Contaminated Ink Causes Tattoo Infection Outbreak

A recent study finds pre-diluted gray tattoo ink to be the cause of a Mycobacterium chelonae skin infection outbreak in Rochester, New York.

Researchers studying a recent outbreak of tattoo infections in Rochester, New York, urge tattoo patrons to take skin reactions seriously.

The study, which was published in the September 13, 2012 edition of the New England Journal of Medicine, investigates the cause of infections with Mycobacterium chelonae, bacteria that is sometimes found in tap water, in 19 patrons of the same tattoo artist at the same parlor. Researchers determined that a premixed gray ink, popularly used in portrait and photography tattoos, was the source of the infection.

The Monroe County Department of Public Health began the investigation on January 4, 2012, after receiving a report from a dermatologist of a 20-year-old man who had developed a rash that resisted treatment. The infection began after he received a new tattoo in October 2011. (The man had gotten previous tattoos without health problems.) After a skin biopsy, the rash was confirmed to be caused by infection with M chelonae.

Investigators identified 18 other patients with similar rashes who had obtained tattoos from the same artist at the same tattoo parlor. Based on an examination of the facilities and interviews with clients, public health officials found no fault in the health and safety practices of the parlor. However, they did learn that the artist had used a new hand-blended, diluted gray wash ink from May to December 2011.

The FDA inspected the ink manufacturer, which was based in Arizona, collecting samples and sending them to the Centers for Disease Control and Prevention (CDC) for analysis. Skin biopsies were performed on 17 out of 19 patients and evaluated at the University of Rochester Medical Center. M chelonae was found in 14 of the 17 biopsies. The CDC found the bacteria in the ink as well.

As a result, the CDC issued an alert regarding the outbreak, and the manufacturer voluntarily recalled the premixed ink. To help minimize the likelihood of future outbreaks, researchers provided information and educational materials to tattoo artists and patrons at a trade show in Rochester.

The researchers suggest that in order to prevent future infections associated with tattoos, ink manufacturers need closer monitoring.

“Our investigation of this outbreak shows that premixed ink contaminated before distribution poses a risk to public health, which may suggest the need for enhanced oversight of not just tattooing but also the inks used in tattooing to ensure public safety,” the researchers write.

However, the researchers suggest that the most important thing tattoo patrons can do is to acknowledge rashes and reactions before they become difficult to handle.

“Patients and doctors need to have a certain level of suspicion when they see a rash developing in a tattoo,” said Mary Gail Mercurio, MD, a dermatologist at the University of Rochester Medical Center who saw most of the patients in the study, in a press release. “Many of the patients I saw thought their skin was just irritated and the issue would go away during the healing process. In actuality, they had an infection that needed to be treated with an antibiotic; it wasn't going to go away easily on its own."