Tattoo Infections Traced to Bacteria in Premixed Ink

Medical researchers and clinicians at University of Rochester with public health officials from local, state, and federal agencies discovered a manufactured tattoo ink caused rashes from bacterial infections among tattoo customers in Rochester, New York. The results of their investigation appear online in the New England Journal of Medicine.

The study reports 19 cases in Rochester of tattoos infected with a type of Mycobacterium chelonae, a bacteria often found in municipal tap water. In October 2011, a 20 year-old man with multiple tattoos, but no history of any problems, received a new tattoo on his arm and soon developed a persistent, inflamed rash in that area. The county health department explored the issue and found 18 other individuals who developed similar rashes after tattoos at the same parlor, from the same artist.

Tests conducted at the Rochester medical center revealed the presence of Mycobacterium chelonae in the patients’ skin that led to the red, itchy bumps in their tattoos. Robert Betts, a Rochester medical center physician who treated most of the patients and co-author of the paper, confirmed that the infection was only in the areas tattooed with the gray ink.

Further testing pointed to a premixed gray ink, which the local artist had bought from a manufacturer in Arizona, contained the same bacteria and likely transmitted it to the skin. The ink is called a gray wash, used to achieve shading and a three-dimensional quality in tattoos.

The tattoo artist says the manufacturer diluted black ink with distilled water to create a gray color. “What probably happened,” says Betts, “is that the water used to dilute the ink introduced the bacteria into it and the trauma associated with getting the tattoo compromised the circulation to that area of the skin, allowing the organism to enter into the skin and grow.”

Betts adds that M. chelonae grows best at around 86 F, somewhat lower than the normal body temperature of 98.6 F. Since tattooed skin is cooler than the rest of the body, the bacteria may have flourished in those tattooed areas.

Following the Rochester investigation, the Centers for Disease Control and Prevention issued a nationwide alert about the outbreak and the manufacturer voluntarily recalled the ink.

Mary Gail Mercurio, a Rochester medical center dermatologist and also a co-author that examined most of the patients says “Patients and doctors need to have a certain level of suspicion when they see a rash developing in a tattoo. Many of the patients I saw thought their skin was just irritated and the issue would go away during the healing process.” As it turned out, says Mercurio, “they had an infection that needed to be treated with an antibiotic; it wasn’t going to go away easily on its own.”

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Photo: Jhong Dizon/Flickr

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