Tattoo Problems

Tatoo Problems

In the US tattoos are regulated to some degree regarding the amount of mercury allowed in the ink. Overseas, however, this is not the case and complications may be more frequent. The most frequently encountered problems are:

Infection
Hypersensitivity
Chronic viral infections

Infections from the tattoo site present with pain, redness and swelling. The redness and swelling may spread from the immediate tattoo area and pus may or may not be expressed. Some pain and redness may be secondary to the tattoo itself but this should be mild and resolve over a few days. If the symptoms seem to be getting worse or the redness, warmth and swelling are spreading, infection is likely. Treat with antibiotics such as Keflex or Dicloxacillin (500mg PO QID. If the patient is febrile, having rigors or looks very ill the infection is likely systemic. IV antibiotics and medevac should be considered.

Hypersensitivity to the dye is another problem. Red dye seems to be the worse but any color including black may cause an allergic reaction. The reaction tends to be local and cause an eczematous rash. This should be distinguished from infection above because treatment is much different and includes steroids. The symptoms usually occur two days or more after the tattoo and can be delayed for a year or more. For mild rash, topical steroids may work but for severe rashes or difficult areas (lips, genitals, etc) oral steroids should be given. Prednisone 40-60 mg QD is acceptable. These patients should be referred to a dermatologist as soon as possible but usually will not need medevac if steroids decrease the symptoms.

Chronic viral infections including HIV and hepatitis are the most worrisome outcomes from tattoos. These are not likely to occur immediately after having a tattoo but acute HIV (seroconversion illness) may present as a viral syndrome. Viral hepatitis can also be acute and may present as jaundice. Although unlikely to be immediate problems, the concerns should be expressed to the crew, particularly in foreign ports where hepatitis and HIV rates are high and tattoo needles may not be clean.

This section provided by LT Fletcher Pierce, MC, USNR

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