvantages?

We first need to undertake a quick lesson in the study of black ink particles so we can better understand how they may behave in the skin and body of tattooed individuals.

Black tattoo ink is made up of very small particles. Particles with at least one dimension less than 100 nanometers are classified as nanoparticles.  Black pigments are made up almost entirely of nanoparticles (see: T Hogsberg et all "Tattoo Inks in General Usage Contain Nanoparticles" Https://doi.org/10.1111/j.1365-2133.2011.10561.x).

Some of the possible consequences of introducing very large amounts of nanoparticles into the skin:

1. Ink particles can move to the bloodstream. This is especially true of inks made from nanoparticles. The risk of ink particles flowing through the bloodstream is they can become lodged in the liver (see: https://www.medicalnewstoday.com/articles/318388.php)

2. The sheer amount of ink introduced into an individual's system can have the potential to cause deleterious effects such as rashes, inflammation and allergic reactions on and around the site of the tattoo.

It also has the potential to put the tattooed individual into toxic shock as the body tries to process the massive amount of foreign bodies which have just been injected into it. Ki Young Jeong et al in the Korean Journal of Critical Care Medicine described an incident of a  "26-year-old man diagnosed with typical TSS [toxic shock syndrome], following tattooing. He complained of fever, chills and erythematous rash at the tattoo site. Subsequently, the patient developed signs of shock." (see: . Ki Young Jeong et al in the Korean Jornal of Critical Care Medicine  (2383-4870) . 2015, Vol. 30 Issue 3, p184-190. 7p)

3. The inks used in tattoos are not specifically used for intradermal use in humans. Most of the inks have been made for other applications such as the printing and painting industries (see: https://www.medicalnewstoday.com/articles/318388.php) With this in mind, it is somewhat unsurprising skin or systemic allergic reactions to tattoos are not uncommon. The problem with the blackout tattoo is the reaction is going to be all or nothing and with so much of the skin's area taken up with black ink, any negative reactions to the ink are going to be consequentially very large.

4. Nanoparticles from ink can coalesce in the regional lymph nodes. The concentration of such nanoparticles can be significant - to the extent people have been misdiagnosed with lymphatic cancers (see: https://www.huffingtonpost.com/elizabeth-chabner-thompson-md-mph/tattoo-ink-or-cancer-cells_b_7756144.html and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3762361/)

Also, because the cells in your lymph nodes cannot break down the particles, they become lodged there. The side effect is the lymph nodes take on the same colour as your tattoo.

4. Neither you, your doctor or even a specialist will be able to conduct a competent inspection or assessment for skin cancer. After all, with black ink over freckles and moles, it would be very difficult for your skin doctor to detect what is a normal freckle or mole and what is not.

Another thing to consider is the fact neither you or a doctor, specialist or not will be able to conduct a competent skin inspection or to conduct proper skin cancer screening. After all, with black ink over freckles and moles, it would be very difficult for your skin doctor to detect what is a normal freckle or mole and what is abnormal. One wonders whether this risk, amongst all the others, is worth it.

We checked out the Cancer Council’s website and found out the following concerning statistics (see: https://www.cancer.org.au/):

1. Approximately two out of every three Australians will be diagnosed with skin cancer by the time they are 70:
2. Non-melanoma skin cancer is more common in men than women, at almost double the rates:
3. Melanoma is the third most common cancer suffered by Australians. Skin cancers account for approximately 80% of all newly diagnosed cancers:
4. The majority of skin cancers are caused by sun exposure. The incidence of skin cancer in Australia is one of the highest in the world:
5 Most shockingly in 2015, 2162 people lost their lives to skin cancer.

Perhaps, given these statistics, blackout tattoos are better in cooler climes, such as in Europe where the sun is not so harsh (the absence of a hole in the ozone layer above them as to help in this regard) and the incidence of skin cancer is much lower.

We think the risks of having a blackout tattoo in Australia, probably outweigh the benefits, especially because the incidents of skin cancer are so high.

Will a blackout tattoo stay black? 

Your immune system recognises ink as a foreign substance which needs to be expelled from your body. Over the years you have a tattoo you will notice it will fade and some of the ink may drop out. If your blackout tattoo is not one which covers up old tattoos, you will find it will go grey over time, however, it will remain fairly uniform, as long as the tattooist impregnated the ink in an even fashion in the first place.

Some people, however, get a blackout tattoo to cover up old, unwanted ink. When this occurs, you will often find that within 3 to 4 years of the blackout being applied, you will see the lines and in some cases the full shadow of the tattoo you covered up. This will oftentimes become more readily visible over time. The only way to fix this up is to have further ink impregnated into your skin to even out the coverage and hide the old tattoo again or to remove the blackout tattoo and the ink underneath it, so it does not rare its ugly head again in another 3 to 4 years.

Photos above and below courtesy of: 
http://www.tlc.com/tlcme/15-breathtakingly-beautiful-pictures-of-blackout-tattoos/

Even though these tattoos are new, you can see the lines where the old tattoo remains. 

The old tattoo underneath the blackout will become more noticeable over time. 

You have a blackout tattoo and now you want to remove it - what are your options? 

There are various options for tattoo removal, which include salabrasion, surgical removal and chemical removal. None of these options are a good idea when considering removal of a blackout tattoo as they either cause significant wound sites with resultant scarring or the tattoo is just too large for these modalities to treat safely.

The best and safest option would be to opt for laser tattoo removal, which is the gold standard in tattoo removal. It is important you research your prospective providers and do your homework on the laser which will be used on you and the technician using the laser. Blackout tattoos present a challenge for full removal due to the sheer saturation of ink within it. It is, however possible to achieve a full removal back to skin (or very close to it if your tattooist has impregnated the particles too deep into the skin for the laser to effectively reach and treat) with the application of a good laser and patience. Even with a top of the line laser, if your tattoo is less than 5 years old, it could take 12 to 14 treatments to achieve a removal.

Photo courtesy of: http://www.tlc.com/tlcme/15-breathtakingly-beautiful-pictures-of-blackout-tattoos/

It is important to research the laser which will be used on you as this will often determine the level of risk you will have of scarring. Cheaper Chinese or Korean lasers will fracture ink and achieve a fade, however, their beam profile is not as homogenous as some of the European and American lasers and as such, there is an increased risk of deleterious effects during treatment, such as pinpoint bleeding and after treatment, such as blisters, welts and the like. If you choose a good practice with a top of the line machine and a great technician all of the risk factors involved with tattoo removal will be mostly mitigated.

At City Tattoo Removal we specialise in hard to remove tattoos, including blackout tattoos and hard to treat inks, such as white, cosmetic ink, greens and blues, to name a few.

We offer free consultations so you can check out our clinic, machine and staff, so you can rest assured you will be well cared for during your treatment journey.

You can check us out at:
http://www.citytattooremoval.com.au/
https://www.facebook.com/citytattooremovalbrisbane/
https://www.instagram.com/citytattooremoval/

Or you can call us to book a free consultation on:
07 3003 0358
0450 306 402

Natasha Collings
City Tattoo Removal
www.citytattooremoval.com.au

It's All in the Ink! - Part 3 - How to remove unwanted ink.

Currently, studies indicate tattoos contain some surprising ingredients, including heavy metals and plastics. Unless they are treated these substances will stay in your skin for the lifetime of the tattoo.

The medical boffins worldwide are unable to tell us whether or not tattoo inks can cause cancer or other major deleterious health concerns over the lifetime of a tattoo, al

though allergic reactions have been known to occur. If the allergy continues and is severe enough, the tattooed individual is best off removing the tattoo which is causing the reaction. The best and safest options for removal, in this case, are surgical excision or shaving the skin off until there are no further ink particles to cause the reaction. Unfortunately, both of these techniques are liable to leave significant scars. Laser tattoo removal is really not an option in this case because it could be that the introduction of laser light on the affected area could cause the allergic reaction (via a new compound which can be created through the interaction of the ink and laser light) or could exacerbate it.

In most other cases, laser tattoo removal with a top of the line Q-Switched Nd:Yag like the QX MAX which we use at City Tattoo Removal, is the gold standard in tattoo removal practice today.

Lasers work via thermophotolysis. The Oxford online dictionary defines Thermo as "relating to heat" and  photolysis as "the decomposition or separation of molecules by the action of light." So, by definition the lasers work by heating up molecules by light, causing them to separate and decompose.

Most modern Q-Switched Nd:Yag lasers, even top-of-the-line lasers, only treat with the 1064nm and 532nm wavelengths. With our QX MAX we are able to also treat at 585nm and 650nm wavelengths, which means we can also treat hard to move greens and blues, as well as black, red, yellow, orange, tan, brown, navy blues, magenta, purple and pink.

So, if you have unwanted ink and have concerns over what has been put into your body, give us a call for the best and safest tattoo removal in Brisbane! You can check out our website on www.citytattooremoval.com.au. You can also check out our work and contact us through Facebook @citytattooremovalbrisbane and Instagram @citytattooremoval

Natasha Collings 
City Tattoo Removal
www.citytattooremoval.com.au

It's All in the Ink! - Part 2 - What is ink made of?

The Council on Health and Disease Prevention (the Council) defined tattoo ink as a suspension of pigment particles in an aqueous medium, often with the addition of isopropanol. The pigments which give the wanted colour are coloured particles and tend not to combine with, or dissolve with lipids or fats. The particles vary in size between 100 to 800 nanometers and are therefore fit into the definition of nanoparticles.

The oldest pigments used for tattoos came from using ground up minerals and carbon black. Today's pigments contain a plethora of ingredients which could include original mineral pigments, modern industrial pigments, vegetable-based pigments and some plastic-based pigments. Thought Co examined the makeup of tattoos and found that in particular the plastic-based pigments, whilst being very intensely coloured can cause reactions (see:https://www.thoughtco.com/tattoo-ink-chemistry-606170)

Thought Co also examined new inks, such as glow in the dark pigments which react under black (ultraviolet) light and concluded that these pigments are "notoriously risky" with some being safe and others being radioactive or otherwise toxic.

The Council  and Thought Co found the industrial inks used to tattoo individuals contained polyaromatic hydrocarbons and primary aromatic amines and metals which included:

- Iron Oxide

- Logwood

- magnetite crystals

- powdered jet

- wustite

- bone black

- amorphous carbon from combustion (soot)

- Ochre (made of ferric oxides mixed with clay)

- Cadmium red

- Cinnabar

- Napthol - AS pigment

- Disazodiarylide and or disazopyrazolone

- cadmium seleno-sulfide

- Cadmium yellow

- Curcuma yellow

- Chrome yellow

- Chromium Oxide

- Malachite

- Ferrocyanides and Ferricyanides

- Lead chromate

- Monoazo pigment

- Cu/Al phthalocyanine

- Cu phthalocyanine

- Azure blue

- Cobalt blue

- Manganese violet

- Aluminium salts

- Quinacridone

- Dioxazine/ carbazole

- Lead carbonate

- Barium sulfate

- Zinc oxide

- Chromium IV

- Nickel

- Lead

- Aluminium

- Aniline

- P-chloraniline

- 3.3 - dichlorbenzidine

- 4-methyl-m-phenylenediamine

- Titanium dioxide

- Copper salts

- Sodium aluminum silicate

- Calcium copper silicate

- Carbon black

- Cobalt aluminum oxides

- Chromium oxides

- Glycerine

- Witch hazel

- Preservatives

Cinnabar and cadmium pigments, which are commonly used in red inks are highly toxic. Both the Council's report and the article from Thought Co recognized that ALL red inks carry with them risks of allergic or other reactions. Copper pigments which are often used to make up blue inks are considerably safer and more stable than cobalt or ultramarine pigments.

Importantly, the Council remarked upon a study which was performed in Denmark and showed that 10% of inks which were tested for the study contained pathogenic bacteria. This is perhaps why preservatives are in use in tattoo inks. That is, to prevent microbial growth in warm conditions. In practice, tattoo inks are not kept in refrigerated storage areas and are often used multiple times by tattooists, which then leads to the introduction of an exterior pathogen. This is added to the risk of 10% of inks having pathogenic bacteria in them from the manufacturing process.

See above for an example of an infection caused by bacteria in ink

The Councils paper noted an analysis report conducted in Denmark which showed there was a massive difference in the labelling of 65 inks purchased from European suppliers. 19 inks did not have a material safety data sheet. Of the remaining inks, where material safety data sheets were provided there was no consistency between the information contained on the actual packaging on the product and the safety sheets.

The study was conducted over 61 colours and found nickel, chromium, copper, barium, lead, cadmium and zinc at levels over those outlined by the Council of Europe.

A study conducted by Anthony L Timko et al titled "In Vitro Quantitative Chemical Analysis of Tattoo Pigments," noted:

"The study showed, not unexpectedly, that individual tattoo inks are complex compounds whose, composition may include organic dyes, metals and solvents. Adding to this complexity, the individual inks are often mixed prior to final manufacturing. Finally, on delivery of the tattoo inks to the artist, it is common for he or she to mix these already complex compounds with other complex pigments. Accordingly, the final color of an in vivo tattoo is often the product of the manufacturer's tendencies and the artist's licence."

This is a real worry because it seems the majority of consideration given to tattoo inks relate to the effects it may have when used outside of the skin.  We think this leaves a massive blind spot in terms of the appropriateness of some ingredients when one considers the purpose of the ink is to permanently leave it in the skin. Given there is little to no regulation into the ink used in tattooing, we think the next real question is: Can tattoo ink effect your health?

What effects can tattoo ink have on tattooed individuals?

Some studies indicate the ink used in your skin may change over time and with exposure to sunlight. Photochemical decomposition of pigments may create a new chemical decomposition product. The potential risks which may arise as a result of the chemical composition of tattoos changing over time can include:

-  the triggering of allergies;

- exposure to cancer-causing mutagens;

- deleterious effects on your reproductive system; and

- toxic health effects as a result of being exposed to heavy metals.

Allergies are often triggered by the development of haptens forming in the skin over time. The online Oxford dictionary defines a hapten as "a small molecule which, when combined with a larger carrier such as a protein, can elicit the production of antibodies which bind specifically to it (in the free or combined state)." (see: https://en.oxforddictionaries.com/definition/hapten). The development of haptens principally occurs in reaction to red ink.  This creates a tricky situation when it comes to assessing the risks of tattoo inks and tattooing in general because the ink does not actually contain the allergen itself. This makes it hard for researchers to isolate, measure and exclude the substances in the ink which may cause an allergic reaction.

The raised red on this tattoo indicates an allergic reaction.

The International Agency for Research on Cancer (IARC) recognise that Cadmium, chromium Vi and nickel have been classified as carcinogenic to humans, however, because cancer has been only been seen to develop in the respiratory tract after inhaling these substances, the carcinogenic effect of the abovementioned substances, at least insofar as tattooing is concerned, has been classified as "non-critical".

The IARC has classified lead as "probably carcinogenic to humans" but the European Union does not see it as having a carcinogenic effect. Tumours have been found, but only after exposure to very high dosages. It is for this reason alone the carcinogenic effect was seen to be "non-critical" in respect of the effect of lead in tattoos.

The IARC has reported that there is a general lack of knowledge between the mechanisms and ingredients of tattoos and cancer. It is now widely known that tattoo colours can be transported from the tattooed skin are to the regional lymph nodes where a tumour may occur. The extent to which there is or isn't a connection between tattoos and tumours cannot be assessed on the current knowledge.

Certain copper salts can cause irritation to the skin, although it has been assessed that irritation of the skin is probably not a critical effect of copper in relation to tattoos.

Titanium dioxide often occurs in the form of nanoparticles and it was not possible to assess any health critical effects from these nanoparticles. The same is true of carbon black.

Conclusion

It is best to bear in mind which type of chemicals and heavy metals are likely to be in your tattoo. Red ink is the most reactive in individuals. It may be a good idea if you intend on getting a tattoo with a lot of red to have a test patch of the ink conducted before going for the whole tattoo. Red ink is especially tricky because the allergic reaction occurs as a result of the development of haptens rather than as a direct reaction to a particular chemical constituent in the ink. This is why a test patch may be a good idea. 

Natasha Collings 

City Tattoo Removal
www.citytattooremoval.com.au

It's All in the Ink! - Part 1 - What is tattoo ink and where does it come from?

In order to safely remove tattoos, we first must know what is in them. In this article we discuss the following questions:

1.  What is tattoo ink?
2. Where does tattoo ink come from?


What is tattoo ink? 

A report compiled by The Council on Health and Disease Prevention ("the Council") titled "Tattoos - Health, Risks and Culture" discusses the makeup and risks associated with impregnating ink into a person's skin.

The Council described tattoo ink as:

"A fluid product that contains one or more pigments and other ingredients in the form of adjuvants, such as binding agents, additives and solvents. The finished tattoo colours may also contain chemical and microbial impurities, which may come from the raw materials and/ or the manufacturing of tattoo colours."

Where does tattoo ink come from?

Tattoo ink is manufactured all over the world, however, the principal manufacturing countries include America, England, China, and other Asian counties. It might surprise you to know that there are no internationally or nationally recognised standards for the use of good manufacturing practices for tattoo inks.

Tattoo inks are under the purview of the Food and Drug Administration in America. Inks are included in the same category as cosmetic products. There is little oversight in relation to the makeup of inks, however, the Food and Drug Administration has provided maximum usage amounts for cinnabar (mercuric sulphide), arsenic and lead as these substances are widely known to affect the health of individuals who have been exposed to them.

The rise of ink from China has also provided the regulatory authorities with a few issues because there is no knowledge about the conditions under which the ink is manufactured. Furthermore, "China ink" as it is known,  oftentimes has little, no or misleading product information.

The question then arises: Is the labelling on tattoo inks to be trusted?

Surprisingly, the Council found and noted, on the whole, there was a lack of labelling on tattoo ink products and when there was labelling it was often incorrect and/ or misleading.

Hogsberg et al studied 58 commonly used tattoo inks from established and credible manufacturers and found the labels on the inks were extremely inadequate. The labels often did not have rudimentary information such as the main pigment used in the ink, what other ingredients were used, manufacture dates and expiry dates. This is a little scary when you consider what is actually found in tattoo ink and the lack of apparent regulation in the industry worldwide.

Conclusion

Not all inks are created equal. Worldwide, the tattoo ink manufacturing industry is largely unregulated or under-regulated. For best results, talk to your tattoo artist and question the pedigree of the ink they intend to use on you. This ink, after all, is going to be impregnated into your skin and it's best to find out before, rather than later, if there are chemicals in the ink you would rather avoid.

Natasha Collings
City Tattoo Removal
www.citytattooremoval.com.au