Mycobacterium chelonae infections in tattoos

After reports of long-term rashes from tattoos, a CDC investigation showed it to be Mycobacterium chelonae, a hardy and fast-growing bacteria that can be found in tap water. It can lead not just to rashes (technically this is a “granulomatous inflammation”), but cellulitis, difficult-to-treat infections, and abscesses are possible as well. It is especially dangerous for immunosuppressed people, for example those with HIV/AIDS. In addition, and this must be noted in the age of eye tattoos, ocular keratitis and related conditions can occur, as the eye has specific weaknesses in regards to this bacteria. The rash-type infections are quite common in tattoos, and can come and go in some people as they flare up in certain conditions with itchiness, sometimes painful, and small raised bumps, often with redness, although this may not always be visible in the case of a solid tattoo, especially blackwork. It typically starts two to three weeks after the tattoo is done, but can also take longer. Assorted studies by health departments, the CDC, the FDA, and scientists and medical researchers internationally seem to show that tattoo contamination from this bacterium is happening on a regular basis all over the world.

As I said, all it takes for a tattoo to become infected with Mycobacterium chelonae (and I suspect there are many other microbes I could say this of as well) is for the tattoo ink or components of the tattoo equipment to come into contact with tap water — this could happen when cleaning the equipment or when diluting the inks. More disturbingly, it may be completely unavoidable by the artist because a number of the infections have been traced back to the manufacturer, who used tap water at some point in their manufacturing process. There’s no way — other than infected clients after it’s already too late — for the tattoo artist to know whether their ink is contaminated, short of using sealed sterile ink. It’s only recently that tattoo ink companies have started offering single-use sterile packages of ink, and only a fraction of artists use these products at present. In addition, a study by the European Journal of Dermatology analyzed about sixty bottles of tattoo ink from different manufacturers, and found that 10% of them were microbially contaminated by a variety of bacterium (and they weren’t even checking for Mycobacterium chelonae — no definitive study has been done to date on what percentage of tattoo ink is contaminated at the manufacturer level).

Treatment of this bacteria is difficult because it is extremely hardy. At a minimum, local wound care for the lesions is required. In some cases antibiotics can help kill the bacteria — and we’re potentially talking about four to six months of treatment that can have serious side effects, although it’s often faster — and in other cases surgical removal (think of skin removal scarification — excising the affected tissue). If the infection is in an eye, surgical debridement is always required — in my opinion, any ink dilution for eye tattoos (and all tattoos) must be with sterile water, and the ink itself should ideally come from single-use sterile packages. It should also be noted that ophthalmic corticosteroids which are sometimes prescribed to deal with the healing of eye tattoos and to deal with the increased intraoccular pressure can cause this type of infection to get worse. All things considered, M. chelonae may turn out to be the largest risk in eye tattooing. Surgical excision of all the affected tissue is usually curative because the bacterium does not seem to spread significantly (which is why you may even notice flare-ups among only certain colours). Multiple surgeries can be required and will almost certainly result in significant scarring (and not the good kind).

The CDC for once gives some advice on the subject of body modification that I agree with, saying that ink manufacturers need to be held to higher product safety standards including production of sterile inks. They recommend that tattoo artists:

  1. avoid using products not intended for use in tattooing
  2. avoid ink dilution before tattooing, and if dilution is needed, use only sterile water
  3. avoid use of nonsterile water to rinse equipment (e.g., needles) during tattoo placement
  4. follow aseptic techniques during tattooing (e.g., hand hygiene and use of disposable gloves).

I would add that I’d like to see tattoo artists using sterile ink whenever possible, seeing as many of these infections traced back to reputable ink manufacturers, and there would not have been anything the tattoo artist could have done to mitigate the problem. They also recommend that customers do the following to reduce their risk of infection:

  1. use tattoo parlors registered by local jurisdictions
  2. request inks that are manufactured specifically for tattoos
  3. ensure that tattoo artists follow appropriate hygienic practices
  4. be aware of the potential for infection following tattooing, and seek medical advice if persistent skin problems occur
  5. notify the tattoo artist and FDA’s MedWatch program (or other appropriate national program in your country) if they experience an adverse event.

I would also add to this that it might be worth printing out this blog post to share with your artist since they may not have the time to keep up with medical news, and being better informed is the most important first step in being safe. Finally, here is a collection of photos of what such an infection can look like. Click the picture to zoom in.

mycoinfections

For more information, there is a good technical introduction with scientific paper references in the CDC’s frighteningly named Morbidity and Mortality Weekly Report here: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6133a3.htm. In addition, because of the volume of cases that are being seen now (this is being characterized by health officials as “not common, but not rare either”), you may see it in the news as well. Here are a few links to get you started, and Googling for “mycobacterium chelonae tattoo” will of course find many more: Study: Tattoo infections traced to tainted ink, Mycobacterial Infections: The Link to Ink, Tattoo ink causes health scare, and Tainted Tattoo Ink Led to Skin Infection Outbreak.

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About Shannon Larratt

Shannon Larratt is the founder of BME (1994) and its former editor and publisher. After a four year hiatus between 2008 and 2012, Shannon is back adding his commentary to ModBlog. It should be noted that any comments in these entries are the opinion of Shannon Larratt and may or may not be shared by BMEzine.com LLC or the other staff or members of BME. Entry text Copyright © Shannon Larratt. Reproduced under license by BMEzine.com LLC. Pictures may be copyright to their respective owners. You can also find Shannon at Zentastic or on Facebook.

9 thoughts on “Mycobacterium chelonae infections in tattoos

  1. Thank you for this post Shannon, too many people out there are not informed on all the risks of tattooing!

  2. Are there any other side effects besides with the tattoo? Would it appear as if you have some sort of flu virus or would your general health be normal and the bacteria only noticeable with the tattoo?

  3. I’m still shocked that to this day, most tattoo inks aren’t sterile. You would think that artists would demand that for something they are basically injecting directly into an open wound. It just feels like this is a problem that is dated- something that should have been worked out a LONG time ago….To me, it seems no different that a piercing putting jewelry into a new piercing that isn’t sterile, and sterile jewelry only has been an industry standard since piercing when mainstream.

  4. my fiance died from this bacterium in 2003. His was not related to a tattoo that we know of but it is still a viciouse nasty infection. be careful.

  5. Hello there!

    I´m from Brazil and I had part of my back tattoed like 3 months ago. From the first week I started having this painful scratching period and I thought it was just a normal period since I have another tattoos. I went to a doctor that did recommended an antibiotics that didn´t help a thing. After that, I decided to look for some kind of reference and I see that this is exactly the problem I got…Mycobacterium chelonae …Well, I´m just writing to tell that somehow this ink or what has not been only spread in the US….

  6. Wow i didnt realise that this was what had happened. Got a Tattoo done in an average studio, i just assumed this was an alergic reaction to the aftercare cream. It looks very much like clogged pores or acne… I have never had any kind of treatment or antibiotic and its been 6 years

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