Lessons learned in a decade: Medical-toxicological view of tattooing.

Tattooing has been part of the human culture for thousands of years, yet only in the past decades has it entered the mainstream of the society. With the rise in popularity, tattoos also gained attention among researchers, with the aim to better understand the health risks posed by their application. 'A medical-toxicological view of tattooing'-a work published in The Lancet almost a decade ago, resulted from the international collaboration of various experts in the field. Since then, much understanding has been achieved regarding adverse effects, treatment of complications, as well as their regulation for improving public health. Yet major knowledge gaps remain. This review article results from the Second International Conference on Tattoo Safety hosted by the German Federal Institute for Risk Assessment (BfR) and provides a glimpse from the medical-toxicological perspective, regulatory strategies and advances in the analysis of tattoo inks.

Allergic contact dermatitis caused by a new temporary blue-black tattoo dye - sensitization to genipin from jagua (Genipa americana L.) fruit extract.

BACKGROUND: Temporary tattoos made with an extract of the jagua fruit (Genipa americana L.) are becoming increasingly popular. It is claimed that it is 'dermatologically tested' and does not contain p-phenylenediamine. Extracts of jagua and gardenia fruits have been used by indigenous people in South America, as well as in traditional Chinese medicine, for centuries. Genipin is currently used for its cross-linking effect in the manufacture of polysaccharides, and is being investigated for its anti-inflammatory and other properties. OBJECTIVES: To report the presence of the allergenic substance genipin in a self-administered temporary tattoo dye made from the fruit juice of jagua (Genipa americana L.). PATIENTS AND METHODS: A 39-year-old female who repeatedly applied 'completely natural and 100% safe' Earth Jagua® tattoo, obtained via the internet, to her left hand developed allergic contact dermatitis within 6 weeks. Analysis of the dye showed the presence of geniposide and genipin. RESULTS: Patch tests with the dye and with its main components, including genipin, gave strong positive reactions to the latter. There was no sensitization to other ingredients or p-amino compounds. CONCLUSIONS: We report an extensively evaluated case of allergic contact dermatitis caused by a temporary Earth Jagua® tattoo. The allergen identified is genipin, a substance that is increasingly used for tattoos and as a therapeutic agent in medicine. This could result in an increase in the number of allergic reactions in the future.

Identification of organic pigments in tattoo inks and permanent make-up using laser desorption ionisation mass spectrometry.

Nowadays, about 12% of the European and 20% of the US population are tattooed. Rising concerns regarding consumer safety, led to legal restrictions on tattoo and permanent make-up (PMU) inks. Restrictions also include bans on certain colourants. Both ink types use organic pigments for colour-giving, plus inorganic pigments for white and black and colour tones. Pigments are only sparingly soluble in common solvents and occur as suspended particles in the ink matrix. Their detection and identification therefore pose a major challenge for laboratories involved in monitoring the legal compliance of tattoo inks and PMU. We overcame this challenge by developing a direct laser desorption ionisation time-of-flight mass spectrometry method, which included an easy sample clean up. The method proved to be capable of detecting and identifying organic pigments in almost all of the tested ink samples. Method validation and routine deployment during market surveys showed the method to be fit for purpose. Pigment screening of 396 tattoo inks and 55 PMU taken from the Swiss market between 2009 and 2017 lead to the following conclusions: Pigment variety is much greater in tattoo inks (18) than in PMU (10); four prohibited pigments (Pigment Green 7, Pigment Red 122, Pigment Violet 19 and 23) were found in both ink types; for PMU, these four pigments made up 12% of the pigment findings, compared to 32% for tattoo inks. Therefore, legal compliance of PMU was at a higher level. A comparison of pigments found with those declared on tattoo ink labels clearly showed that banned pigments are rarely declared, but rather masked by listing non present legal pigments and label forging; therefore, highlighting the urgency of widespread market controls.

Occurrence and concentrations of isothiazolinones in detergents and cosmetics in Switzerland.

BACKGROUND: In recent years, the frequency of contact allergy to isothiazolinones has increased alarmingly in Europe, but only limited data are available on concentrations of isothiazolinones in consumer products. OBJECTIVES: To examine the current frequency of isothiazolinones [methylisothiazolinone (MI), methylchloroisothiazolinone (MCI), benzisothiazolinone (BIT), and octylisothiazolinone (OIT)] in a wide array of detergents and cosmetics relevant for the Swiss population. METHODS: By means of a market survey, the occurrence of isothiazolinones was investigated in 1948 consumer products. Of these, 88 products were analysed by liquid chromatography-high-resolution mass spectrometry after ultrasonic extraction. RESULTS: Only 7.6% of all cosmetics contained isothiazolinones, but the prevalence in detergents was much higher (42.9%). The measured concentration ranges in detergents were 4.3­10, 3.5­279, 3.8­186 and 7.9 ppm (one product only) for MCI, MI, BIT, and OIT, respectively [corrected]. For cosmetics, these were 1.3-133 and 4.8 ppm (one product only) for MI and MCI, respectively. CONCLUSIONS: Our study has shown that high concentrations of isothiazolinones (including MI) can be found in a large variety of products, in particular in detergents. Therefore, the safe use of these preservatives should be re-evaluated by including detergents in the exposure assessment.

Chemical Analysis: An Indispensable Means for Uncovering Severe Cases of Fraud with Cosmetics and Tattoo Inks.

Three cases of fraud with commodities containing illegal stealth compounds are presented, which were uncovered by the State Laboratory Basel-City, Switzerland. All three commodities, grapefruit seed extracts, a phytocosmetical skin cream, and tattoo inks, were produced abroad, had forged declarations of ingredients and, in the case of the extracts and the cream, were marketed with far-reaching health claims. While inspections will identify suspicious products and would be able to eliminate health claims to some extent, only chemical analysis can uncover the illegal agents used and give law enforcement bodies the necessary evidence to immediately clamp down on those brands, where the stealth agent presents a serious health hazard to consumers.

A medical-toxicological view of tattooing.

Long perceived as a form of exotic self-expression in some social fringe groups, tattoos have left their maverick image behind and become mainstream, particularly for young people. Historically, tattoo-related health and safety regulations have focused on rules of hygiene and prevention of infections. Meanwhile, the increasing popularity of tattooing has led to the development of many new colours, allowing tattoos to be more spectacular than ever before. However, little is known about the toxicological risks of the ingredients used. For risk assessment, safe intradermal application of these pigments needs data for toxicity and biokinetics and increased knowledge about the removal of tattoos. Other concerns are the potential for phototoxicity, substance migration, and the possible metabolic conversion of tattoo ink ingredients into toxic substances. Similar considerations apply to cleavage products that are formed during laser-assisted tattoo removal. In this Review, we summarise the issues of concern, putting them into context, and provide perspectives for the assessment of the acute and chronic health effects associated with tattooing.

Photostability and breakdown products of pigments currently used in tattoo inks.

Tattoos fade with time. Part of this fading can be attributed to the photodegradation of pigments. When people get tired of their tattoos, removal by laser irradiation is the method of choice. In vivo laser irradiation of tattoos on mice has shown that the degradation of pigments can result in toxic compounds. Various in vitro studies on photodegradation by sunlight or laser have shown similar degradation products for both irradiations. Even visible light was shown to be able to decompose some pigments to toxic degradation products in vitro. Whereas the investigated phthalocyanins (C.I. 74160, 74260), quinacridones (C.I. 73915) or dioxazines (C.I. 51319) were fairly photostable in vitro, all azo pigments exposed to sunlight or laser were degraded into a variety of products, some of which were toxic or even carcinogenic, such as 2-amino-4-nitrotoluene, 3,3'-dichlorobenzidine and o-toluidine. Up to now, the absence of specific toxicological data is the reason why legal restrictions for tattoo inks are derived from those for cosmetics, toys and textiles. Photodegradation has not been considered. In light of the present analytical findings, even with their possible shortcomings, the evidence weighs heavily enough to consider banning azo pigments containing carcinogenic aromatic amines or allergens in their structure from use in tattoo inks.

Organic UV filters in personal care products in Switzerland: a survey of occurrence and concentrations.

Organic ultraviolet (UV) filters are a group of compounds designed to absorb UV radiation and hence protect our skin against UV-induced damage. Apart from traditional sunscreens, they can be found in many other categories of personal care products (PCPs). These include skin care, facial makeup and lip care products, which are often used simultaneously, and on a regular basis. The frequency of occurrence as well as concentrations of organic UV filters contained in PCPs change over time. Furthermore, in Switzerland the exact UV filter concentrations are confidential. To date, only limited data are available for the levels of organic UV filters in PCPs, and these data refer mainly to sunscreens. In this paper, we provide an up-to-date frequency of occurrence and concentrations of organic UV filters in PCPs, including for the first time PCPs used in everyday life. A total of 116 PCPs was selected on the basis of a product-use questionnaire and distributed among seven PCP categories: lip care products, lipsticks, face creams, liquid makeup foundations, aftershaves, hand creams, and sunscreens. Concentrations of 22 organic UV filters were measured in the selected PCPs. The most frequently occurring UV filters were butyl methoxydibenzoylmethane (BMBM) detected in 82 products (71%), ethylhexyl methoxycinnamate (EHMC) in 59 products (51%) and octocrylene (OCT) in 50 products (43%). BMBM, EHMC and OCT concentrations averaged 2.6%, 4.0%, and 6.0%, respectively. Overall, UV filter concentrations in PCPs applied regularly throughout the year can be as high as those in sunscreens that are primarily used for sun protection and hence applied only on selected days. PCPs that are used on a regular basis, and often simultaneously, thus represent an important and, as yet, unquantified source of UV filter exposure. This study provides essential information for aggregate exposure assessments that combine data on concentrations of individual UV filters widely used in a variety of PCP categories.